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Drug Addiction Treatment: Suboxone & Subutex

Jaclyn is an avid reader and writer from New Jersey who loves life and indulges in all it has to offer.

Bottle of Suboxone sublingual tablets

Bottle of Suboxone sublingual tablets

For a long time, methadone detox or methadone maintenance, coupled with Narcotics Anonymous meetings, was the only way to treat drug abuse long-term on an outpatient basis. Clients with a bed at an inpatient rehab facility, however, had access to a variety of methods and medications, including Buprenorphine.

Buprenorphine hydrochloride, commonly known as Buprenex, is an injectable analgesic that has been used for the treatment of opiate addiction since the 1980s. Buprenex is effective on any opiate (heroin, oxycodone such as Oxycontin and Percocet, hydrocodone such as Vicodin, morphine, oxymorphone, fentanyl) whether it is smoked, taken into the body intranasally or taken in through intravenous mainlining. Due to the fact that it needed to be directly injected into the bloodstream in order to be effective, it has been unavailable for doctors to prescribe to clients on an outpatient basis or for methadone clinics to offer to their outpatients as an alternative to methadone.

Enter Suboxone and Subutex. In October 2002, the FDA approved these buprenorphine-based medications for release in the United States. Although also intended for use at inpatient facilities, the breakthrough was the FDA allowing Suboxone to be prescribed by federally approved doctors and psychiatrists, and allowing pharmacies to fill these scripts. The reason for the change in procedure was that Suboxone and Subutex took a high dose of Buprenorphine and condensed it into a small 2-mg or 8-mg pill, which would be ingested sublingually by holding it under the tongue.

Suboxone tablets

Suboxone tablets

Subutex tablets

Subutex tablets

The difference between Suboxone and Subutex

The only difference between Suboxone and Subutex is that Suboxone contains naloxone, an opiod-receptor antagonist. It is commonly misunderstood that naloxone is put in Suboxone to block the effects of other opiates if the patient attempts to get high during treatment, and although this is certainly an advantage, the additive's main purpose is to prevent abuse of the drug. In order to begin Suboxone therapy, the patient must refrain from using opiates for at least 24 hours before beginning treatment. If someone is switching from methadone to Suboxone, it is recommended that he be at a methadone dose of 30mg or less. If he does not refrain and is not in full-fledged withdrawal, or is not at the methadone minimum at the time of the first dose, the medication will precipitate even worse withdrawals as the medicine is administered. This is because the naloxone (which is used by emergency response teams in cases of overdosing) attacks the drug by binding itself to any opiates present in one's system. Subutex, on the other hand, can be taken sooner, when only mild withdrawal is beginning, and is often prescribed to pregnant women where full-fledged withdrawal can threaten the baby's life or cause miscarriage.

How it works

When opiates are taken into the body, dopamine is released which produces a feeling of pleasure and euphoria. As the drugs wear off, the receptors which received the opiates are left empty, causing withdrawal symptoms to begin. The buprenorphine in Suboxone attaches to the empty receptors and stops them from feeling the pangs of craving and withdrawal. It is a partial opioid agonist, which means it completely halts withdrawal without producing the euphoria and unconsciousness that is counterproductive to a healthy, functioning lifestyle. At its best, buprenorphine also blocks other opiates from attaching to the empty receptors and does not allow a high to be felt.

Suboxone fills empty opioid receptors, thereby suppressing withdrawal symptoms

Suboxone fills empty opioid receptors, thereby suppressing withdrawal symptoms

Advantages

Unlike methadone clinics, which require clients to come in every day to take their dose in front of nurses, after the first Suboxone/Subutex dose is monitored by a doctor in his office, a one-month prescription may be filled that will allow the patient to take the pill in the comfort of his or her own home. Although a 2mg, 8mg or 16mg dose can potentially last anywhere from 48-72 hours, almost all doctors instruct that it be taken every single day to ensure that a proper, active level of medication is running through the system at all times. One of the benefits of buprenorphine-based drugs is that they have a low ceiling effect, making it less likely for individuals to overdose on the medicine. Buprenorphine also has a limited effect on breathing, also making it less likely to induce overdose via respiratory distress.

