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♪
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Hi there, welcome to
Basecamp Recovery Center’s
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“Begin Your Climb” series.
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I’m Brian Borland
and I have the pleasure
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of serving as
the Medical Director
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here at Basecamp Recovery Center
in Columbus, Ohio.
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Today we’re going to talk
about an important topic
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involving a medication
that we use called Suboxone.
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There’s a lot of concern
and there’s a lot of questions
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surrounding the use of Suboxone,
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and so I really want to go over
sort of five questions.
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What is it?
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Why do we use it?
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Is it necessary?
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Can you get high from it?
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And aren’t you just switching
from one drug to another?
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So to begin, Suboxone is
a combination medication.
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It involves buprenorphine
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and naloxone.
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Buprenorphine is an opioid
in and of itself.
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Naloxone is an opioid blocker.
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So the question is:
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“Why would you put an opioid
with an opioid blocker?
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That doesn’t make
a lot of sense.”
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The theory behind it is that
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Suboxone is taken
in a very specific manner.
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It’s placed under the tongue
and let dissolved completely.
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In taking the medication
like that,
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you get primarily absorption
of buprenorphine
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and less absorption of naloxone
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because it doesn’t do as well
absorbing through that route.
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However, if you were to
melt it down
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and try and shoot it in a vein,
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that’s how naloxone
likes to be used,
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and it’s Narcan essentially,
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so it prevents and deters people
from melting the medicine
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and shooting it up into a vein.
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So why do we use it?
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Suboxone is
a partial opioid agonist,
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which means that when it binds
to an opioid receptor,
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it fires at about,
let’s say, 30 percent.
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Whereas if you’re using
a drug like fentanyl,
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or morphine, or heroin,
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those are full agonists,
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so when they bind
to the opioid receptor,
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you get, like, 100 percent,
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and so it’s substantially more.
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So why would we use it?
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Well, for number one,
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once it binds
it’s like concrete,
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and so it sits
on that opioid receptor
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and it doesn’t allow other drugs
to get onto the opioid receptor.
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So if you are on Suboxone
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and you were to use,
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such as fentanyl or heroin,
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you would have
far less of an effect,
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and it would basically be
like a waste of money.
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In addition,
as long as that Suboxone
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is bound to those receptors,
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it stays there
for a very long time,
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and because of that,
if you were to have
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a lethal dose
of fentanyl or heroin,
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which would normally
cause an overdose,
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that Suboxone on those receptors
would allow you to still be okay
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because you didn’t get
the full effect of that dose.
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So we use it for patients
who have opioid addiction
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and who are struggling
to be able
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to work a treatment program.
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This happens
because opioid addiction
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has significant
withdrawal symptoms
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when a person abruptly
stops using the opioid.
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For example, after a person
stops using opioids
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with anywhere from
six hours to a day or two,
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they’re going to start
having symptoms of sweatiness,
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cold chills, restless legs,
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nausea, vomiting, diarrhea,
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body aches, body pains, chills,
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and these symptoms are going to
continue to increase
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over the period
of the next few days
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to the point where
it’s almost intolerable,
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it’s almost like torture.
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So there’s no way a person
is just going to lay there
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and suffer through that
for as many days
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as it’s going to take,
up to 7 to 10 days,
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and then try
and go to treatment.
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So if we don’t use Suboxone,
Suboxone being an opioid,
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it binds to the receptors,
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and so the person
doesn’t necessarily
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go through withdrawal
because they’ve got
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enough opioid on board
that it will allow them
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to not suffer
really bad withdrawal symptoms,
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and if it’s bound
to the receptor,
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that tells the brain
that there’s something there,
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and it helps with cravings
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because the brain
no longer goes searching
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for other opioids
because it’s got things
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bound to its opioid receptors.
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So that sort of crosses into
“Is it necessary?”
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Well, unfortunately it is.
