Suboxone is the trade
name for a medication that contains buprenorphine and naloxone. A very similar medication, Subutex, contains buprenorphine without naloxone. Both are manufactured and sold by a
British company, Reckitt-Benckiser, and are scheduled to lose their patent protection in 2009. Both medications are indicated for treatment of opiate dependence, and both are also used 'off
label' to treat chronic pain.
The active substance, buprenorphine, has effects at the mu opiate receptor that are different than effects of pain pills or methadone. Oxycodone, methadone, and hydrocodone are all 'agonists', meaning that the more drug, the more effect at the receptor. Naloxone and Naltrexone are mu 'antagonists'-- they
will block the effects of pain pills and have no stimulating effect at the receptor. Buprenorphine is a 'partial agonist'-- in between the two. It
will activate the mu receptor and relieve pain up to a certain point, where it has a 'ceiling' to it's effect. Beyond that point, any increases in dose of buprenorphine
will have no
extra effect. Buprenorphine becomes an 'antagonist' at that point, blocking the receptor so that any other opiate medications
will be ineffective.
The result is that treatment with buprenorphine virtually eliminates cravings for opiates in opiate addicts who use it properly. It can be taken once per day, and
will also block the effects of any other opiates the addict
may take. Because of these effects, buprenorphine is considered a 'remission agent'-- it
will induce remission of opiate addiction, but it is NOT a cure. When an addict stops buprenorphine, all of the prior features of his/her addiction
will return if the addict does not do something to replace the buprenorphine-- such as become involved in 12 step groups.
While not a cure, there is no
truth to the oft-heard comment that buprenorphine is only 'replacing one drug with another'. Opiate addiction consists of the obsession for opiates; the addict's mind is taken over by the singular concern for finding the next dose. Buprenorphine effectively treats addiction by eliminating the obsession far beyond what occurs with taking an opiate agonist.
More and more addictionologists are recognizing that buprenorphine and Suboxone should be considered
long term treatments.