Over 3.7 million Americans have either tried opiates or are currently addicted to them, but 400,000 of those suffering have successfully completed a buprenorphine program in the five years since it was approved for distribution in the United States. Although considered a "miracle drug" by the thousands who have escaped the grip of addiction through buprenorphine treatment, Suboxone and Subutex were primarily designed for, and are most effective on, those suffering from low level opiate dependency. Those with a high degree of dependency may benefit best from a different form of treatment such as methadone maintainence. Below are some helpful links citing resources for the different types of addiction therapies.

Refereces

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

John on August 10, 2020:

I took 1 8 mg Suboxone by mistake,how long will it show in urine?

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Self Destructive on October 08, 2016:

I went on Suboxone in 2005 after 2 weeks in detox. By day 5 I was ready to leave, but I had insurance that thought 2 weeks was how long I needed to start working a program. In 2007 I as rear ended and my dr changed me to 4 - Non Generic SUBUTEX a day, 120 tramadol, & within 2 months I was supplying 4-5 people a month. We 5 who tried it I.V. lost 4 years of our lives. I managed to work 40 hours, was a care giver, and raising 2 sons. June of 2014 I cold turkeyed everything, lost a job of 8 years, and had had enough. I slipped once & couldn't believe what all was involved. I was shooting one 8mg subutex in 4ths, one a day. I cold turkeyed a 400 mg. oxycontin habit for a month, it was easy compared to the IV Subutex. I found a new job, had the shits for6 months, no energy. Now I am back on the tablets. the dr. feelgood I was seeing unknowingly killed 18 patients and no longer has a medical licence in Ohio.

Victoria Lynn65 on January 09, 2016:

To each and everyone that is taking suboxin to get off other drugs plese do yourselves a huge favor ans simply ween yourself off the drug you have been taking. By switching to another drug your just trading one evil for another and once you go into thise suboxin clinics and say i need help im addicted to pain pills there will be no going back. I have seen first hand what happens to someone that is being rushed into a ER and in a suboxin clinic. There is very little that can be done for you due to the fact that a doctor does not want to be sued for giving you narcotics while you are attempting to get clean. My friend was thrown from a vehicle which landed on her leg and upon arrival to the ER one of the staff pulled her name up on the computer nd there it was where she was in a suboxin clinic. She was given every pain reliever known to man but non narcotic and my friend suffered greatly. They finally gave her something in her IV and eventually she went to sleep. So if you really want to get clean you can do it on your own without the aide of other drugs.

Seems to be a great deal of surety that suboxin will not show up in a urine screen. Id sure like to know how it came up in mine during my yearly drug screen and not only mine but a neighbor of mine as well and i have never taken one of those things in my life

Tigger on January 09, 2014:

Ken,

Addiction is not just taking a drug. It is taking a drug, ETOH, food or anything else that causes your life to become unmanageable. Taking Suboxone responsibly will help you manage your life.

If u take it like an addict then you r one. After 20yrs of addiction I have been clean for 7 bcus of Suboxone.

Addiction treatment no suboxone on October 05, 2013:

[URL="http://www.awaremed.com/"]Addiction treatment no suboxone[/URL]

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Jen on September 04, 2013:

Been on subutex for 3 years after 5 years (any) pain pill addiction and then a 3 year methadone addiction. I was getting everything off the street. The only positive of the methadone addiction was that it helped me reduce the number of doses I took a day. Pain pills I was taking every couple of hours, but with methadone, I was able to take 2 doses per day. The subs have saved my life. My kids now have a better life. I have a new car now. I have a house. I have money. I exercise daily. I lost all the methadone weight plus some. I'm in the best shape of my life. However, now I want off the subs. I long for a life that does not include medicating myself daily. I want a chance to see if the old me is in here somewhere.

Becky on May 21, 2013:

I had a baby on subatex

kent on January 17, 2013:

if you are on suboxine you are still in active addiction. that's the way it is no if ands or buts about it.

martellawintek on December 03, 2012:

long time no see matt i shouldnt give it out but here is the contact

and some info , they have a deal on at the mo ,say mrs wintek put you on

colorado marijuana dispensaries on August 11, 2012:

Take it under the advice of your doctor.

Gary on June 27, 2012:

I am currently on subutex and was on suboxone and it saved my life and gave me the greatest gift of all it enabled me to be a father to my son who is my whole world ... oh and I know 100% fact don't get this twisted subs do NOT show up on any modern conventional drug screens.

brit on June 08, 2012:

no suboxen doesnt show up on a drug test as opiates so either ur still doin them or its still in ur system bc that makes no sense at all to me y it would show up as that..

becauseilive (author) from N.J. on May 07, 2012:

Good luck to you!

