Suboxone is a combination drug, administered sublingually, of buprenorphine HCL and naloxone HCl dehydrate in a ratio of 4:1, used for the treatment of opioid addiction, for example in heroin addicts and narcotic painkiller abuse, in higher doses; and in lower doses is used for the treatment of acute and chronic pain (FDA, 2010). Buprenorphine is a μ receptor partial agonist and a κ receptor antagonist; naloxone is an opioid receptor antagonist, which has a higher affinity for μ receptors then full agonists do and can thus displace the full agonist from the receptor reversing the effects of opiate overdose, such as respiratory and central nervous system depression (Wesson and Smith, 162-163). Naloxone was added to buprenorphine so that IV drug abusers would be less inclined to dissolve the drug and inject it. Buprenorphine and naloxone bind to the receptors with nearly the same affinity and therefore when taken sublingually the effects of naloxone are not appreciated due to its low bioavailability; however when injected, naloxone quickly leads to withdrawal symptoms (Wesson and Smith, 163).
In the United States the only drug that can be prescribed, as directed by the FDA, for the use of opioid addiction is buprenorphine. In 2000 The Drug Addiction Treatment Act (DATA) allowed for physicians to prescribe certain schedule III, IV, and V drugs to be administered for treatment in settings other than a drug treatment facility i.e. Methadone clinic (U.S Department of Health and Human services: Substance Abuse and Mental Health Services Administration). With the ability to access the drug outside of such regulated facilities, a black market for suboxone quickly developed. Increasing access to the general population by being used for the treatment of chronic pains, also means more of the drug is “out there”.
There are two sides to the black market trade for suboxone. On one hand you have former heroin addicts who are unable to pay the doctors fees and the prescription drug cost associated with their treatment and therefore turn to buying it on the street. On the other hand, buprenorphine is ultimately a partial agonist at μ opioid receptors, and is thus used as a drug of abuse in itself, effectively being used as a heroin substitute (Wesson and Smith, 166). For example in Findland, a needle exchange program in Helsinki in 2005, found that 68% of people reported the intravenous abuse of suboxone to either treat withdrawal symptoms or to self treat their opioid addiction (qtd. in Wesson and Smith, 167).
In a study done at the University of Maryland, College Park, the center for substance abuse research stated that buprenorphine is more likely then methadone to be seized by law enforcement. They reported that in 2003 the number of law enforcement drug seizures of buprenorphine was around 90 while in 2010 the number drastically increased to over 10,000 (CESAR, http://buprenorphine.samhsa.gov/CESAR-FAX21-13_BuprenorphineVSMethadoneSeizures.pdf)
NPR in July 2012 released a podcast titled: “The Anti- Addiction Pill That’s Big Business For Drug Dealers.” During the podcast we are introduced to a heroin addict, who decides to try suboxone and buys it from his dealer. After taking it, he was able to continue working and not have any of the withdrawal effects that he got from heroin. However, without suboxone to give him his fix for the day he turns to heroin and it becomes a never-ending cycle.
The U.S government spent billions upon billions of dollars trying to develop a wonder drug to treat opioid addiction. The development of buprenorphine was thought of as the holy grail of answers to the treatment of opioid addiction. While methadone for a long time was considered to be the holy grail of treatment, it is possible to overdose on it, in fact the CDC estimates it is accountable for up to 30% of painkiller deaths (Martin). Methadone is also far more addictive. Buprenorphine on the other hand is almost impossible to overdose on. Buprenorphine exerts its maximum effect at 32mg and anything more would not result in more effective treatment. While suboxone is considered to be a wonder drug by many in the medical community for the treatment of addiction, it has now become a source for addiction. The ever-growing painkiller abuse epidemic currently going on means that the number of people that will be on buprenorphine is ever increasing, leading to a greater supply of drugs available to buy on the street. Nevertheless, properly used for the treatment of addiction, suboxone can be used to get a person who is physically addicted to opiates through the harsh process of withdrawal.
Works Cited
Wesson, Donald R. and Smith, David E. “Buprenorphine in the Treatment of Opiate Dependence” Journal of Psychoactive Drugs 42.2 (2010): 161-175. Print
“Episode 391: The Anti-addiction Pill that’s Big Business for Drug Dealers”. Planet Money. NPR. 02 Aug 2012. Podcast
“Buprenorphine Now More Likely Than Methadone to be Found in U.S. Law Enforcement Drug Seizures.” Center for Substance Abuse Research. Vol. 21, Issue 13. April 2,2012. Web. April 20,2013. http://buprenorphine.samhsa.gov/CESAR-FAX21-13_BuprenorphineVSMethadoneSeizures.pdf
Subutex and Suboxone Questions and Answers, FDA. January 08, 2010. Web. April 21, 2013. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm191523.htm
Buprenorphnie. U.S. Department of Health and Human Services: Substance Abuce and Mental Health Services Administration. Web. April 21, 2013
Martin, Timothy. “Addicts Misusing Drug Treatments.” The Wall Street Journal. July 04, 2012. Web
