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Opioid addiction in the United States has reached epidemic levels. Thousands of people every year overdose on these drugs. If they are fortunate enough to survive the overdose, in too many cases, they return to their addictions after a hospital stay.
Since the 1970s, pharmaceutical researchers have worked hard to find medical treatments to help people overcome addictions to opioid drugs, and these have had mixed effectiveness. One of the first treatments popularized for its potential to help was methadone, but due to budget constraints in many states, overcrowded maintenance clinics, and a recent increase in the number of people struggling with opioid addictions, other treatments, particularly with buprenorphine, have been developed. Suboxone was created to prevent abuse or tampering, so the person taking Suboxone could not get high from it; however, this medication, too, has had limited success.
Maintenance therapies are effective when a physician oversees the process, and the individual uses the maintenance therapy as part of a larger addiction treatment plan. Different people may respond better to different maintenance therapies, so it is important to understand the pros and cons of each.
Methadone is an opioid medication that has a very long half-life. This powerful narcotic became famous in the 1960s and 1970s as a method to slowly taper people who struggled with heroin addiction off the illegal drug. Now, in some cases, methadone is prescribed as a generic painkiller, especially for people who have government insurance or cannot afford alternative, long-lasting painkillers. While this has been problematic, the original use of methadone, to help people with opioid addictions overcome this condition, has been sanctioned by the World Health Organization, which added methadone to its 2013 list of Essential Medicines. Because methadone is a potent, full opioid agonist, however, it is a Schedule II substance per the DEA, just like oxycodone and hydrocodone.
As a powerful narcotic synthesized from morphine, methadone binds to the opioid receptors in the brain. By doing so, methadone helps to reduce withdrawal symptoms that can otherwise prevent a person from successfully detoxing from heroin or other narcotic substances. When used appropriately in a clinic, with a physician’s oversight, methadone does not lead to euphoria, analgesia, or sedation, which is associated with the intoxication of narcotics. In a detox program, the supervising physician will decrease the methadone dose over time, allowing the individual’s body time to adjust to the “new normal” level of opioid in the brain. Although this process can take years for some people, they can lead healthy, normal lives while working toward sobriety, in conjunction with rehabilitation, therapy, support groups, and other parts of a comprehensive treatment plan.
Methadone lasts for 24 hours in the body, allowing the person undergoing methadone treatment to spend much more time focusing on other aspects of their lives. The medication comes as a powder, liquid, or tablet, and it is often recommended that the individual mix methadone with water or juice to dissolve the dose before ingesting it.
People undergoing detox treatment with the help of methadone must go to a methadone clinic, doctor’s office, or opioid treatment center to receive each dose. Those who receive methadone as a treatment for pain may receive smaller prescription doses that they can take home. However, this access to methadone, as well as illicit use of methadone, can lead to addiction to the drug.
Symptoms of methadone abuse include side effects like:
Because methadone is an opioid agonist, it can be abused just like other narcotics, including heroin, Percocet, Vicodin, or OxyContin. People who do not have tolerance to or physical dependence on opioids are especially at risk of developing an addiction to methadone, while people who have struggled with opioid abuse and addiction for a long time do not generally experience euphoria from the medication. That is why methadone has been used as a tapering and detox medication for so long, while using the drug as a prescription painkiller is especially dangerous. However, with appropriate oversight from medical professionals, methadone can work for both purposes.
According to the Drug Enforcement Administration (DEA), the 2012 National Survey on Drug Use and Health reported that 2.46 million people ages 12 and older had reportedly abused methadone for nonmedical reasons at least once in their lives. This number represented an increase from 2.1 million people the previous year. The National Forensic Laboratory Information System (NFLIS) noted seizures of 5,324 methadone “exhibits” in 2013.
The substance is widely abused and distributed for nonmedical reasons, which can lead to opioid addiction. Once a person struggles with addiction to such a long-lasting opioid drug, detox can become difficult.
Suboxone is a brand name prescription treatment, similar to methadone, used to help those struggling with addiction to opioid drugs detox in a way that reduces the risk of relapse. The medication is a combination of buprenorphine, a partial opioid agonist approved for use in maintenance therapy by the FDA in 2002, and naloxone, a medication that binds harmlessly to the opioid receptors in the brain, blocking any other chemicals that attempt to bind to those receptors. Suboxone is about 80 percent buprenorphine and 20 percent naloxone. It is considered a Schedule III drugby the DEA.
Buprenorphine is much newer than methadone, but it effectively works the same way without being as potent a narcotic. The drug binds to opioid receptors for a long period of time, offering relief from withdrawal symptoms for people who are working to overcome their addiction to opioid drugs like heroin and OxyContin.
Unlike methadone, buprenorphine has been approved for use outside of specific clinics. Physicians can receive training in how to monitor buprenorphine use and abuse in their patients, along with a waiver from the DEA, and then prescribe the medication in a different clinical setting. People with buprenorphine prescriptions are carefully monitored by physicians but do not have to take their dose in a specific clinical setting. This allows individuals much more freedom to attend rehabilitation, therapy, work, school, family obligations, and support groups, which are all important aspects of living a sober life.
Naloxone was added to buprenorphine to create Suboxone, in order to prevent abuse of buprenorphine. People who struggle with opioid addictions have, in some instances, attempted to abuse buprenorphine by crushing pills and snorting them, or dissolving sublingual tabs in water and injecting the substance. While this does not create significant euphoria like heroin or fentanyl, it can make the person feel “high.”
Naloxone is a drug famed for stopping opioid overdoses, at least for a certain period of time. The substance does not bind to opioid receptors for very long, but it does kick opioids off those receptors, effectively reversing an overdose long enough for emergency medical treatment to arrive. By adding naloxone to buprenorphine, Suboxone attempts to prevent abuse of buprenorphine when a person tries to bypass the slow release of the medication into the body. The naloxone should, instead, cause the person to go into withdrawal by binding to opioid receptors instead of the buprenorphine.
Because Suboxone contains buprenorphine, some individuals have found ways to abuse the medication to get high and bypass the naloxone component. One of these methods, according to a report in The New York Times, involves taking Suboxone with benzodiazepines to enhance the depressant qualities on the central nervous system (CNS). The article blames insufficient physician training, as doctors may not be used to closely monitoring their patients’ prescriptions. Some physicians have also been accused of prescribing buprenorphine and Suboxone in order to make money, allowing fake prescriptions and an illicit market for the drug to grow. Just like with methadone, people who have no tolerance to opioids can get high off buprenorphine or Suboxone without taking other drugs at the same time.
Another New York Times article highlights the potential dangers of abusing Suboxone and buprenorphine when the body has no tolerance to opioids. Especially when mixed with alcohol or other substances, large doses of Suboxone can lead to overdose the same way that heroin, oxycodone, or morphine can – by depressing breathing until it eventually stops altogether.
Although methadone has a greater potential for abuse compared to Suboxone, both of these drugs have some potential for abuse and addiction. A rehabilitation program can provide the tools needed to overcome an addiction to either methadone or Suboxone. Through medical detox and a comprehensive therapy program, individuals can leave Suboxone or methadone abuse in the past and embrace a healthier future.