K-Li on May 07, 2012:

Thanks.. I had chances at the clinic but my detox is half over and it's crazy but I actually feel a little better than before- still ddnt hit the worst part yet tho.. Trying to stay positive bout it. I think it's time for me to try and work my new found willpower- it's bc of methadOne I feel more comfortable going on Subs.. I tried it when I was using but I couldn't do it.. Now that I've been away from everything for a while. I think I'm ready to try taking Subs everyday.. Methadone isn't easy to take- it takes dedication I began going to a clinic an hour and half away from my house for a few mOns then they opened 1 in my town- but still it's everyday & harsh on the Tummy. So my advice is Try it All before Methadone- but it does work, I don't even thInk bout using & I NeveR thought that was possible- but it takes a long time.. Thanks for all the advice and I'll keep posting how I feel during the transition ;) Mayb it'll help some1 out

miss misty on May 06, 2012:

does anyone know how i can find a suboxone doc who accepts tenn care.i live in clinton tn and cant find a doc.ive researched and looked everywhere.none of them accept tenncare for the visit and i cant afford to pay the fee for the visit right now.

miss misty on May 06, 2012:

def have the experience.methadone clinic to suboxone to methadone to subutex...you name it.been outa methadone clinic for 1 year now and looking back, the subutex was better for me i think its up to the individual.i was in the same shape came off 100mg in ten days to 0.i ended up in a 10 day detox center.the withdrawals were pretty bad im not gunna lie.i think the withdrawals from subutex are pretty bad also.be careful taking the suboxone too close to the last time you took the methadone or it will send you into instant withdrawals!bad.you will be okay.the subutex or suboxone is cheaper per month and you dont have to drive it every day!its usually once a month which saves alota gas.good luck.

becauseilive (author) from N.J. on May 06, 2012:

@K-Li: Is there any way you can talk to your counselor (or any other staff member you have a good rapport with), explain your circumstances, and give them a promise to pay by date? Have your UAs been clean and have you been compliant with treatment thus far? I was in the same situation several times and each time I was able to speak with my counselor, then the director of the clinic, and work out a payment plan since I'd always paid on time up til that point. Good luck and let me know what happens.

P.S. Going to a clinic an hour away and paying more per month is STILL worth it if it's your sobriety and recovery at stake. I know it's not the most optimal choice, but unfortunately it's sometimes the price we have to pay.

K-Li on May 05, 2012:

I'm Scared Shitless..I have been on a Methadone Clinic for about 2 years now and it helped me to get away from people, places and things.. But bc of payment I'm being discharged and it's a 10day detox from 125mgs to 0. I've been contemplating whether to go to a new clinic an hour away instead but it's $340 monthly.. Before Methadone I tried Subs to get off dope but it didn't work- but I was still in Using mode. I no longer think about Heroin but I am scared shitless of the withdraw of Methadone.. I need to know If Subutex will be good to switch to and not feel the intense withdraws. I know it's supposed to b oka- but I need advice from someone with Experience Only. Sorry but those without can guess as well as I can.. Subutex is 'Supposed to' be okay but I don't want to throw myself in a worse withdraw then I have to. Thanks to everyone- a lot of the posts help and Addicts learn most (good/bad) from fellow Addicts

brittany new on May 01, 2012:

i am trying to find a doctor to give me subutex not suboxone i cannot take them does anyone no any drs?

jd on March 29, 2012:

hi i am starting subox tomorrow morning and hope all eorks out for me been on opiates for about 10 years or so it is only reasently i have relized how much of a problems it has been in my home life trying to hide it all the time and stuff anyone got any advise i bought some 8 mg strips to start i hope they work well yjanks and have a bless day

Ladyjade on March 20, 2012:

Also meth hangs around in your system for days whereas heroin only lasts around 8-12hours. If you take subs straight from meth, wait as long as you possibly can, at least 18 hours. I was terrified of subs, had heard bad things and totally was prepared to fail. But they really work. They're the easiest opiate substitute to reduce and I don't look or feel like a junkie anymore - ppl don't know I'm an addict unless I tell them these days. I started on 16mg a day and am now on 4.8mg a day (been ten months.) It wasn't until I was really bad that I wanted to be clean bad enough to do it. But once you stop lying to yourself its actually pretty cool achieving a life rather than an existence :-) the best thing ever is waking up each morning not ill and not panicking about money and scoring, good luck everyone

