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Suboxone is a trade name for the combination medications of buprenorphine and naloxone. 

Buprenorphine is used to help to alleviate opioid withdrawal symptoms, such as is caused by heroin withdrawal, by taking its place on the opioid receptors in the brain. Since it partially blocks the receptors in the brain, where heroin causes its addictive effect, there’s a decreased chance that breathing problems will be encountered in cases where the medication is abused. 

Naloxone is an opioid antagonist which means that it displaces the opioid drug used by the patient from the opioid receptors in the brain. 

Suboxone therefore works by having the naloxone remove the offending opioid from the receptors in the brain and the buprenorphine then takes the opioids place in order to prevent withdrawal symptoms. 

What is the issue with a Suboxone, combination of buprenorphine and naloxone?

The issue with this combination, though, is that if it’s used by persons who are not addicted to opioids then the buprenorphine can lead to opioid addiction and the naloxone isn’t effective enough to remove it from the mentioned receptors. It is therefore very important that this medication is prescribed by a health care professional who is trained in alcohol and drug rehabilitation programs. This will ensure that the correct medication and dose is prescribed to the patient, and that these patients then follow up accordingly with these doctors to assess and monitor them. The involved doctor will also setup a tapering program for the patient so that the dosage of the medication is decreased gradually in order to prevent undesired withdrawal symptoms. 

Buprenorphine and methadone are both used as in- and out-patient treatments for opioid or heroin withdrawal. Methadone is a cheaper alternative to buprenorphine but tends to have a larger addiction and side-effect profile. It therefore needs to be observed as being consumed by the dispensing health care professional to make sure that the patient is using it and not giving it to someone else. 

Medications used in the in-patient setup

In the in-patient setup, other medications such as diazepam, oxazepam and other anxiety reducing tranquilizers may be used to help curb the jitteriness, tremors and nervousness caused by the withdrawal symptoms until the buprenorphine or methadone start to work effectively. This can take between 24-48 hours but the tranquilizers work nearly immediately to help offer some relief. During this stage the patient’s blood pressure may increase as well, so medication such as clonidine will be prescribed which also offers some relief of the withdrawal symptoms. Anti-inflammatory medication can also be given to help reduce pain from muscle spasms. These medications can be used together with buprenorphine or methadone as there aren’t any interactions associated with their use. 

Involvement in a group therapy 

It is also important to get involved in a group therapy session where you will be encouraged to continue on the path of sobriety. Heroin and other opioids are extremely addictive and people who used to use these products still get cravings up to 10-12 years after their last use. This isn’t mentioned to discourage you, but rather to motivate you to make use of these available programs. You can speak to the occupational therapist or social worker involved at the rehabilitation centre to offer you more information on these services.

Suboxone and pregnancy

The combination use of buprenorphine and naloxone is contraindicated for pregnant women in the U.S. and the U.K. This medication has been identified as a category C drug pertaining to pregnancy. In other words, when it was tested on animal subjects, it was found to cause issues such as miscarriages and preterm labour. It may be used, though, if the benefit of the medication outweighs the risk to the mother and the unborn baby.

In mothers who have used this medication, the babies were born experiencing symptoms of buprenorphine withdrawal such as slow heart rates, agitation, tremors and increased muscle tone. The onset of these symptoms was usually around 1-8 days after birth. The newborn is then closely monitored for this time, but fortunately the symptoms resolve in most cases.

Trying to get pregnant while using Suboxone

If you are not pregnant yet but wish to do so and are still addicted to opioids, then the best way forward is to discuss options such as Naltrexone treatment or being admitted to a rehabilitation facility to go through a ‘detox’ program. These options are best because going through withdrawal symptoms while pregnant can cause one to have a miscarriage.

If you are already using Suboxone and wish to become pregnant, then the best would be to switch over to a safer medication such as methadone. It’s very important to consult with your primary care physician to determine the best option for your circumstances.

If you are using Suboxone and find out you are pregnant then it would be best to continue the medication because suddenly stopping the medication would result in withdrawal symptoms which could lead to a miscarriage. The only change that could occur is that the combination Suboxone is replaced with buprenorphine on its own.

What about any negative effect on sperm?

Regarding the effect on sperm, there is no evidence to show that Suboxone has any negative effects whatsoever.

Long term issues caused by Suboxone

The main issue surrounding long term use of this medication is that it may cause dependence in people who use it. This means that they may become addicted to it and stopping this medication can cause unwanted withdrawal symptoms characterized by opioids withdrawal. This is why it is so important to make sure that you are following up with your prescribing doctor in order to taper down the medication appropriately. This helps you take control of the situation and should prevent you from getting addicted to the medication.

Other long term effects may include:

  • Confusion and disorientation.
  • Drowsiness.
  • Decrease in pain tolerance.
  • Anxiety.
  • Increased chance to develop depression.
  • Difficulty in dealing with social situations.
  • Getting into trouble with the law regarding addictive behaviour.
  • Failed relationships with family and friends.

Transferring from methadone to Suboxone

In general, it isn’t recommended to change patients who are stable users of methadone over to Suboxone. There are instances though where these patients would like to change over because of issues they may be having such as increased side-effects caused by methadone. This transfer needs to be closely monitored by the physician in charge of the program and the benefits in doing the transfer need to outweigh the associated risks.

It’s important to take note that in the beginning of this transfer, one may experience discomfort for the first couple of weeks. It’s very important that these patients are then counselled properly before embarking on this change.

Dangers of possible relapse

As with most addictions, when one relapses back onto the offending product or situation then one has to start the ‘detox’ and rehabilitation program from the beginning. At this initial stage it will be determined whether the medication needs to be restarted, if the dose needs to be adjusted or if an alternate therapy is needed.

The major problem with Suboxone is that it competitively blocks opioids receptors. Therefore, when you start using opioids again, then you probably won’t feel the euphoria from those drugs. This may lead to consuming or using more opioids, to try getting to that ‘high’ feeling, which can result in overdosing and possibly leading to death.

Does Suboxone show up on toxicology tests?

The answer here is yes and no.

Routine toxicology tests, like those done in the workplace, won’t show Suboxone present. Also, neither component of this medication will show up as positive for opiates and would only occur if one was using those drugs.

If a toxicology test is done to request for buprenorphine and naloxone specifically, then those would be positive in a patient using Suboxone. 

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