Research and Review of Articles on Suboxone and Suburex, Agonist and Antagonist Opioid Replacement Drugs.
Research and review of articles on Suboxone and Suburex, agonist and antagonist opioid replacement drugs. The purpose of this paper is to explore the pros and cons of Suboxone and Suburex, two treatments for heroin dependence, which are both agonists and antagonists for opioids. The chosen articles, Ling,Walter, et al. ’s, “a decade of research by the National Drug Abuse treatment clinical trials network”, Bell, James, et al. s “a pilot study of bunprenorphine-naxolone combination tablet (Suboxone) in the treatment of opioids dependence” and Mc Cormick’s “management and post-marketing surveillance of CNS drugs”, bring up the benefits and the disadvantages of using Suboxone or Suburex for opioid addictions. Suboxone is the formulation primarily used in the United States for the treatment of opioids addiction. In addition to burponephrine, it contains Naxolone, an opioid antagonist It is an improvement on Suburex, which contains only burponephrine. The naloxone in Suboxone is well absorbed when one takes the medication as directed sublingually.
If however, someone dependent on heroin or other strong opioid analgesics administer Suboxone intravenously, the naloxone will precipitate a very intense withdrawal syndrome. Thus, the addition of naloxone decreases the likelihood of the diversion of Suboxone into the drug-using subculture. The prescription medicine is used to treat adults as part of a complete treatment program also including counseling and behavioral therapy. Additionally, physicians prescribe Suboxone in an office setting thus avoiding the stigma of inpatient treatment and helping the patient maintain a normal life style.
Suboxone has become the new replacement drug for opioid users. Reckitt Benckiser Pharmaceuticals UK invented it, the FDA approved it in 2002, and over 7,000 physicians, holding a special license began prescribing it in 2003. Not every health insurance program reimburse Suboxone and the cost can be high, but at $3850 a year, it is still cheaper that methadone and the treatment is shorter, sometimes the patient will only take Suboxone for 4 to 5 months, including the tapering down part of the process. The drug has been on the market for close to 9 years now so it hould become available in a generic form very soon. Buprenorphine is the main active ingredient in Suboxone, in combination with Naxolone. The addition of Naxolone makes the drug very difficult to abuse by a heroin-addicted person in an injected form, as it does not dissolve properly. Before the addition of Naxolone, Suburex, the original Buprenorphine, was frequently abused as an injection drug. The drug seems very efficient to help opioids dependent patients withdraw with only mild symptoms and to stay clean after the treatment.
Suboxone at a small dose (2 to 16mg) acts as an agonist, giving the user a similar but much milder experience than heroin, stopping the cravings and the severe symptoms of withdrawal. Taken at a higher dose or more often (24 mg or up), however, it becomes an antagonist, making the patient sick, and unable to take pleasure in using heroin. In 2004, the VA started using Suboxone to treat veterans in their 50s and 60s addicted to prescriptions analgesics like Vicodin and Percocet. Initially the VA used the medicine only for short-term detoxification and was successful, but the long-term recovery rate was substandard.
The medicine is now as a long-term maintenance program with much better results. Patients who have used methadone in the past generally reported that Suboxone made them feel much better, energetic, clear headed and functioning almost at their full potential. Additionally, the risk of overdose by buprenorphine is significantly less than that of methadone. The best results were observed in people who have been successful at quitting the use of heroin before, are regularly employed, and have a relatively stable life with permanent lodgings.
The treatment requires some discipline as the clients will be in charge of their own Suboxone once a week, then monthly for their prescription and UA tests. The principle of self-administration accomplished great progresses with clients who otherwise would not have access to the treatment because of geographical locations or their employment schedule and are now in a Seboxone program. Self-administration also greatly reduces le cost of treatment for the patient and their insurance companies. The clients have reported a better sense of autonomy and self-efficacy.
Gone is the stigma attached to the methadone clinic where clients have to go once a day to receive their doses. There is no confidentiality, when one has to wait in line on the street until one can go in and get one’s medicine. Additionally, methadone is a full-fledged opioids agonist and provides the same effects than heroin, often condemning the client to another addition although with a legal drug. Initially, the medical community did not receive Suboxone very well. Clinicians were reluctant to use yet another opioids replacement drug and the failure of many methadone treatments did not endear them to use Suboxone.
However, the decade long research performed by the Clinical Trials Network (CTN) at the request of the National Institute on Drug abuse (NIDA) convinced them that when used in conjunction with psychological and drug addiction counseling, Suboxone was very successful. Compared to treatment with clonodine, 29% of Suboxone induced patients were successful compared to 5% for those treated with clonodine. The study also concluded that a 5-month treatment, including first inducement all the way to post tapering was the most efficient way to use Suboxone, making it an economical treatment for opioids abuse.
