Starting a new treatment can be intimidating and, in some instances, costly. In this article, we will explore how to know if Suboxone therapy might be right for you or your loved one including information on the medication, who is the ideal patient, and who isn’t.
Suboxone (buprenorphine/naloxone) is an FDA-approved medication to treat opiate use disorder. Suboxone is the brand name for a product that combines buprenorphine and naloxone. These medications also come in a generic form.
Suboxone was first approved by the FDA to treat opiate use disorder in October 2002. It is classified as MAT (medication-assisted treatment) or MOUD (medication for opiate use disorder.) The active ingredient in Suboxone, buprenorphine, has been shown to diminish the effects of physical dependency on opioids, such as withdrawal symptoms and cravings. It has a lower potential for misuse and increased safety in cases of overdose.
Who is an ideal patient for Suboxone therapy?
· They have a diagnosis of opiate use disorder. Individuals who seek treatment with Suboxone need to have opiate use disorder, not just opiate dependence. Opiate use disorder can begin in many situations including with valid prescriptions or excess recreational use. Suboxone is effective regardless of the situation that started the opiate use. When you consult with your doctor, they will do an evaluation to see if you have an opiate use disorder. If you are not certain, please call the office in advance to discuss your situation.
· They have chronic pain with opiate use. The active ingredient in Suboxone was developed to help manage pain. Many patients with chronic pain experience benefits with suboxone therapy including pain improvement. If you have developed an opiate use disorder and still suffer from chronic pain, Suboxone may be an excellent tool to manage both the pain and opiate use.
· Pregnancy with opiate use disorder. Many individuals who use opiates are of childbearing age. Many women wish to discontinue their opiate use during pregnancy. Suboxone or Subutex is a good option to stop opioids while decreasing the risk of withdrawal. Withdrawal is to be avoided in pregnancy. The active ingredient in Suboxone/Subutex has decreased risk of neonatal abstinence syndrome after delivery than other opiates a pregnant person might be consuming.
Who is not an ideal patient for Suboxone therapy?
· People who do not have a diagnosis of opiate use disorder. People with only sporadic occasional opiate use. People in chronic pain management can wean or discontinue their opiate therapy without issue other than worsening their chronic pain.
· People with advanced liver disease. Suboxone is metabolized by the liver. If you are under the therapy of a liver specialist, please discuss your therapeutic options with them as they will have the best understanding of your liver function and the risk of medication. If you have concerns about your liver health but are not under the care of a liver specialist, your doctor will be happy to evaluate your situation and make an appropriate treatment recommendation.
· People with severe, chronic pain not managed with Suboxone. In some instances, an individual’s chronic pain will not be adequately managed with Suboxone. Most people with chronic pain are pleasantly surprised by the effect of Suboxone and it generally cannot be predicted who will or won’t do well. If you have trialed Suboxone and your pain doesn’t seem to be improving after several weeks of treatment, you may need to consult with a pain specialist or transfer to methadone maintenance.
· People who are desiring detox. If detox or a short-term (less than 12 weeks) taper are desired, patients generally should seek to do so in a residential detox facility. Unfortunately, studies have shown more than 90% of individuals will relapse in the month following discharge from such a program and the overdose rate is higher amongst these individuals. Lasting sobriety is much more likely with Suboxone maintenance and/or a longer-term taper.
Making medical treatment decisions should always be done with the help and guidance of a medical professional. If you are considering starting Suboxone or another treatment option a consult with a physician knowledgeable in addiction medicine is your best bet at choosing the best path for your situation.