Suboxone and Subutex
The New Medication: Suboxone, Subutex, and now Sublocade
Buprenorphine is a long acting opioid medication that only partially activates opioid receptors. Because of this, it has a ceiling of narcotic effects, which, along with its delivery mechanism, makes overdose much less likely, even in large dosages. The main form used is combined with a small amount of naloxone and marketed as Suboxone. The medicine is rapidly absorbed when dissolved underneath the tongue, and is not absorbed very well at all if swallowed. For these reasons, it is much less likely to be lethal in accidental ingestions by children. If Suboxone is injected, only the naloxone, an opioid antagonist, works and causes severe withdrawal for chronic opioid users.
There are several other brands of the combination in tablet form. They are Zubsolv and Bunavail. The new one is an injectable, lasting 28 days, called Sublocade. It must be administered by the staff nurse, cannot be done at home due to potential side effects.
This, as with other medications, must be used with a regular schedule of counseling.
Suboxone and Methadone
As buprenorphine is only a partial agonist, it is not equivalent in maintenance strength to higher dosages of the full agonists, methadone and LAAM. That is why a patient would have to be on a daily dose of methadone of 40mg or less to try Suboxone. There is a significant chance of relapse into opioid use for those on higher dosages of other treatments who try to wean down to use Suboxone.
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