Safely Managing Opiate Withdrawal Symptoms With Suboxone®

Heroin addiction, as well as all opiate addictions, usually require medically monitored detox for the severe withdrawal symptoms the drugs produce. Heroin use causes a strong physical dependence and therefore opiate detox can result in serious complications when the use of the drug is stopped abruptly. Cold-turkey heroin detox and withdrawal symptoms can include seizures, heart irregularities, vomiting, insomnia and the sweats. Once the body has adapted to the presence of the drug, withdrawal symptoms may occur if heroin use is reduced or stopped. Opiate withdrawal, in regular abusers, may occur as early as a few hours after the last administration. It may also produce drug craving, restlessness, muscle and bone pain, diarrhea, cold flashes, goose bumps, leg kicking movements and various other physical symptoms. Most heroin detox and withdrawal symptoms peak between 48 and 72 hours after the last dose.

Sudden withdrawal from some synthetic opiates such as methadone can be fatal. Several different schools of thought exist as to the best method for opiate detox. The most comfortable detox from opiates is under medical supervision utilizing the newest medication, Suboxone®.

THE FORMULA

Suboxone®, a sublingual tablet, comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone.

SAFETY

Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16-32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects.

OPIATE ADDICTION TREATMENT WITH SUBOXONE®

This section provides a brief overview of the clinical use of buprenorphine (Suboxone®) for heroin, methadone and all other opiate addiction treatment.

Ideal candidates for heroin and other opiate addiction treatment with Suboxone® are individuals who have been objectively diagnosed with an opiate addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy and who agree to buprenorphine treatment after a review of treatment options. There are four phases of Suboxone® therapy: induction, stabilization, titration and treatment.

INDUCTION

This phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opiate-dependent individual has abstained from using heroin or other opiates for 12-24 hours and is in the early stages of opiate withdrawal or detoxification. If the patient is not in the early stages of detoxification, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could cause acute withdrawal.

Induction is typically initiated as observed therapy in the physician's office and is carried out using Suboxone®.

STABILIZATION

This phase begins when the patient has discontinued the use of his or her drug of abuse, no longer has cravings, and is experiencing few or no withdrawal symptoms. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved.

TITRATION

The titration phase is reached when the patient is doing well on a steady dose of Suboxone®. Once the patient shows no sign of opiate withdrawal, the patient is then titrated (stepped-down) from the buprenorphine therapy, until he or she is drug-free. This phase replaces what is otherwise known as "detoxification".

TREATMENT

Effective treatment of heroin, methadone or other opiate addiction requires comprehensive attention to all of an individual's medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus Suboxone® therapy should be combined with concurrent behavioral therapies and with the provision of needed addiction treatment services. This point is of such importance that physicians must attest to their capacity to refer patients for addiction treatment and counseling when they submit their Notification of Intent to begin prescribing Suboxone® to SAMHSA (Substance Abuse and Mental Health Services Administration).