Ladyjade on March 20, 2012:

I was prescribed subs straight from heroin gram+ a day and was well scared thanks to all the bs fellow junkies who have no interest in sorting themselves out fed me. I can promise you if it has been at least EIGHT HOURS from your last hit, you will be fine if you take the subs properly ie under your tongue. You can use gear on top of subs but it's pointless- however it won't make you ill. Taking subs straight after gear will make you ill

Ladyjade on March 20, 2012:

Drug tests for opiates (the mouth swab ones) test for 6-mam, this distinguishes between heroin and codeine so they can tell if it's actual smack. Also, if you have never had problems with iv use, or have kidney or liver problems, they will prescribe you subutex instead of suboxone. Subutex is injectable whereas suboxone isn't, which is why they dont like to prescribe it. Also suboxone only comes in 8mg and 2mg tablets, whereas subutex comes in 8mg, 2mg and 0.4mg so once you get down reducing to small amounts ie less than 6mg they will swap you to subutex.

savs on March 19, 2012:

I'm five months pregnant have been on methadone most of my pregnancy I have been out of town for two days its the weekend and im so sick. I called the doctor they didn't help much were kinda rude actually what can I do how can I get well I don't want my baby to be going thru withdrawl but I also don't want to have to use ever again

clean and free on March 10, 2012:

suboxin used CORRECTLY is help nd can detox u in as little as 5 days. Everyone as a story and mine is no different other than people posting negg things about the drug are the ones abusing it or not following directions. I hav been clean for 14 days after 3 years of opiates/oxys and its all due to subs

Patricia on March 08, 2012:

I LIVE IN PA DOES ANYONE KNOW WHERE I CAN GET SUBUTEX AT NOT SUBOXONE I CANT STAND THE TASTE OF THEM AND MOST DOCTORS ONLY GIVE YOU SUBUTEX IF YOUR PREGANT SO CAN SOMEONE PLEASE HELP ME FIND A DOCTOR AS CLOSE AS POSSIBLE THAT GIVE SUBUTEX! THANKS ALOT!

TheSherminator on March 07, 2012:

Also, the test for buprenorphine actually isn't that expensive as people say. Some people are going around saying that it costs so much that most employers and doctors don't do it unless absolutely necessary.

I found individual EMIT immunoassays for buprenorphine only for about $2 each. My doctor said he pays less than that for them by buying in bulk and by being a doctor prescribing Suboxone (like super cheap). Then they usually buy an additional 5 panel dip test for cheap, and occasionally other things such as oxycodone tests. Suboxone treatment doctors usually do a standard 5-panel along with oxycodone and buprenorphine.

If you do test positive for something during an employment drug test while using Suboxone legally and are truly not taking or being exposed to illegal drugs (prescription drugs used without prescription are the same as an illicit drug) and you are an existing employee, you have the right to request a confirmation test of the original sample, which are usually more accurate. Whether this will clear up the false positive or not, who knows; the drug testing lab makes money by saying their product is infallible, so they are going to resist ever having to say their test messed up to the people who they depend on for income, but they are SUPPOSED to.

If you are in pre-employment and have established a good relationship with your future employers and you get a false positive, stand firm but do not become defensive. You do not have the right to a confirmation test before employment, but try to offer to have the original sample confirmation tested at your own expense ($100-200). Explain to them that you take a medication that is chemically similar and can break down in the body to cause false positives. You don't have to explain why you take it or what it is for. Offering to pay that much for a better test shows that either you are certain there was a mistake or that you are very stubborn dummy. Because if you knew you had taken drugs illegally and offered to pay over $100 to have that fact confirmed, you're not really thinking straight.

TheSherminator on March 07, 2012:

Suboxone/buprenorphine definitely can help many people, but it depends on the person. In some it can cause very negative side effects which make taking the medication less beneficial, but usually still good. And of course there are still always the people who think it isn't working because it doesn't get them high, because, well, that's all they really know anymore. But if they used a little bit of sensibility and common sense they would realize the problem. You HAVE to want to get better for ANY kind of treatment to work, I don't give a crap what it is. And I don't mean the "I'm miserable so I guess I'll do it" kind of desire to get clean, but the "I'm miserable and I HAVE to change what I do right now and improve my life through whatever means necessary" kind of desire to get better.

