The length of therapy depends on your needs, and is up to you, your doctor, and your counselor. Some patients stay on SUBOXONE for as little as a few weeks; others continue taking it for months or years. Combining SUBOXONE treatment with counseling should increase your chances of success.
Physical dependence is only part of the opioid dependence picture. For some patients, short-term treatment with SUBOXONE may not allow enough time to deal with the emotional and behavioral components of their condition. The risk of relapse is often higher with short-term treatment since patients may not have had enough time to overcome all aspects of their dependence. Seeking counseling with a professional trained in substance abuse treatment can help.
Remember: Stopping SUBOXONE abruptly will probably cause withdrawal symptoms. When you're ready, consult your doctor about decreasing your dose until you are able to stop taking SUBOXONE.
It is important for you to understand that because opioid dependence is a chronic medical condition, relapse may occur. This is not an indication of failure or lack of desire to stay on track with your recovery. If you feel a trigger or have a strong craving, talking to your doctor or your counselor can help. Your doctor may choose to adjust your daily dose of SUBOXONE.
This limitation, known as the "ceiling effect," is due to buprenorphine being a partial agonist. While full agonists (opioid painkillers, heroin, methadone) continue to slow breathing as a person takes more of the drug. This "ceiling effect" makes an overdose death from slowed breathing less likely, when buprenorphine is taken alone.
Even with this "ceiling effect" patients should avoid taking SUBOXONE while taking other sedatives, especially benzodiazepines unless specifically advised to do so by their doctor. This is because the effects of other sedatives may add to the sedating and respiratory depressant effects of buprenorphine, and the combination may be dangerous. Mixing buprenorphine with benzodiazepines for snorting or injection is especially dangerous. Patients being treated with buprenorphine should not use tranquilizers, antidepressants, or sedatives except under a doctor's orders, and they should avoid alcohol.
How SUBOXONE helps patients:
When a doctor starts patients on SUBOXONE, they should be experiencing mild to moderate withdrawal. At this point, the opioids from prescription painkillers or heroin have begun to leave the brain's opioid receptors. As these opioids move off the receptors, buprenorphine—the active ingredient in SUBOXONE—moves onto and attaches to the available receptors. Patients' withdrawal symptoms are usually suppressed as the receptors are occupied by the buprenorphine. SUBOXONE usually starts to have an effect within 30 to 60 minutes after the first dose.
With daily maintenance doses, SUBOXONE continues to keep the brain's opioid receptors occupied. Even if the patient uses another opioid at this point, the effects of that opioid will likely be blocked. By suppressing withdrawal symptoms, reducing cravings, and reducing illicit opioid use, SUBOXONE enables patients to remain in treatment, thereby increasing their chances of success.
With a full opioid agonist, such as oxycodone, hydrocodone, morphine, methadone, or heroin, the key fits the lock, opens the door wide, and produces full opioid effects (which include feelings of euphoria, or being high, as well as slowed breathing)
With a partial opioid agonist, such as buprenorphine, the key fits the lock but doesn't open the door all the way, so it produces less than full opioid agonist effects and, depending on the dose, blocks other opioids from opening the door fully
An opioid antagonist, such as naloxone—another ingredient in SUBOXONE—fits in the lock, but doesn't open the door at all and, depending on the dose, blocks other opioids from opening the door.
SUBOXONE therapy step by step:
+ Induction. Patients receive their first dose of SUBOXONE in the doctor's office. To start drug therapy with SUBOXONE, patients need to be in mild to moderate withdrawal at the time of induction. After 30 to 60 minutes, the patient should begin to feel the effects of the buprenorphine and their symptoms (cravings, withdrawal) should begin to decrease. An additional dose of SUBOXONE may be given if there is still a medical need.
+ Stabilization. As patients stabilize over the next few days, their doctor will decide what their target daily dose should be and adjust accordingly. The target stabilization dose is generally 12 to 24 milligrams for most people. Additionally, the doctor may discuss appropriate counseling options at this time.
+ Maintenance. During maintenance, patients take a consistent dose of medication that suppresses withdrawal symptoms, controls cravings, reduces illicit opioid use, and retains the patient in treatment. Their doctor should make sure some form of counseling is in place and may decide to see them less often. Their doctor will continue to periodically supervise their progress periodically during this phase.
+ Medical withdrawal. The final phase is medical withdrawal. Some patients may be able to stop receiving SUBOXONE therapy for opioid dependence. For these patients, the doctor gradually reduces their dose until they can comfortably stop taking SUBOXONE. Patients should remain alert to signs of withdrawal symptoms or relapse as their dose is decreased and tell their doctor how they are feeling.
Office-based treatment offers privacy—and convenience since 2000, when the Drug Addiction Treatment Act (DATA 2000) was passed by Congress, doctors have been able to treat opioid dependence in their private office setting.
What is SUBOXONE and how it works:
SUBOXONE is a medicine used to treat opioid dependence in the privacy of a physician's office.
Buprenorphine is the active ingredient in SUBOXONE. It has unique characteristics that may help reduce cravings and suppress withdrawal symptoms in order to reduce illicit opioid use and support staying in treatment. The way different opioids work can be explained using a lock and key example. Receptors are like a lock to a door. Only the right key will fit the lock, and only opioid-like drugs fit opioid receptors.
In the United States, only SUBOXONE® C-III (buprenorphine HCl/naloxone HCl dihydrate sublingual tablets) and SUBUTEX® C-III (buprenorphine HCl sublingual tablets) can be prescribed by a doctor to treat opioid dependence within the office setting.
What this means for you: People with opioid dependence, who, prior to this time, had only been able to seek drug therapy in treatment clinics, now have a more private, confidential, and convenient treatment option.
When SUBOXONE moves onto the opioid receptors in a dependent patient's brain, it does three important things.
First, by attaching to the brain's opioid receptors, SUBOXONE suppresses withdrawal symptoms and drug cravings.
Second, SUBOXONE attaches to the brain's receptors—so other opioids have difficulty attaching.
Finally, although all opioids slow down breathing, when SUBOXONE is taken alone and as directed, it has an upper limit on how much it affects breathing.
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