Understanding Suboxone, Bunavail and Zubsolv

Understanding Suboxone, Bunavail and Zubsolv

Suboxone, ( just like Bunavail and Zubsolv) is actually two drugs in one pill or film.  The first and only active ingredient, Buprenorphine, is a narcotic analgesic, which was originally released as a regular pain medication.  Buprenorphine in and of itself is a very effective pain medication.  The second component is naloxone, which does nothing if the medication is taken as directed.  If ground up, injected or snorted or when taken with other opiates, the naloxone component can precipitate withdrawal symptoms etc.  When the medication is taken as directed. The naloxone passes through the GI tract totally inactive.  Naloxone is there only as a deterrent to discourage abuse and as a safety factor.   Methadone does not come with a combined deterrent medication because of the risk of precipitated withdrawal.

Unlike other opiates and narcotics, buprenorphine does not cause as much tachyphylaxis and tolerance (loss of effectiveness of a given dose of the drug.)    So you don’t develop ever-increasing dose requirements etc.  Unfortunately people on methadone do have issues with ever increasing dose requirements and have much more difficulty tapering off the drug.

Another significant virtue of Suboxone is that patients are more alert and cognitive functions are not as compromised on Suboxone as compared to methadone.  This is related to the fact that, while very effective in treating and preventing withdrawal, Suboxone does not cause the patient to experience “the high” experienced with methadone and other opiates.  After induction with buprenorphine patients are able to return to work or school in just one day, and the drug allows some patients to be otherwise narcotic free in as little as one day. .

Because Suboxone is a long acting drug, there is less chance of abrupt onset of withdrawal symptoms when a dose is missed.  Therefore, when used as a tool to “detoxify” an individual, gradual reduction in dose to wean off of the drug is much easier than with the other opiates.  Thus, Suboxone can be used as an effective pain medication or as a tool to detoxify an addicted patient gradually on an out patient basis.  In our practice, we have another modification in management of patients that has allowed us to be successful in weaning them off Suboxone.  Empirically, envision the brain as being able to recognize changes in dose in percentages rather than milligrams. A decrease in dose from; say 16 mg to 8mg, is perceived by the brain the same as from 2mg to 1mg.  Both adjustments are a 50% decrease in the amount of medication the brain has become accustomed to.  Compounded buprenorphine in customized dosages and flavors allows us to reduce doses in smaller amounts (percentages) at variable intervals.  This has been a wonderful and refreshing change from experience with methadone or even propriety formulations of Suboxone.  Experience to date is early, but empirically, relapse rates appear to be better than with methadone as well.

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