UMEM Educational Pearls

Title: Suboxone for managing opioid addiction

Keywords: Buprenorphine, Suboxone (PubMed Search)

Posted: 2/16/2017 by Kathy Prybys, DO
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Question

The current opioid epidemic is considered the worst drug crisis in American history responsible for 50,000 deaths per year in the US from overdose of heroin and opioid prescription drugs. A 200% increase in the rate of overdose deaths involving opioids occurred between 2000 and 2014. The continued rise in opioid related deaths calls for an urgent need for treatment. Three types of medication-assisted therapies (MATs) are available for treating patients with opioid addiction:methadone, buprenorphine, and naltrexone. Suboxone a combination of buprenorphine and naloxone, is emerging as one of the best choices for the following reasons:

Buprenorphine is a partial agonist that suppresses opioid withdrawal and cravings.
Binds opioid receptors with high affinity but low intrinsic activity.
Lasts 24 hours. Binds opioid receptors to prevent full opioid agonists such as heroin or prescription opioids from binding.
Less risk for dependency as increasing doses does not result in full opioid effect.
Less respiratory depression in overdose due to partial effect.
Naloxone, an opioid antagonist is poorly absorbed by oral route and is added to discourage injecting or snorting of suboxone as it can precipitate severe withdrawal.
Precipitated withdrawal can occur if other opioids are present with administration of Suboxone. This is particularly important with long acting opioids such as methadone.
Can be prescribed in the primary care setting and does not require a specialized clinic.
Comes in 2 or 8 mg tablet or sublingual film.

Answer

Image result for suboxone opiate agonists

References

Rudd RA, Seth P, David F, Scholl L. Increase in Drug and Opioid-involved Overose Deaths -Unted States, 2010-2015. MMWR Morb Mortal Wkly Rep. ePub: 16 December 2016.

Jones HE. Practical Considerations for the Clinical Use of Buprenorphine. Science & Practice Perspectives. 2004;2(2):4-20.