If you talk to people who are prescribed Suboxone, you may hear them say that there is a “blocker” in Suboxone that prevents them from feeling high if they use opiates such as Oxycontin or heroin.
Suboxone is a medication used to treat opiate dependence. Suboxone contains two active ingredients: buprenorphine and naloxone. Many people are under the impression that the naloxone is added as a “blocker.” But that isn’t the case. Instead, it’s the buprenorphine that blunts the effects of other opiates.
Buprenorphine is itself an opioid. It attaches to the opiate receptor sites in the brain, just like Oxycontin or heroin. Those receptor sites full of buprenorphine leave an opiate-dependent person feeling satisfied, but not high. Many people say it makes them feel “normal.” And many say that they haven’t felt like that in a long time (not sick, not craving but not high).
When a person on an adequate dose of buprenorphine uses another opiate, the opiate floats around looking for available opiate receptor sites in the brain. But none can be found, because all of the receptor sites are already occupied by buprenorphine. This is what prevents the person from feeling the intoxicating effects of the other opiate.
I often hear people say, “I thought about using an Oxy, but why waste my money when I won’t feel it anyway.”
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This is the most easy to understand explanation of Suboxone I have ever read. This is how my son’s doctor described it and it did work! Unfortunately if you stop taking it (because you want to make money selling it to your dopesick friends who are desperate) it no longer works.
Thanks for your comment on my “writing from the inside out” blog. I wish I could combine all my blogs but “recovery happens” keeps my son’s identity more private.
Thanks Barbara. Diversion of medication is a problem. It’s hard for people to say no to friends sometimes. Especially since they know what it is like to feel sick, maybe were helped out by that friend in the past, and often could really use the money. And let’s not forget the temptation to get money to buy Oxys or something else.
I often see people sell some of their medication early in the month because they are broke, and intend to buy it back later in the month before they run out. Often they end up short on their medication and relapsing on whatever is available that will keep them well.
As you say, it limits the effectiveness of the treatment.
This is one of the reasons that I think we need programs that provide extra supports to people especially early in treatment. I started and run a program like that where I work.
I’ve focused on people transitioning from incarceration, and have had some good success over the first year of the program. One thing that I am especially happy about is that for those people who weren’t able to hold their medication successfully, there was a program there helping them with other options. So they had a soft (softer) landing.
In the private doctor setting, the provider usually doesn’t have the knowledge or time to do that and the result is that the patient feels discouraged, and is almost guaranteed to relapse. This needlessly places them at higher risk for OD, HIV, Hep C, jail or other drug-related harm until they somehow get linked with some other provider or treatment program.
It’s all so predictable, why aren’t we as a community, state, and country doing more to stop it?
I don’t know what it will take for the communities, states and our country to do more…but I hope it happens soon. I want to do more than I am doing now as an individual, but what? I guess if enough of us keep talking maybe our voices will be heard by the right people (whoever they are). Thank you for all you do, I think your site is excellent.
It works if you take it.
Great work my daughter has been able to not put a needle in her arm for sometime now. I was told it would buy her time to get the other areas in her life sorted out and it has and she is doing really well. I was also told she was not clean being on it but that was views from people who are not properly informed. She started out with group three times a week, random UA, random sub checks, one on one counseling, and chose by her own choice to live in a sober environment. good stuff. Thanks
Sounds like your daughter is going to a well run program. I think these kinds of supports are really helpful especially in early treatment with Suboxone. I wish there were more programs like that…if you get a chance I’d like to hear more about the program she goes to.
Naloxone (Narcan) is the same thing paramedics use to reverse an opiate drug overdose.
The Naloxone bumps the opiates out of the opiate receptor sites in the brain. This reverses breathing suppression and prevents an overdose death, but it does so by putting the person into immediate withdrawal.
The theory is that by pairing buprenorphine and naloxone together (as in Suboxone), you can create a medication that is less subject to abuse than buprenorphine alone. The claim is that if Suboxone is crushed and snorted or crushed and injected, the naloxone will be released causing the person to go into immediate withdrawal.
Naloxone has the potential to cause a precipitated withdrawal, but in the real world people crush and snort or inject Suboxone all the time without going into sudden withdrawal. This is because buprenorphine has a stronger affinity for the opiate receptor sites and is harder to knock off the receptor sites than many other opiates. It seems likely that in cases where precipitated withdrawal does happen, it is because opiates other than buprenorphine were occupying the opiate receptor sites at the time that the person crushed and snorted or injected the Suboxone (for example, used heroin and then a short time later used Suboxone).
Also, naloxone is a short acting medication, while buprenorphine is a long acting medication. So if a person uses Suboxone, waits a while and then uses other opiates like heroin or Oxycontin, the naloxone is long gone and has no effect.
I do hear a lot of people who believe that they will be subjected to a precipitated withdrawal if they try to inject Suboxone or use Suboxone with other opiates. So the claim has some value as a deterrent. But I strongly suspect that the inclusion of naloxone is Suboxone is mostly for the public relations value in claiming that it limits the potential for abuse.
By the way, it’s important to understand that naloxone is a short acting medication in the context of a drug overdose. Sometimes after an overdose is reversed with naloxone, the emergency room will discharge the person without monitoring them long enough to make sure that the longer acting opiates in the person’s system don’t outlast the naloxone, and put the person back into an overdose. This may be a lack of knowledge or caring on the part of the emergency room, or a refusal of the patient to wait before leaving. Always stay with a person who has overdosed for a period of hours even after naloxone has been administered.