What does your doctor say about Suboxone?

1. What does your doctor say about Suboxone? • Dr. Sadia Dar • August 31, 2013

2. Suboxone: a drug to treat Opioid dependence & addiction • Buprenorphine was discovered in 1970’s in Europe by Scientists who were researching a drug to help with withdrawal symptoms and dependence caused by painkillers • It has been used in Europe for more than 2 decades for both treatment of Opioid dependence and pain • The drug was studied in the United States and got its FDA approval only for treatment of Opioid dependence in 2002

3. Suboxone is not approved by FDA for treatment of pain • Reckitt Benckiser, the pharmaceutical manufacturer of the drug has not shown interest for indication of Suboxone for pain • Suboxone and Subutex are schedule 3 and controlled substance • Subutex is only approved for treatment of Opioid dependence during pregnancy, or for patients who are admitted and under direct supervised treatment

4. Both Suboxone and Subutex are known for its potential for abuse and diversion • Suboxone and Subutex can be injected intravenously and used for treatment to get “High” • Intravenous use of either one of those drugs can, and is known to cause death • When Suboxone/ Subutex is taken with other controlled drugs, for e.g., Benzos, it can cause respiratory failure and death

5. Suboxone: is a combination of Buprenorphine and Naloxone • Buprenorphine is a partial mu agonist with much more potent effect on mu receptors than morphine, the effect lasts at least 18 hours and up to 1 week. The drug does not work on kappa receptors • Due to its partial mu receptor properties, the drug has analgesic (pain relieving) effect. • Naloxone is an Opiate blocker

6. How will suboxone help me overcome my addiction to Opioids? • Suboxone competitively binds to the receptors in the brain to stop the cravings for Opioids and the naloxone part of it, blocks the receptors so you do not feel the effects of Opioids in the system • Over time, as the medicine completely occupies the receptors to stop the cravings, the number of active receptors goes down • The receptors start to down regulate and shut down • Different people have different number of receptors in the brain

7. So, the time it takes for one person to fully recover is different from time it may take for another person • Based on duration of addiction and dependence, for some people addiction is considered a chronic disease and it may be necessary for them to stay on a low dose Suboxone for long term, just like you would for treatment of High Blood Pressure and Diabetes

8. Psychosocial support and counseling to help modify the addiction behavior is extremely important in overall treatment of Opioid dependence • For most Opioid addiction clinics, it is mandatory that you receive appropriate and effective counseling

9. Withdrawal Symptoms with Suboxone • Chronic use of Suboxone and Subutex can cause dependence similar to Opioids. Abrupt use of the medicine can cause withdrawal symptoms, although symptoms may be milder and delayed in onset • Due to presence of Naloxone, if suboxone is administered in the presence of Opioids in the system, it can cause severe withdrawal symptoms. That is why your doctor may require you to take the first dose of the medicine in direct supervision

10. When can you stop Suboxone • You and your doctor can decide the wean down process from the suboxone. • Typically, Suboxone dose is tapered slowly over several weeks and months till it can be completely stopped. • It is advisable to communicate closely with your doctor, your counselor and your support system during this wean down process. • During the process, you may notice increase in cravings and other symptoms.

11. In most cases, those symptoms are easily manageable and treatable with non-Suboxone medication. • It is extremely important to be compliant and adhere to the treatment plan when weaning down from Suboxone.

12. Drug Diversion • Unfortunately, Suboxone has a known street value and widely diverted among drug users. • Due to its known efficacy in treatment of Opioid dependence, in most cases, it is diverted and/ sold to people who have a problem with addiction and they are trying to self treat. • On the other hand, some addicts try to experiment with Suboxone to get high. Intravenous use of the drug (although very dangerous) but can cause the feeling of euphoria.

13. Due to a rise in diversion and street value of Suboxone, Drug Enforcement Agency and law enforcement agencies work with doctors and experts very diligently to minimize it. • In several states, including the state of TN, it is the law to check central drug database, before a prescription of a controlled substance can be written or dispensed to a patient. • It is your responsibility to inform your doctor(s) immediately if you are being prescribed a controlled substance.

14. As doctors and health care providers, we feel the responsibility to take measures to stop the diversion of this otherwise very beneficial and powerful anti-addiction medicine. • Most offices and practices have policies and protocols in place to minimize drug abuse and to stop diversion of the drug. • Our policy is to help you and to help the community we all share.

15. Our Policy • We do everything in our capacity to help you get off the narcotics and stay off of them. • We do not prescribe Suboxone if there is a reasonable doubt or suspicion that you may be diverting the medicine. • We ask that you bring all the film wrappers with you to your appointments. • If you are prescribed tablets, we can call you for random pill count.

16. We can call you for random drug screen at any time. • Its your responsibility to come for a random drug test if we ask you to come. • It is your responsibility to call us if there is a change in your address, your phone or contact number. • It is your responsibility if you change your pharmacy. • It is your responsibility to “say No to drugs” when it is offered to you whether in the form of a drug or a prescription.