Treating Opioid Use Disorder: The Pharmacology of Suboxone

Suboxone is an oral maintenance medication used for the treatment of moderate to severe opioid use disorder. Suboxone is a combination of buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist that is used to treat overdoses) and is typically taken orally.

The combination of buprenorphine and naloxone is vital to the Suboxone’s successful use as a treatment to opioid use disorder. When taken orally, buprenorphine is active and naloxone is not, as naloxone is poorly absorbed sublingually. Thus, when taking suboxone orally, patients have a reduced craving for stronger and more dangerous opiates like heroin, without experiencing withdrawal symptoms that would come as a result of naloxone. Importantly, however, if a patient were to crush the oral tablets and inject suboxone subcutaneously, the presence of naloxone precipitates intense withdrawal symptoms, deterring patients from injecting the medication to experience a rapid high.

 structural formula of methadone

structural formula of methadone

Until the Drug Addiction Treatment Act (DATA) came into effect in 2000, it was not legal for a doctor to prescribe narcotic drugs in the treatment of narcotic dependence. Today, Schedule II drugs must be confined to use in a clinical setting. However, Suboxone, a Schedule III drug, can be prescribed for opiate addiction by specially qualified doctors and does not have to be administered in a clinical setting. Thus, suboxone does not have to be administered in a clinical setting and can be administered at home, unlike methadone, another maintenance medication used in the treatment of opioid dependence.

For more information from the FDA on Suboxone, who can prescribe Suboxone, and how to verify whether or not your Physician is qualified to do so, please see here:

www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM191533.pdf


Becoming Suboxone Certified

Interested in becoming Suboxone Certified? See below for how!

1.     Check to see whether you meet the requirements to apply for a physician waiver for prescribing buprenorphine

www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/qualify-for-physician-waiver

2.     If you do not meet above requirements, then complete an online buprenorphine training course (costs ~$200)

www.samhsa.gov/medication-assisted-treatment/training-resources/buprenorphine-physician-training

3.     After completing course (if you need to), apply for waiver here

www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management/apply-for-physician-waiver

4.     Receive prescriber number within ~45 days

5.     Start prescribing Suboxone (limit of treating 30 patients with Suboxone at a time for the first year)!