What about the Buprenorphine and Naloxone combination medication, known as Suboxone?

Patients addicted to or dependent on pain pills, heroin, or opium may be detoxified using the medication Suboxone (buprenorphine/naloxone). Buprenorphine is a long-acting opiate, similar to methadone, but shown to be potentially safer for patients due to the differences in how the medicine affects the brain. We believe this to be particularly true for patients with addiction and pain issues, who misuse or abuse their opiate medications. Suboxone is an opiate and an opiate blocker in combination. It is far more difficult to overdose using this medicine for the treatment of opiate dependence than it is to overdose taking methadone. The reason for this is because of  the opiate blocker in the medicine.

It is important to note that if a patient is taking Suboxone it is still possible for them to inject, snort, or orally take enough opiate to overdose. It is believed that the “window” of awareness is far reduced; meaning a person trying to get high in the setting of relapse during Suboxone treatment will not be aware how much opiate they have used. The medical literature demonstrates that Buprenorphine and Naloxone in combination has been used for over 15 years in Europe for treatment of opiate addiction. This medicine has been associated with few deaths, specifically these deaths have occurred when buprenorphine is injected with tranquilizers at the same time.

What about Methadone?

Methadone has been used for thirty years for treatment of opiate dependence in the setting of Opioid Treatment Programs. Patients pay a fee and are given an on-site dose of methadone to treat their symptoms of withdrawal and reduce craving. The presence of methadone in the body does not prevent the use of other opiates. In addition, oral methadone therapy has a very long half-life of medicine, meaning that changes in the methadone dose take 5 days to “catch-up” with the brain and breathing system. The medical literature demonstrates that since methadone has become a frequently prescribed medicine for the treatment of chronic pain, the frequency of methadone related death due to overdose has dramatically increased. In the State of Oregon, in 2008, there were over 500 methadone-related deaths. Over 80% of these deaths occurred in patients taking methadone for chronic pain related issues. Hazelden’s Beaverton physicians do not prescribe or treat patients with methadone for addiction or pain-related issues.

How does Buprenorphine work?

Buprenorphine replaces the other opiate of choice (i.e. oxycontin) in the brain. The medicine reduces the craving to use opiates to get high. Buprenorphine addresses both the physical and emotional aspects of opioid dependence. After a stable initial buprenorphine dose is determined, the dose of buprenorphine is slowly tapered over a period of weeks to months. During the early phase of detoxification, patients experience freedom from significant physical withdrawal and the craving to get high. During this phase patients are free from the behaviors and patterns needed to continually obtain their drug of choice. This newfound free time is best spent working on the beginning of their recovery.

For patients who have become dependent on opiate medicines for treatment of chronic pain issues, and their opioid pain medications, have become less effective, or have become problematic in terms of being misused, abused, or become a drug of addiction buprenorphine is a safe and clinically indicated medicine for the treatment of the condition of opiate dependence.

Most of our opiate dependent and addicted clients who have pain issues, report their pain is adequately controlled with the transition to buprenorphine/naloxone, and they are able to slowly taper the buprenorphine/naloxone dose over a period of months.

Many of our pain patients use muscle relaxing medicines and anti-inflammatory medicines if they have pain flares. It is important to remember that no other opiate medicines may be used while taking buprenorphine/naloxone. Patients can safely undergo surgery and we are able to safely and easily transition back to buprenorphine/naloxone within 2-3 days postoperatively, without having to undergo another detoxification.