There were 9.3 million prescriptions filled for buprenorphine in 2012, the Drug Enforcement Administration reports. The majority of these orders for medication were filled for individuals who were battling addictions to opiates like heroin, oxycodone, and other opiate drugs. As with any form of prescription medication that carries the potential for abuse, Suboxone is no exception. In 2011, the Substance Abuse and Mental Health Services Administration accounted for 21,483 people being treated in emergency rooms across America for issues stemming from the abuse of buprenorphine, the active ingredient in Suboxone.
Typically, Suboxone treatment consists of starting a client on a structured dose of the drug and monitoring the person to determine whether that dose is efficient or not. If it isn’t, it will be increased by 2-4 mg the following day. This process continues until withdrawal symptoms are relived. At that point, the dose remains steady until both the client and the treating physician feel it is time to reduce it. Decreased doses happen over time as a way of slowly weaning the individual off all opiates entirely. Treatment minimums of one year are recommended, though many people stay on Suboxone for far longer than that.
While buprenorphine does work in a similar manner as heroin and opioid painkillers do, by attaching itself to opioid receptors in the brain and thereby satisfying cravings and calming nerves, it doesn’t cause the euphoric high that those illicit substances do when taken as prescribed. Naloxone works in a different way. It removes drug molecules that are attached to receptors. With typical use, only some of the buprenorphine can attach. When Suboxone – a cocktail of these two drugs – is abused in large amounts, the naloxone goes into overdrive and sweeps away every last attached molecule. Then the user goes into immediate withdrawal. The original intention of this drug was to make attempts toward overuse virtually impossible and so uncomfortable that it would deter people from even trying to abuse it. SAMHSA notes the approval of buprenorphine in 2000 cited its ability to be prescribed by physicians rather than requiring in-person delivery of each dose like methadone does.
With the naloxone component deterring abuse, how then can people get high off this drug and even end up addicted to it? They use higher doses than they’re supposed to and risk the risk of plummeting into withdrawal.
Many who abuse Suboxone are also abusing other substances as well, which can increase the potential for a high. This can further complicate the treatment process and make it difficult to discern which drugs are causing which side effects. People generally abuse other drugs, like alcohol, cocaine, or benzos, to intensify the effects of Suboxone. This type of polydrug use only compounds the possibility of side effects from all substances involved.
Signs that someone may be abusing or addicted to Suboxone include:
- Ingesting Suboxone in ways other than prescribed, such as crushing and snorting or injecting it
- Using the drug to induce sleep, get high, or mellow out
- Taking larger doses than prescribed
- Using Suboxone when withdrawal symptoms start to appear in order to make them stop
- Extreme lethargy
- Sudden mood changes
Many individuals make the assumption that the only people who are susceptible to abuse of Suboxone are those who are placed on it for treatment, but this isn’t exactly true. Suboxone can now be bought as a street drug just like any other opiate. The Drug Enforcement Administration notes 10,804 cases of drug seizures related to buprenorphine use were reported in 2012.
SAMHSA reports 90 percent of people who abuse Suboxone buy it from a dealer. In addition, 17 percent of physicians claim prescriptions are doled out for it too easily, thereby contributing to the abuse epidemic. Many opt for it over prescription painkillers and even heroin because it can be cheaper to buy. Street sales of Suboxone are particularly common in the northeastern region of the United States, but it’s happening all over the country.
Help Is Available
What is the right choice if people are abusing the medication that is used to treat their opiate addiction? Medical detox is still an option for people who are hooked on Suboxone. Often, a tapering schedule may be set up initially to wean the individual off the drug. Generally, the length of the weaning period will depend on how large of a dose the individual has been using. Once a 2 mg dosage is reached, the person can often be completely detoxed from the drug.
Switching to methadone is another option. The California Society of Addiction Medicine reports a 60-90 percent success rate for the treatment drug. While methadone can also be abused, methadone maintenance plans require that individuals appear in person at a clinic or other designated office for their regular doses of the drug. This stricter policy may result in decreased potential for abuse than with Suboxone, which is distributed via prescription for individuals to take at home. This may be a major contributing factor as to why success rates have been reportedly higher among individuals treated with methadone than with buprenorphine-based drugs. The National Institutes of Health reports a success rate of 49 percent for buprenorphine.
Intensive therapy and other support resources should always occur in tandem with any Suboxone addiction treatment. Remember that dependency is both a physical and psychological problem. The best way to recover from Suboxone abuse is via a professional addiction treatment program that offers medical detox and research-base treatments.