Answers from Doctors
Suboxone is a combination of Buprenorphine and Naloxone prescribed for opiate addiction, most commonly to heroin and prescription pain killers like Morphine, Hydrocodone and Oxycontin. Suboxone is a “partial-agonist” opiate, this means that it occupies the opiate receptors in your brain (so you don’t have cravings or feelings of withdrawal) but does not cause feelings of being “high”.
Suboxone comes in many forms, but the two most popular are, sublingual tablets and sublingual film, aka “strips”. Both forms are designed to be slowly dissolved under the tongue. The strips come in 2 dosages, 8mg and 2mg, which can be cut into smaller pieces with scissors to obtain the required dose. The tablets are available in 1.4mg to 11.4mg. There’s also a trans-dermal patch available, under the brand name Butrans, which works like a nicotine patch administering the dosage over time. Its important to note, however, that the patch contains only Buprenorphine and not Naloxone (more on that later). Recently, a new delivery system has been developed. Bunavail is a “buccal film”, meaning it dissolves inside the mouth, by being pressed against the cheek. Its available in dosages ranging from 2.1mg to 12.6mg.
Suboxone – sublingual film
Zubsolve – sublingual tablets
Butrans – transdermal patch
Bunavail – buccal film
NAABT – The National Alliance of Advocates
for Buprenorphine Treatment
Suboxone works by binding with empty opiate receptors in your brain, so your brain thinks it is getting opiates, when in fact it’s not. Opiate receptors can only become free when opiates are no longer being delivered to the brain, therefore, Suboxone treatment can start only when your opiate receptors are all free.
“Free” opiate receptors is also what causes withdrawal symptoms, but in order to begin Suboxone treatment, your brain’s opiate receptors must be fully free which means that a patient must not have used opiates for a length of time prior to taking the first dose of Suboxone.
The length of time depends on the drug being used. Heroin, for example, will take only 4-8 hours for opiate receptors to begin to free-up and full withdrawals to take effect. Hydrocodone on the other hand, may take 24-36 hours. Failure to completely withdraw, prior to taking your first dose of Suboxone will cause “precipitated withdrawals.”
Precipitated withdrawals can be caused by taking the Suboxone too early and not letting those opiate receptors clear out, thereby causing withdrawal. You do NOT want this to happen. To make sure that you are in full withdrawal, your prescribing doctor will rate your withdrawal symptoms on a certain scale called the C.O.W.S. (Clinical Opiate Withdrawal Sale). That way, you both can make sure that you avoid precipitated withdrawals.
After your opiate receptors have cleared and you are in full withdrawal, you can then take your first dose of Suboxone. This will “trick” your opiate receptors into thinking it’s being fed opiates and will also block any other “real” opiates that try to occupy those receptors.