Suboxone is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid dependence.[1] It’s considered a safe and effective therapy for people struggling with opioid use disorder (OUD).
Due to lack of access, insurance issues, and limited number of available providers, Suboxone is often underprescribed: Almost 90% of people with opioid use disorder don’t get medications like Suboxone that can be lifesaving. [2] The addiction community is working fervently to increase access and availability of this essential medication.
What Is Suboxone?
Suboxone is an FDA-approved medication used to treat OUD.
Before Suboxone, methadone therapy was the medication of choice for the treatment of OUD. However, there were many barriers to its use, including the fact that legally it can only be distributed through a methadone facility, requiring a patient to arrive daily to clinic to receive their methadone dose.
Suboxone is different. This medication is designed for at-home use and can be prescribed by a doctor in a regular office visit.
Who Can Prescribe Suboxone?
Before 2023, doctors needed a special waiver to prescribe products like Suboxone that contain buprenorphine. That changed due to legislative action to increase access to this medication. Now, the federal requirement for a waiver has been eliminated so doctors can more readily prescribe this medication. [3]
Once prescribed, you can pick up Suboxone from your local pharmacy. Unlike methadone, you do not need to go to a specialized clinic to get it. This greatly expands access for patients with OUD.
Substances Suboxone Can Treat
Suboxone, especially when used to treat heroin or fentanyl addiction, can be a lifesaving medication. It can help prevent overdose by switching to a less potent and partial opioid agonist that will not create the high (or the same level of sedation and respiratory depression) while still activating opioid receptors enough to keep withdrawal symptoms at bay.
Any medication in the opioid class can be addressed with Suboxone, including the following:
Prescription Painkillers
These opioids come in pill form and are mainly used for pain relief. They include medications like these:
- Oxycodone
- Hydrocodone
- Morphine
These drugs can cause physical and psychological dependence even if taken as prescribed by a doctor, particularly in patients who have been using them for an extended period of time.[4]
They work the same way as heroin by binding to opioid receptors in the brain. Even when taken as directed, prescription opioids may need to be tapered off slowly to avoid uncomfortable withdrawal symptoms.
Painkillers may seem safe, but they can be very dangerous. Every day, approximately 18 women die from overdoses caused by opioid painkillers.[5]
Heroin
This highly addictive illicit opioid is fast acting and rapidly binds to opioid receptors in the brain, causing an intense euphoria or “high.”[6]
Heroin addiction involves both physical dependence, related to changes in brain chemistry caused by the drug, and behavioral modifications, including mood swings and drug-seeking actions. Heroin is an extremely dangerous illicit substance.
Heroin can be snorted or injected. For those who inject, there is an addition risk of: [7]
- Scarred or collapsed blood vessels
- Heart damage
- Abscesses
- Soft tissue infections
- Blood stream infections
- Sepsis and death
Heroin can also be contaminated by other substances, including fentanyl and cocaine. Since people must buy their heroin from street dealers, it’s impossible to know what’s in each dose.
Fentanyl
Of all opioid drugs, fentanyl and carfentanyl among the most potent. Fentanyl quickly enters the bloodstream and binds tightly to opioid receptors in the brain.
Fentanyl produced synthetically and sold illegally has the potential to be anywhere from 80 to 100 times stronger than morphine.[8] Because fentanyl purchased illegally is unregulated, its potency can be highly variable, greatly increasing the risk of accidental overdose.
Experts say fentanyl is responsible for a so-called “third wave” of overdose deaths in the United States.[9] It’s incredibly strong, and it’s often mixed with other drugs like heroin because it is even less expensive. This can lead to contaminated drug supply, and accidental overdose.
Alternate Uses for Suboxone
Suboxone is a medication that is FDA-approved for OUD treatment, but sometimes, doctors use this medication to treat other conditions.
The buprenorphine inside Suboxone is a powerful pain reliever, and is more and more commonly being used to treat refractory or chronic pain, particularly in patients who do not want to be on opioids long term.
By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
- Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf. August 2010. Accessed January 2023.
- Almost 90 Percent of People With Opioid Use Disorder Not Receiving Lifesaving Medication. NYU Langone. https://nyulangone.org/news/almost-90-percent-people-opioid-use-disorder-not-receiving-lifesaving-medication. August 2022. Accessed January 2023.
- Big News for Hospitalists: Elimination of the X-Waiver. Society of Hospital Medicine. https://www.hospitalmedicine.org/policy--advocacy/letters/immediate-elimination-of-x-waiver-for-prescribing-buprenorphine/?utm_medium=Social&utm_source=Twitter&utm_campaign=Advocacy&utm_term=1.13.23&utm_contentJanuary 2023. Accessed January 2023.
- Opioids. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/opioids. Accessed January 2023.
- Prescription Painkiller Overdoses. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html. September 2018. Accessed January 2023.
- What Is Heroin? National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/heroin. June 2021. Accessed January 2023.
- What Are the Medical Complications of Chronic Heroin Use? National Institute of Drug Abuse. https://nida.nih.gov/publications/research-reports/heroin/what-are-medical-complications-chronic-heroin-use. June 2018. Accessed January 2023.
- Fentanyl. Drug Enforcement Agency. https://www.dea.gov/factsheets/fentanyl. October 2022. Accessed January 2023.
- The 'Fourth Wave' of the Overdose Crisis. Stat. https://www.statnews.com/2022/12/29/the-fourth-wave-of-the-overdose-crisis/. December 2022. Accessed January 2023.
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