Suboxone is a drug that was approved by the United States to help in the management of addiction to opioids. (Schwarz, Cantrell, Vohra, " Clark, 2007, pg. 651-652). The drug is comprised of two chemicals fused (in ratio 4:1) in a single sublingual strip: naloxone and buprenorphine. The two substances perform various functions. On the one hand, buprenorphine prevents the effects of opioids from exceeding a specific dosage thus it is categorized under the partial opioid agonists. The analgesic, Central Nervous System (CNS) as well as the respiratory depression effects of buprenorphine are exerted at two points: The opioid mu receptor and opioid kappa receptor. At the first point, the drug acts as a partial agonist while at the second point it serves as an antagonist. Naloxone’s presence in the medicine is, therefore, a safety measure to guard against either intravenous or intranasal misuse of the medication. As opposed to buprenorphine, naloxone has relatively poor bioavailability orally or sublingually. This means that it is ineffective in offering help when buprenorphine poisoning is orally or sublingually related. Naloxone acts fast when administered intravenously. If the drug is injected into the blood, withdrawal symptoms from use of opioids may begin showing up. That is why it is advisable to administer it sublingually where its safety and therapeutic efficacy is similar to when only buprenorphine is used. (Fudala et al., 2003, p. 949-958)
The risks when used in treatments
The risk of using Suboxone is compounded when it is used alongside other depressant drugs. These include such as substances such as alcohol or benzodiazepines. The likelihood of Suboxone being abused is because it produces opioid effects. Those who are likely to abuse Suboxone are those who have an opiate addiction.
Due to the presence of opioids within it, Suboxone can be misused, which may lead to breathing difficulties. Using too much of Suboxone (overdosing) or using it alongside other depressants may lead to shallow breaths and a feeling of suffocation commonly referred to as respiratory depression or hypoventilation. During normal respiration, oxygen is inhaled through the nose, goes to the lungs and is transported by the blood to all body tissues. The same blood carried the waste carbon (IV) oxide back to the lungs. The gas is expelled from the body during exhalation. However, during a respiratory depression, the body is not capable of effectively removing carbon (IV) Oxide and transporting oxygen to the tissues. Less oxygen enters the bloodstream leading to a feeling of suffocation since the body tissues are not getting adequate oxygen to break down glucose and release energy. The signs of mild respiratory depression include fatigue, shallow breath, depression, suffocation and drowsiness during the daytime. However, as the concentration of carbon (IV) Oxide increases in the body, a victim may show the following signs a headache, bluish lips or toes, confusion, and seizures.
In the event the drug is used in excess it may lead to sedation. Sedation alludes to the calming or slowing down of the nervous system. It is brought about when depressant drugs such as the benzodiazepines are administered. The depressant drugs are used to relieve certain conditions such as anxiety, nervousness, and discomfort. Depressants tend to induce sleep. The depression effects of Suboxone has been found in especially in people of the female gender aged between 30-39 years ("Will you have Sedation with Suboxone - from FDA reports - eHealth Me," 2018). When Suboxone is used excessively, it may induce sleep and lead to comatose or dead. Care must be taken to avoid excessive dosage of the drug. Patients should be advised beforehand the effects of an overdose. Additionally, when on Suboxone medication, patients should be encouraged to keep off from depressants such as the benzodiazepines and alcoholic drinks.
Suboxone use can lead to addiction, especially for former opioid drug addicts. Since Suboxone’ active components contain opioids, it is straightforward for those hooked to powerful opiates like heroin to misuse it to satisfy their cravings. The drug can be abused through intravenous injections which hinders the action of buprenorphine and promotes the activity of naloxone. The drug is made in such a way that it should be administered sublingually to produce the effect of buprenorphine dominant over that of naloxone. Being an opioid agonist, buprenorphine is meant to create the feeling that opioids provide but to a limited extent. An additional dosage of the drug increases the opiate effect of Suboxone until the effect finally levels off. Naloxone is an opioid antagonist which means that on the other hand reverse the effects of opioids when their actions exceed the limits. Buprenorphine has a higher bioavailability when the drug is administered sublingually than naloxone. However intravenous injections lead to the reverse. When injected, the drug may lead to withdrawal symptoms of opioids which is undesirable leading to addiction. To avoid dependence, the drug must be administered strictly under the tongue and never injected into the bloodstream.
Suboxone may also lead to liver problems (Upadhyay " Xueming, 2010, pg. 545-546). Since the drug is hepatotoxic and is broken down in the liver, excessive usage such as addiction may put extra strain on the liver which may have damaging impacts. Some of the signs associated with liver problem include yellowing of the skin or the cornea (jaundice), loss of appetite, dark urine, nausea, and abdominal pains and lightly coloured stools. Tests should, therefore, be conducted before and during the time the patient is taking the drug whenever such signs are seen so that appropriate measures can be made to avoid further damage to the liver.
