Tox Tuesday: Suboxone

Approved by the FDA just over a decade ago, suboxone is prescribed to patients with narcotic dependence and addiction. While the drug’s intended use is to help addicts cope with and end their addiction, ongoing reports of the drug being abused and leading to deadly overdoses have created a debate causing many to weigh the drug’s risks versus its benefits.

Composed of a combination of two drugs, suboxone is made from four-parts buprenorphine and one-part naloxone. According to an article from the National Institutes of Health (NIH), buprenorphine prevents withdrawal symptoms including vomiting, diarrhea, insomnia, sweating, agitation and anxiety, that commonly occur when someone stops taking an opioid drug (such as codeine, heroin, morphine and OxyContin). The feeling of euphoria that is produced by buprenorphine is similar to the high opioids produce, thus allowing a person to stop taking the illegal drug while easing the symptoms of withdrawal.

Naloxone, on the other hand, is an antidote to opioids and counters the effects and feelings of an opioid drug. Hailed by some as the “opiate overdose reversal medicine,” the effects naloxone has on a person’s central nervous and respiratory systems can actually save their life during an overdose. The combination of these two drugs together in the form of suboxone is today part of a complete treatment program for drug abuse.

According to an article published in the New York Times, suboxone first became available with a prescription in 2002. During that time an estimated 2.5 million Americans were dependent on or abused opioids. To combat this problem, another drug known as methadone was being prescribed to fight the growing number of those addicted.  However, it soon became clear that methadone was causing a new set of addictions, was being sold on the black market, and was responsible for thousands of overdoses each year.

This laid the groundwork for suboxone to enter the scene and it soon became prescribed as a way to more safely combat the same growing drug problem seen both in the U.S. and abroad. According to the article, the drug saw early success in helping patients kick their addiction and return to a healthy life free of opioids.

According to one doctor quoted in the article, the drug worked so well, his patients were in tears over how grateful they were to be prescribed the drug and in turn living an addiction-free life. However, because doctors able to prescribe the drug are held to a patient cap, demand for suboxone outstripped supply. This led to patients sharing, trading and selling the drug and it trickling out onto the streets.

In a document produced by the Drug Enforcement Administration, suboxone is described as being 20-30 times more potent than morphine and has gained popularity as a heroin substitute. The article also states the drug has been documented as being abused in areas outside of the U.S. including France, Ireland, Scotland, India, Nepal, Bangladesh, Pakistan, and New Zealand.

The Drug Abuse Warning Network (DAWN ED) estimated 21,483 emergency department visits were associated with nonmedical use of the drug in 2011, nearly five times the number in 2006. The article also states that the American Association of Poison Control Centers Annual Report indicates that U.S. poison centers recorded 3,625 case mentions and three deaths involving the drug in 2011.

As the concern of the abuse of the drug grows, states such as Kentucky have began cracking down on and closing pain clinics where doctors dispense drugs such as suboxone. Because of this, one article states that cash-only “suboxone clinics” have opened for those seriously looking for help with their addiction as well as those looking to abuse the prescription drug.

In that same article, Kentucky Attorney General Jack Conway is quoted as saying that suboxone abuse “is certainly on my radar, but I’ve kind of been careful to tread lightly. Some people desperately need suboxone. I view it as a treatment of last resort . . . not a magic pill for addiction.”


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