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How Drugs Like Suboxone and Subutex work

Suboxone and Subutex are brand names and formularies of the drug Buprenorphine, a synthetic opioid used to treat pain and opioid addiction. This drug, developed several decades ago, is a synthetic analog of an alkaloid, thebaine, derived from the poppy flower. It lies under schedule III drug because it has a potential for moderate or low physical dependence or high psychological dependence.

Medication-Assisted Treatment With Drugs Like Suboxone and Subutex

Buprenorphine helps people reduce the use of heroin and other opiates like morphine, which is used as a pain reliever. In October 2002, the FDA approved Buprenorphine clinical use as the latest medication-assisted treatment (MAT).

Buprenorphine is prescribed to patients as the best treatment for opioid dependency recovery, along with counseling and behavioral therapies. Buprenorphine is safe and effective, taken as prescribed.
FDA approved Buprenorphine for the management of pain and opioid dependence. Buprenorphine is used in agonist substitution treatment, in which it is used as a substitute for more potent agonists in the treatment of addiction.

When the patient starts on Buprenorphine, the prescriber tapers down the addicted drug, and the patient quits the opiate addiction with minimal discomfort. Buprenorphine has minimal withdrawal effects that allow the patient to emphasize therapy rather than focus on withdrawal effects. It is an effective selection to treat opioid dependence and decrease cravings and improve patients’ quality of life suffering from addiction treatment. It also allows the patient to avoid many uncomfortable opioid withdrawal symptoms by creating a treatment plan that patients are more likely to adhere to, thereby decreasing morbidity and mortality.


Mechanism of Action
When taking opioids, they go to the brain and attach to receptors. With three main effects; reduced respiration, euphoria, decreased pain. The more opioids ingested, the more impact they have on the body, brain, and general intoxication level. Opioid effects depend on mechanical union; the better the fit, the more the opioid effect. Buprenorphine is different. It too binds to the receptors, however, without a perfect fit.

Image showing how suboxone and Subutex work
How Drugs Like Suboxone And Subutex Work

Buprenorphine partially stimulates the opiate mu receptors and acts as a partial agonist at the mu receptor site. As a result, all the receptors are occupied by Buprenorphine without exerting any opioid effects. The receptor is deceivably occupied with opioids without causing intense feelings of euphoria and without significant respiratory depression.

Drugs like Suboxone and Subutex are also weak delta receptor agonists and kappa receptor antagonists. It acts on the central nervous system (CNS) as a potent analgesic.


The partial agonist activity of Buprenorphine at the mu receptor makes it a unique compound. This quality gives it many unique properties, like how its analgesic effects plateau at higher doses, and after that, these effects become antagonistic.


This, in turn, prevents that receptor from joining with full opioids; therefore, if the patient uses heroin or painkillers, they are unlikely to experience the additional effect. Buprenorphine has a high binding affinity to the mu-opioid receptors and slowly dissociate from the receptor. Buprenorphine tends to bind with the receptors, blocking them for a longer time than opioids do.


This stickiness is what makes Buprenorphine last so long, up to 3 days. This effect shows milder withdrawal symptoms and increases ease for the patient compared to full opioid agonists like morphine and fentanyl. Buprenorphine is a safer drug for opiate addiction treatment as it shows ceiling effects on respiratory depression.


Naloxone is also added with Buprenorphine because it is an opioid antagonist. It limits the misuse of Buprenorphine as it stops injection of the drug, limiting diversion. Naloxone minimizes the systemic effects of Buprenorphine as it is poorly absorbed sublingually. If people were to inject this drug, the naloxone blocks mu receptors and stops receptor stimulation or precipitates opioid-dependent patients’ withdrawal.


Conclusion
Buprenorphine treatment is not simply replacing one drug with another. Buprenorphine is the best choice in treating opioid dependence due to its slow onset of action and prolonged duration of action. Initially, it is given on alternate days, once the patient has stabilized with the drug, shifted to the daily dose.

If you are in need of substance abuse treatment, Wellness Center NJ can help. We have an opiate addiction treatment program that specializes in the use of medication like Suboxone and Subutex. You can reach out today at 201-945-2905.

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