Suboxone.com - Advances in Treatment

The requested information is provided in Portable Document Format (PDF). To view and print this document you'll need to install a copy of the free Adobe® Acrobat® Reader®. If you already have Adobe Acrobat Reader installed click "View PDF" below. If you need the Acrobat Reader you can download it from the Adobe Acrobat Reader Download page.

You are leaving Suboxone.com. Links are provided as a public service and for informational purposes only. No endorsement is made or implied. Clicking on "Continue" will take you to a website that is outside the control of Reckitt Benckiser Pharmaceuticals. You are solely responsible for your interactions with such websites.

Links are provided as a public service and for informational purposes only.

IMPORTANT INFORMATION:

On December 8, 2006, Federal legislation was passed allowing physicians to treat up to 100 opioid dependent patients with Suboxone at any given time—a significant increase from the previous limit of 30 patients.

If you can read this, then your browser cannot interpret Javascript. To take full advantage of what this website has to offer, please make sure that you have Javascript enabled in your browser preferences, or update to a browser that supports Javascript. Thank you.

Prescribing Information -- Site Map

Mechanism of Action (MOA)

Learn about how SUBOXONE addresses the biological basis of dependence.

Get certified to prescribe SUBOXONE

Information on becoming certified to treat opioid dependence in your office with SUBOXONE

Advances in Treatment

Office-based treatment with SUBOXONE is regarded as an important advance in the treatment of opioid dependence for 4 primary reasons:

Enhanced treatment confidentiality
Enhanced treatment convenience
Treatment advantages of a partial opioid agonist
Limiting diversion and misuse

Enhanced Treatment Confidentiality
The strength of the stigma attached to opioid dependence and treatment is hard to dispute.

Every year in the United States, thousands of patients decide that the benefits of being treated for opioid dependence are outweighed by the risk of that treatment being exposed—and the patient's being irreversibly stigmatized as a result.^1,2

Edwin A. Salsitz, MD, director of the methadone program at Beth Israel Medical Center in New York was quoted in The New York Times as saying "the most stigmatized thing in this world is [opioid dependence treatment]..." adding that "there is nothing people try to hide more..."³

Under these circumstances, the enhanced confidentiality afforded by office-based treatment should have significant appeal to a number of opioid-dependent patients.

For many, the draw of office-based treatment is as simple as there being nothing about the visit that might cause a SUBOXONE patient to stand out from anyone else.

Back to List | Back to Top

Enhanced Treatment Convenience
SUBOXONE's status as a prescription medication that can be dispensed for take-home use offers patients a freedom and convenience unique among opioid-dependence treatments, specifically:

SUBOXONE patients are not tied to daily clinic visits
Patients are free to go on business trips, to visit family and friends out of state, and to go on vacation
SUBOXONE does not require patients to be admitted to a residential healthcare facility
Patients do not need to take extended time off from work or otherwise call attention to their treatment

Back to List | Back to Top

Treatment Advantages of a Partial Opioid Agonist
Buprenorphine, the primary active compound in SUBOXONE, is a partial opioid agonist at the mu-opioid receptor.

The treatment advantages of buprenorphine stem from 3 features: a high affinity for the mu receptor, slow dissociation from that receptor, and a relatively low intrinsic activity. These properties enable buprenorphine to:

Control patients' opioid withdrawal symptoms and opioid cravings
Cause limited euphoria compared with full agonists, but still produce sufficient positive effects to aid in treatment compliance^4,5
Cause less physical dependence than full agonists⁵
Less physical dependence and euphoria mean buprenorphine carries a lower potential for abuse than full agonists⁵
Block the effects of subsequently administered opioids by preventing them from binding to the mu receptors⁵
The appeal of using supplemental opioids is undermined by their diminished ability to produce a euphoric effect in the patient¹
Provide a wider margin of error with respect to dosing time and regularity
Slow dissociation from the mu receptor allows the therapeutic effect of SUBOXONE to last for up to 2 to 3 days, depending on dose
Pose less risk for fatal respiratory depression compared with full agonists because of the "ceiling effect" characteristic of partial opioid agonists^5,6
As with all opioid agonists, there is a risk of respiratory depression; patients should be warned of the potential danger of not using SUBOXONE according to the product information labeling and physician instructions

Back to List | Back to Top

Limiting Diversion and Misuse
SUBOXONE also includes a naloxone component to discourage diversion and abuse. Generally, naloxone has no clinically significant effect when taken sublingually. If SUBOXONE is crushed and injected, the naloxone is included to attenuate the effects of buprenorphine and to precipitate withdrawal in an individual dependent on a full opioid agonist.

Please see WARNINGS and PRECAUTIONS sections of full SUBOXONE Prescribing Information for additional safety data.

Back to List | Back to Top

References

1.	Center for Substance Abuse Treatment (CSAT). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004.
2.	Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2003 national survey on drug use and health: national findings. Rockville, Md: Department of Health and Human Services, SAMHSA, Office of Applied Studies; 2004. NSDUH Series H–25, DHHS Publication No. SMA 04-3964.
3.	O'Connor A. New ways to loosen addiction's grip. The New York Times. August 3, 2004;sect F:1.
4.	Mattick RP, Ali R, White JM, O'Brien S, Wolk S, Danz C. Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients. Addiction. 2003;98:441-452.
5.	Walsh SL, Eissenberg T. The clinical pharmacology of buprenorphine: extrapolating from the laboratory to the clinic. Drug Alcohol Depend. 2003;70(suppl 2):S13-S27.
6.	Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55:569-580.