What Is Suboxone and How Does it Help with Opioid Use Disorder (OUD)?

doctor counsels patient about suboxone for oud
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Suboxone is the brand name a combination of two medications: buprenorphine and naloxone. Suboxone is in a category of prescription drugs called medications for opioid use disorder (MOUD). These medications are approved by the Food and Drug Administration (FDA) to treat people diagnosed with opioid use disorder (OUD).

Medications like Suboxone are a critical component in our work to help people who experience the negative consequences of the opioid crisis in the U.S, which led to close to a million deaths between 1999 and 2020.

That’s not an exaggeration.

In fact, when we add the latest data from the Centers for Disease Control (CDC) on overdoses in 2021, the death toll increases to a shocking number: 1,039,306. That’s why we work every day to help individuals, families, and communities impacted by opioids and drug overdose.

Here’s the most recent verified nationwide data on the opioid crisis.

Overdose Fatalities 2019-2021: Overall and Opioids

  • 2019: 67,697 total drug overdose fatalities
    • 50,178 opioid-related
  • 2020: 78,056 total drug overdose fatalities
    • 69,061 opioid-related
  • 2021: 107,306 total drug overdose fatalities
    • 73,453 opioid-related

Those figures indicate that between 2019 and 2021, roughly 75 percent of overdose deaths in the U.S. were related to opioid use or misuse.

That’s the reason medications for opioid use disorder (MOUD) are an important component of OUD treatment in our substance use disorder (SUD) treatment centers in Williamson, West Virginia and Laconia, New Hampshire, two states hit hard by the opioid crisis.

Here’s are the latest statistics on overdose and opioid-related overdose for West Virginia.

Overdose Fatalities in West Virginia 2019-2021

  • 2019: 870 overdose deaths
    • 665 opioid-related
  • 2020: 1330 overdose deaths
    • 1,137 opioid-related
  • 2021: 1,553 overdose deaths
    • 1,201 opioid-related

Here are the latest statistics on overdose and opioid-related overdose for New Hampshire.

Overdose Fatalities in New Hampshire 2019-2021

  • 2019: 415 overdose deaths
    • 372 involving opioids
  • 2020: 406 overdose deaths
    • 357 involving opioids
  • 2021: 381 overdose deaths
    • 323 involving opioids

The rate of overdose death in West Virginia is the highest in the country, at 81.4 per 100,000 people. New Hampshire has the 23rd highest rate of overdose death, at 30.3 per 100,000 people.

The medications we introduce above – including Suboxone – are part of an approach to OUD treatment called medication-assisted treatment (MAT).  Before we get into the details on Suboxone, let’s define MAT.

Medication-Assisted Treatment: The Most Effective Available Treatment for OUD

In 2020, the opioid crisis entered its third decade. Since 199, when the crisis began, the OUD treatment community has implemented a wide variety of approaches to reducing opioid overdose and preventing relapse to opioids for people diagnosed with OUD.

Research indicates there are key three factors related to successful treatment, overdose prevention, and relapse reduction among people with OUD.

Overdose and Relapse Prevention: What We’ve Learned

  1. Starting MAT within 14 days of diagnosis of OUD reduces overdose and relapse risk
  2. Patients who attend a minimum of two outpatient appointments within a month of starting treatment show decreased rates of overdose and reduced risk of relapse
  3. Continuous participation in MAT program using MOUD for a minimum of six months reduces overdose and relapse risk

Now let’s get to that definition MAT. Here’s a simple and clear definition published by the Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT:

“MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

Benefits of MAT include:

  • Reduced withdrawal symptoms
  • Reduced cravings
  • Decreased euphoric/sedative effect of opioids
  • Reduced overdose rate
  • Reduced relapse rate
  • Decreased infectious disease transmission
  • Increased time-in-treatment

Evidence also indicates participation in an MAT program can:

  • Reduce illegal or criminal behavior related to opioids
  • Improve outcomes for pregnant women with OUD
  • Help people with OUD seek and find steady employment
  • Help people with OUD improve relationships with family, friends, and loved ones

That’s a solid review of MAT and how MAT can help people on OUD. We’ll now narrow our focus to one specific MOUD: Suboxone.