The usage of Suboxone is associated with withdrawal symptoms (Bell, Byron, Gibson, and Morris, 2004, pg. 311-317). Whereas Suboxone is used in to help alleviate the withdrawal symptoms of opioids, sudden discontinuation of use may have devastating results. A patient may experience withdrawal symptoms and get hooked up again to the opioid. The body must be able to produce enough neurotransmitters for it to function normally. In the case of those addicted to opioids, discontinuation of the drug makes it impossible for the artificial opioids to interact with the brain receptors. This is what leads to withdrawal symptoms. However, since it is a slow acting drug, the symptoms may take up to three days before they begin showing up. Some of the withdrawal signs associated with the prescription include watery eyes, fever, and chills, headache, Diarrhoea, nausea, enlarged pupils, sleeping difficulties, Suboxone craving, constipation, restlessness, and anxiety. These symptoms may last for one or so months but the initial 72 hours are the worst. To avoid these withdrawal symptoms, the patient should be gradually discontinued from the drug.
The benefits when used in treatments
When Suboxone is taken under the tongue as prescribed, it may be of great interest to a recovering addict. Naloxone, a component of the drug, prevents withdrawal symptoms associated with discontinuation from the use of the opioids by knocking off opioids from the brain receptors. Naloxone only hinders the action of buprenorphine when Suboxone is introduced to the body through intravenous injection. However, when Suboxone is administered sublingually, less naloxone will be bioavailable it cannot hinder the action of buprenorphine. Suboxone has a number of benefits when used in treatment as explained in the paragraphs below:
Suboxone can reduce overdependence on opioids as well as withdrawal symptoms. (Veilleux et al., 2010, pg. 155-166). Severe withdrawal symptoms may come up as a result of discontinuing an opioid drug. Here is where Suboxone plays a critical role. The essential component of the drug known as buprenorphine gives the same effect as the other opiate drugs, but there is a level that it cannot even with increased dosage. This is termed as the ‘ceiling effect.’ The only problem with this is that if the addicts were taking more powerful opioids like heroin, they may be compelled to overdose to achieve a level of euphoria they were used to. Additionally, those who were addicted to less powerful opioids may have cravings for Suboxone since it gives a higher level of happiness leading to dependence. It is therefore essential to know the type of drug the patient was using so that appropriate dosage can be given to minimize withdrawal effects.
Apart from reducing withdrawal effects on opioids, Suboxone use can reduce the ‘thirst' for opiates (Brady, McCauley, " Back, 2015, pg. 18-26). This is because its active component (buprenorphine) is a partial agonist. Suboxone has opioids which give a sense of euphoria that other opiates give albeit to a lower degree since the critical component is a partial agonist. When given to patients, the drug reduces the craving for opiates since it the feeling it provides reduces tolerance to opioids as compared to the full agonists. Because it gives a reprieve from adverse withdrawal signs, Suboxone helps retain patients for additional counseling and observation of how they are responding to the treatment. When the usefulness of Suboxone is over, the dosage can be reduced gradually until such a time when it is no longer required.
Conclusion
To sum up, the problem of addiction to opioids is a serious issue that needs to be addressed critically. This is because it is tough for an addict to stop using a particular drug due to the associated withdraw symptoms which may even turn out to be fatal. Despite Suboxone being used to reduce dependency on full agonists, it has got its limitations. For example, the drug can lead to dependence, withdrawal symptoms, sedation, breathing difficulties, and addiction. This means that it should not be used in isolation. The necessary mechanisms should be put in place to this effect to curb these adverse consequences as well as reduce misuse of the drug by patients. However, Suboxone remains a useful drug in reducing the cravings for full agonists such as heroin. This is because it is a partial agonist hence gives only a limited euphoria as compared to a full agonist. It also aids in the treatment of drug opioid addicts and reduction of the withdrawal effects of drug use.
References
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Brady, K. T., McCauley, J. L., " Back, S. E. (2015). Prescription opioid misuse, abuse, and treatment in the United States: an update. American Journal of Psychiatry, 173(1), 18-26.
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Upadhyay, A., " Xueming, Y. (2010). Buprenorphine-Induced Elevated Liver Enzymes in an Adolescent Patient. Journal of Child and Adolescent Psychopharmacology, 20(6), 545-546. doi:10.1089/cap.2009.0093
Veilleux, J. C., Colvin, P. J., Anderson, J., York, C., " Heinz, A. J. (2010). A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clinical psychology review, 30(2), 155-166. Brady, K. T., McCauley, J. L., " Back, S. E. (2015). Prescription opioid misuse, abuse, and treatment in the United States: an update. American Journal of Psychiatry, 173(1), 18-26.
Will you have Sedation with Suboxone - from FDA reports - eHealthMe. (2018, October 6). Retrieved from https://www.ehealthme.com/ds/suboxone/sedation/