There was some discussion about the issue of suboxone and drug tests. While it will still always depend on the person, considering we don't understand EVERYTHING about metabolization in the body, as a general rule buprenorphine does not metabolize into morphine in the body and as a result does not usually test positive for "opiates." HOWEVER, Suboxone also contains Naloxone. It seems there was a little bit of disagreement and discussion about this above, but regardless of what anyone says I can guarantee you that naloxone has the ability to create a false positive for "opioids" such as oxycodone.

Here is why:

While the bioavailability of naloxone is next to none is because it is largely not water soluble. This does not mean it is COMPLETELY insoluble, though. On the other hand, most opiates/opioids ARE soluble and thus can be absorbed sublingually. The usual company line is that naloxone CANT be absorbed orally, but this is basically bogus because when it comes to the gastrointestinal, even the most insoluble substances to some degree can be absorbed. So, while it may not be absorbed sublingually, it can definitely be absorbed intestinally to some degree. This was evidenced by a peer reviewed study that found 50% of unknowing subjects reported adverse effects common with introduction of naloxone into the bloodstream with buprenorphine after switching from Subutex. This was primarily in the high dosage range, but long term treatment also shows some negative effects. As for naloxone testing positive on an oxycodone EMIT immunoassay, a peer reviewed medical study found in Clinical Chemistry in 2009 reported that 69% of samples tested positive for the HEIA through the metabolites noroxycodone and noroxymorphone. Some cross-reactivity for oxycodone and opiates has also been reported with use of other prescription pain medicines such as hydrocodone.

So in short, 70% of the samples tested positive for oxycodone due to the presence of naloxone in the blood stream. Jenkins would later test actual Suboxone patients with similar results. He also said that increasing the cut off level of the immunoassay would reduce the false-positive rate from 69% to 5%, which is still obscenely high in any kind of "medical" test.

For those doubters, I tested this myself. I bought 3 identical 12-panel tests. I am a long term patient of Suboxone treatment since 2007 and have not taken any other controlled substances since 2007. I take 8mg/day. The first urine test was taken about 30 minutes after swallowing the medication, and it was a clear positive result for oxycodone. The half life of naloxone is usually 1-1.5 hours, and around 7 times that the drug is fully metabolized in a healthy, active patient. So I took the second test roughly 48 hours after no medication, and received a faint but clear negative on everything including oxycodone. The last test was conducted after taking medication but not swallowing it afterwards (I spit it out) for a couple of days, and the result was again a faint negative.

So you can see here that the problem is not the buprenorphine, which most people assume it is. Your enemy is the naloxone, which, despite very low bioavailability, can become present in the bloodstream through prolonged treatment at high doses and frequencies (including daily), regardless of what anyone says. The problem is that no doctor (including a Suboxone doctor) will have ever heard of this happening, care of hearing about it, or believe what you say. This includes MRO's who evaluate positive results in drug tests. They believe their training and knowledge is god and nothing can contradict it, so good luck convincing them otherwise. Your only chance would be to kindly explain you take a prescribed medication that is chemically similar and has been shown to cause false positives for oxycodone through a peer reviewed medical/chemistry/pharmacology journal article. The link to the data is here: http://www.clinchem.org/content/55/7/1434.full.pdf...

I suggest that just to play it safe and to possibly make yourself feel better anyways by limiting the possible effects of a minor naloxone counteraction in the body, JUST DON'T SWALLOW YOUR MEDICATION AFTER TAKING IT. Leave it in about 10 minutes, spit it out (politely/privately), then rinse your mouth with water and spit that out.

OffOfSubs.2weeks on February 21, 2012:

Hi everyone. I went cold turkey from 12mg a day 2 weeks ago. I was taking them for many years from a doc. He would give me my scripts and had NO Idea how this stuff really works. Just stop taking them. Theres no WD's. Youll be fine. 1st week really sucked. 2nd week is getting better. Tomorrow will be day 15. I have NO Energy and cant Sleep for anymore than a couple of hours a night. Anyone have any ideas or suggestion for sleep and and energy. Ive been clean for two week and Not going to a doc or rehab center. Ive made it this far and will finish this! Just looking for ideas. Thanks Jay