Suboxone: How it Helps People with OUD

Suboxone contains two medications: buprenorphine and naloxone. Buprenorphine is a partial opioid receptor agonist, which means it attaches to opioid receptors in the brain and prevents the action of opioids and opioid-derived drugs. Naloxone is an opioid receptor antagonist, which means it blocks any substances from attaching to the opioid receptors in the brain.

When used in combination in a sublingual film – as in Suboxone – buprenorphine overpowers naloxone, binds to opioid receptors, and prevents withdrawal symptoms and opioid cravings. The presence of naloxone prevents diversion of Suboxone for recreation purposes. When sublingual tablets are crushed, cooked down, and used intravenously, naloxone overpowers buprenorphine, prevents the any potential euphoric effect of buprenorphine, and can lead to opioid withdrawal.

In other words, the buprenorphine in Suboxone helps people manage opioid use disorder, while the naloxone in Suboxone prevents use for recreational purposes.

Those are the basics of how Suboxone works, in general. Now we tell you the details on how treatment with Suboxone works.

MAT With Suboxone: How it Works

  1. An individual diagnosed with opioid use disorder (OUD) receives a full assessment and a licensed physician prescribes the medication.
  2. An individual with OUD can begin taking Suboxone within 6 hours of their last dose of opioids, when the first signs of withdrawal appear. The presence of buprenorphine mitigates withdrawal from opioids, whether they’re illicit, such as heroin, or prescribed, such as Oxycontin.
  3. Suboxone is delivered via a two-sided sublingual film placed on the inside of the cheek. One side adheres to the cheek and delivers the medication, while the other prevents buprenorphine and /or naloxone from leaking into the mouth and being swallowed.
  4. Suboxone comes in four different dosages. The appropriate dose for each patient is determined by the prescribing physician.
  5. On days 1-2 of Suboxone treatment, a physician initiates treatment and observes each patient. If there are no adverse reactions, patients receive a second dose. This is called the induction phase. If withdrawal symptoms appear, the physician will increase dosage. If no withdrawal symptoms appear, the physician will determine the appropriate daily dosage for the next phase of treatment, called the maintenance phase.
  6. During the maintenance phase, patients take Suboxone daily, since the effect of Suboxone fades in 24-72 hours, depending on each patient’s unique metabolism. Stable patients are allowed take-home doses, which reduces barriers to long-term care.
  7. When an individual begins MAT with Suboxone or any other MOUD, they also participate in therapy, counseling, and various forms of social support to help them recovery from OUD and rebuild their lives.

That last point is critical: MAT programs are about a full recovery, rather than medication management. Federal regulations require MAT programs with Suboxone to include a variety of supports in addition to medication.

Non-Medication Components of MAT Programs

  • Mental health treatment and support
  • Addiction counseling
  • Vocational training and support
  • Academic support
  • Relapse prevention skills development
  • Relationship skills development
  • Help finding and connecting to social services to address challenges including homelessness, food insecurity, and basic medical needs

The goal of these additional supports is to allow an individual with OUD to heal, grow, and rediscover what life is like without the use of opioids. The goal of the medication is to prevent cravings and allow an individual with OUD to participate in the life-building aspects of recovery that lead to lasting change. 

There are some potentially negative side-effects to Suboxone use, however. We’ll discuss those now.

Suboxone: Risks and Benefits

In some cases, patients on MAT with Suboxone experience side effects, which may include:

  • Nausea
  • Diarrhea
  • Drowsiness
  • Muscle or joint pain
  • Constipation
  • Dizziness
  • Blurry vision
  • Irritability
  • Insomnia

In most cases, these side-effects are mild and fade quickly, but not everyone who takes Suboxone experiences side effects – and the benefits of MAT with Suboxone far outweigh the risks.

A person who is stable on Suboxone in a federally licensed MAT program can learn to move past the cycles of opioid addiction and live a full and fulfilling life in recovery. We consider Suboxone not only life-saving, because it reduces rates of relapse and overdose, but also life-changing, because it allows people with OUD to rebuild their lives, their relationships, and rediscover hope for a better future.