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We’ve known for a while
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that patients who do not receive
any sort of Suboxone,
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if they just try
and withdraw cold turkey,
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or if they just
do a rapid taper of Suboxone,
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like, they show up,
they get a day or two of it,
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then they take them
off of it really fast,
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patients will not stay sober.
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They need longer term treatment,
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detox, and this rapid detox
is not treatment.
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That’s simply trying
to help someone
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with the symptoms of withdrawal,
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but it in no way helps treat
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their disease
of substance use disorder.
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So therefore we shouldn’t think
that a rapid Suboxone taper
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or making them go cold turkey
is going to fix anything
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because they still need
to have real treatment
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for their
substance use disorder,
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which involves inpatient,
or IOP, or PHP,
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or various other levels of care.
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Now the question,
“Can you get high on it?”
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Yes, you can,
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and I know that
that’s probably surprising,
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but let’s take a look
at how that works.
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So 0, 30 percent, 100 percent.
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Most of the people
that we’re putting Suboxone on
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are coming from here
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and coming down to 30 percent,
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and then
they’re going to stay there.
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These people
can actually go through
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precipitated withdrawal,
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which means if they take
the Suboxone too soon,
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it will push the opioids
out of their system
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off the opioid receptors,
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replaced with Suboxone,
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and they can actually
drop from 100 percent,
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drop straight down
to 30 percent,
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and suffer from really,
really bad withdrawal symptoms.
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On the contrary,
if you are a person
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who does not have
opioid tolerance.
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Let’s say you’ve only used
pain pills a couple times,
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or you’ve never had
an opioid before,
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you’re going to be
down here at 0,
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and so if you use it,
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yes, you are going to
feel high from it.
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But that is not
the patient population
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which we use Suboxone for.
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We use Suboxone on people
who already have
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tolerance to opioids
and are having difficulty
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with going through
the withdrawal process
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because it’s gotten too bad,
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where these patients,
literally they would be
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doing it recreationally,
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and they don’t have
an opioid tolerance,
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so if they did need
early treatment
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for substance abuse disorder,
they wouldn’t need Suboxone
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because their withdrawal
would be mild
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and could be treated
with some comfort medications.
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Then the question always comes,
“Aren’t you just
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switching one drug
for another drug?”
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In this case,
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it is switching one drug
for another one.
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However, the benefits being
with Suboxone
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and its 30 percent
agonist effect.
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Let’s say, for easy example,
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you have five opioid receptors
in your body
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and you get Suboxone.
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On each one of those receptors,
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once it’s there
it’s stuck there like concrete,
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and so it helps people
decrease cravings,
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it helps with
the withdrawal process,
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not allowing them to go through
such a horrible withdrawal,
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and if you don’t use it,
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no one gets sober.
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Unfortunately, what we know
about this opioid epidemic
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is that there’s a very,
very high risk of death involved
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when someone has a low tolerance
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from maybe being in
treatment or detox,
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and then they go right back
to their same dose,
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they have a high likelihood
of dying.
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Whereas if they are on Suboxone,
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are they switching
one drug for a medicine?
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Yes, they are,
but it makes sense
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because without it
a lot of opioid addicts
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will never get treatment,
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they’ll never get
comfortable enough
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to understand
what needs to be done
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to work a recovery program,
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and will continue
to allow people
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with no medications
to assist them
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who will then inevitably
go right back out,
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use and overdose,
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and have the potential
for dying.
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So there are a lot of benefits
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as to why we use Suboxone,
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and there are also
some consequences
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and some things that we don’t
necessarily like about Suboxone.
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But what we do know is
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we do not get
very many people sober
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and get them back
to a successful life,
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get them back to their homes,
and their families,
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and their jobs.
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Without Suboxone we get
a very, very small percentage
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of those,
even in the single digits,
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like, 8 to 10 percent.
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So I hope those answers
to your five questions
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on Suboxone,
and I look forward to
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talking about Vivitrol
in another class
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that we have coming up.
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♪
