Frequently Asked Questions About Suboxone

Frequently Asked Questions About Suboxone

First of all, what exactly is Suboxone?

Suboxone is a prescription medication that is a form of an opioid drug. Unlike most other opioids, Suboxone is approved by the Food and Drug Administration for the treatment of opioid addiction and opioid dependence. Actually, Suboxone contains two drugs. The first, and most important, is buprenorphine. Buprenorphine is both an opioid receptor blocker and receptor activator at the same time. The buprenorphine molecule blocks the receptor and simultaneously activates it partially. This unique activity at the mu-opioid receptor is what makes this drug so uniquely suited for treating opioid use disorder. The second drug is naloxone. Naloxone, in this role, serves as an abuse deterrent. When taken as directed, the naloxone component of Suboxone does absolutely nothing.

Who can prescribe Suboxone?

Doctors have to have a special certification to prescribe Suboxone Film for opioid dependence. Fortunately, there are many certified doctors who are able to prescribe sublingual buprenorphine and related drugs, such as Subutex and ZubSolv. The most popular form of the drug is the Suboxone Film. This sublingual film, or strip, is placed under the tongue to dissolve. In order to find a healthcare provider in your area, you can ask your primary care physician or use the SAMHSA treatment provider locator.

I recently quit heroin and started sublingual buprenorphine. When should I start tapering?

The decision to start lowering your dose of sublingual buprenorphine/naloxone is an individual one. Most importantly, it must not be rushed. While you and your doctor may make adjustments to your dosage in the early days and weeks of treatment, once you are stabilized, plan on a very gradual reduction, and only as tolerated. There is no race to finish taking Suboxone. 

People in 12-step meetings have told me that I should quit taking the Suboxone film. They say I am not clean yet. Am I?

Unfortunately, this is a dangerous activity that has been happening in addiction treatment programs and recovery fellowships. When you talk about your addiction treatment program with buprenorphine/naloxone to people other than your doctor and close family

What are Suboxone strips?

Suboxone is a long-acting prescription drug that contains both buprenorphine and naloxone. The current brand version of Suboxone is a film or strip. The official term to describe the form of the medication is “film”. Commonly, many people refer to these films as “strips”. The two terms may be used interchangeably. The brand is known as Suboxone SL Films.

When will generic Suboxone film be available.

Right now! Yes, you are able to fill prescriptions for Suboxone films and get a generic alternative. There are multiple generic buprenorphine manufacturers. There is Mylan, Dr. Reddy. These are the two which I have seen filled by pharmacies. Apparently, there are also Sandoz, Alvogen and even Indivior, the maker of the Suboxone brand. These generics are affordable compared to the brand. With the GoodRx discount, the price is typically between $2 and $3 per 8mg strip.

Suboxone strips vs pills, which is best?

Now that the playing field has been leveled with the new generic sublingual strips, I believe that the strips are better for most patients. While there are generic Suboxone tablets, the primary reason that patients were given prescriptions for the tablets was to save money compared to the cost of the brand Suboxone films. The Suboxone generic tablets tend to take longer to dissolve. Now, with pricing about the same for strip and tablet, my opinion is that the strip, or film, is the better choice.

What strengths does Suboxone come in?

While there are multiple strengths of Suboxone film available, two are most often carried by pharmacies. There are Suboxone 2mg strips and Suboxone 12mg strips. There are also Suboxone 8mg strips and Suboxone 4mg strips. Typically, pharmacies carry the 8mg and 2mg. The 12mg and 4mg are not as easy to find. This may be because they can be substituted with combinations of 8mg and 2mg.

What are common side effects of Suboxone strips?

The Suboxone sublingual strips do have some side effects to be aware of. One of the most common side effects is constipation. It is also possible to experience headache and nausea. Most patients do not complain of significant side effects. One way to address side effects is to lower the daily dosage. If you are having constipation or other side effects from Suboxone, ask your doctor if you should reduce your dosage.

Is Subutex less likely to cause withdrawal symptoms compared to Suboxone Film?

In treating opioid addiction, there are some myths that are important to address. Some patients request Subutex over Suboxone because they have been told that the naloxone in Suboxone can cause withdrawal symptoms when first quitting heroin or another opioid. This is simply not the case. The buprenorphine itself, which is present in both Subutex and Suboxone, is what causes the precipitated withdrawal that can happen with the first dose taken after quitting opioid use. Because of the unique nature of buprenorphine, being a partial agonist and full antagonist, it is important to wait long enough, until withdrawal signs are present, before considering taking the first dose of sublingual buprenorphine. 

Can buprenorphine cause respiratory depression?

Respiratory depression occurs with opioid overdose and can lead to death. Many people are under the impression that buprenorphine does not cause breathing problems with overuse. While there is some truth to this when buprenorphine is used alone, the combination with other drugs, such as benzodiazepines, can very well lead to breathing problems and overdose due to respiratory depression. While it is possible for a patient to safely take buprenorphine and a benzodiazepine prescribed together, the healthcare provider should explain this risk.

Is the drug naloxone that is combined with buprenorphine the same drug found in Narcan?

Yes, naloxone is the active drug in Narcan. Naloxone is a potent opioid receptor blocker. When administered as Narcan or Evzio, either by nasal spray or injection, naloxone can reverse an opioid overdose and save a patient’s life. So, why is it combined with buprenorphine? In this other role, naloxone is acting as an abuse deterrent. If a patient attempts to inject the buprenorphine/naloxone combination in an attempt to get high, the naloxone will quickly block the opioid receptors, causing unpleasant withdrawal symptoms. This is thought to be an effective deterrent against diversion and abuse of buprenorphine outside of medication-assisted treatment programs overseen by credentialed healthcare practitioners.