The study also evaluated the benefits of the treatment for the adolescent population, one that has become the main user of opioids, especially heroin; it demonstrated that a three months treatment with Suboxone and counseling sessions was 70% more efficient than detoxification and counseling alone. It also showed a sharp decrease in the use of cocaine and marijuana. We need further study before Suboxone is approved for the treatment of cocaine addiction but the preliminary results are encouraging.
Unfortunately, Suboxone is fast becoming a new drug of abuse, selling on the streets and slowly replacing heroin as a drug of choice. Data collected in France indicate that buprenorphine has replaced heroin as the main injected opioids. In the jail population, a survey indicates that the inmates treated with Suburex used over 40% of the Suburex prescribed legally in the jail illegally in order to obtain cigarettes or other drugs. The rise in the use of buprenorphine and deaths associated with its use in the period from 2000 to 2004 was accompanied by a sharp decrease in the death rates from heroin.
The reduction in heroin use probably was not caused by reduced availability but because the addicts were successfully treating their heroin addiction and/or withdrawal by substituting buprenorphine. Support for this conclusion comes also with the finding that the respondents had used other intravenous opioids significantly longer than buprenorphine. Reckitt Benckiser introduced the combination of buprenorphine and naloxone to help eliminate diversion and IV use of buprenorphine. The combination is supposed to have a lower ntravenous abuse potential than buprenorphine alone. A 68% of the respondents from the French survey had tried injecting buprenorphine and naloxone and 66% of those who tried it, took it again or even regularly. This may indicate that combining naloxone with buprenorphine does not block all agonist effects when using intravenously. The finding that 80% reported that they had a “bad” experience with the combination product, while less than 20% reported it “similar” to experiences with injecting buprenorphine supports the latter conclusion.
Consistent with this finding, respondents were willing to pay a significantly higher street price for buprenorphine than for Suboxone. We should note, however, that the addition of naloxone does not prevent the intravenous abuse of Suboxone by individuals who are not physically dependent on strong opioids. It is possible that the rigid control of the drug treatment delivery system contributed to these individuals resorting to illicit buprenorphine.. Treating more people within the system, especially with the combination of buprenorphine and naloxone, could reduce the number using buprenorphine intravenously on the street.
Thus, it appears that the next logical step in attempting to stop the diversion and misuse of buprenorphine should include both increased availability of treatment programs and increased use of buprenorphine plus naloxone in these programs. In conclusion, we discovered more benefits than disadvantages in the use of Suboxone. Like any other agonist drug replacement substance, there is a potential for abuse. However, the medication is tightly controlled; Reckitt Benckiser Pharmaceuticals uses only one distributor in the United States. The physicians who prescribe the medication have to hold a special license.
The danger for illegal distribution comes from the clients themselves who sometimes sell their Medicine to buy heroin or other drugs. The principle of self-administration is both a benefit and a draw back because it leaves the ultimate control of the drug absorption to the client. Seboxone is a new product; while methadone, invented in 1937, has been used in the US for over 64 years (41) for opioids dependence treatment. We need further research to find out if Suboxone is the “miracle cure” for heroin addiction or just another opioid substitutes, the new illegal drug on the market.
Reference Bell, James, et al. A pilot study of buprenorphine – naloxone combination tablet (Suboxone1) in treatment of opioids dependence. Drug and Alcohol Review (September 2004), 23, 311 – 317. Retrieved from ProQuest, web 26 May 2011 Ling, Walter, et al. From research to the real world: Buprenorphine in the decade of the clinical trials network Journal of Substance Abuse Treatment Vol. 38, Supplement 1, June 2010, pages S53-S60. Retrieved from Google Scholar. Web 4 June 2011. McCormick, Cynthia G. Risk Management and Post-Marketing Surveillance of CNS Drugs. Drug and Alcohol Dependence. Volume. 105, 1. 1 December 2009, p S42-S55 Retrieved from Academic Science Premier. Web 4 June 2011. Smith, Meredith Y, et al. , Case histories in pharmaceutical risk management. Abuse of buprenorphine in the United States: 2003–2005. Journal of Addictive Diseases, 2007, 26, 3, p107-111, 5p. Retrieved from: Academic Search Premier, Web 3 May 2011. Ministere Francais de la Justice, Cahiers d’Etudes penitentiaires et criminologiques web 5 June 2011.
