Suboxone Addiction: Symptoms, Causes, Effects, Treatments And Prevention 

Suboxone addiction refers to a condition where an individual develops a dependency on Suboxone. The medication is a combination of buprenorphine and naloxone and is widely used to treat substance abuse withdrawal symptoms.

Suboxone addiction manifests through various physical (withdrawal, tolerance, and dependence) and psychological symptoms ( mood swings, depression).

Suboxone addiction impacts the user’s physical health (dental problems, infections, hormonal imbalances), mental well-being (depression, anxiety), and social relationships (social isolation and occupational problems).

The causes of Suboxone addiction include pharmacological (partial agonist effects, long-term use, and physical dependence ) and sociological (misuse in non-medical, inadequate medical supervision) factors.

Withdrawal symptoms of Suboxone include gastrointestinal problems, sleep disturbances, runny nose, dilated pupils, and flu-like symptoms.

Effective treatment for Suboxone addiction involves a combination of medication-assisted treatment (MAT), behavioral therapies  (cognitive behavioral therapy), and support systems (Narcotics Anonymous, family counseling).

Suboxone comes in several forms (sublingual film, buccal film, implants) and has various street names including subs, strips, and boxes.

Law enforcement agencies play a vital role in combating opioid addiction through Naloxone Programs, Diversion Programs (Angel initiative and Law Enforcement Assisted Diversion), and partnerships and data sharing.

What is Suboxone Addiction?

Suboxone addiction refers to the compulsive seeking and use of the drug due to an individual developing a dependency on Suboxone. It is a combination of two medications: Buprenorphine and Naloxone. Buprenorphine is a synthetic opioid used as an analgesic and for treating opioid abuse disorder. On the other hand, Naloxone is an opioid antagonist. It is commonly used to reverse opioid overdose or reduce its effects. 

Suboxone, also known as Bunavail, is widely used in the treatment of opioid addiction due to its effectiveness in reducing withdrawal symptoms and cravings. A 2020 report by Brar R., et al, on the use of a novel prescribing approach for the treatment of opioid use disorder.

Buprenorphine/naloxone micro-dosing – a case series, published in the Drug and Alcohol Review journal, demonstrated that Suboxone shown is highly effective in treating opioid use disorder. However, despite its intended purpose, Suboxone itself can become a substance of misuse.

Suboxone works by partially activating opioid receptors, which helps to alleviate withdrawal symptoms and reduce cravings without producing the full opioid effect. According to a 2020 article “Can You Become Addicted to Suboxone? Separating Fact from Fiction”, published by Healthline, Suboxone works by reducing the withdrawal effects and craving by producing mild opioid effects.

In addition, it blocks opioids such as heroin from attaching to receptors which effectively prevents euphoria. Finally, Naloxone comes in to reverse the opioid effects on the brain. While it is a valuable tool in medication-assisted treatment (MAT), the potential for dependency and misuse is ever-present.

Addiction to Suboxone occurs when individuals take higher doses than prescribed or use the medication for non-medical purposes. The Naloxone component is included to deter misuse by causing withdrawal symptoms if injected, but this does not prevent oral misuse. Chronic misuse leads to physical dependence and addiction.

What Are The Signs And Symptoms Of Suboxone Addiction?

Suboxone addiction manifests through various physical (withdrawal, tolerance, and dependence) and psychological symptoms (mood swings, depression).

Physical Symptoms

1. Withdrawal Symptoms: When addicted individuals attempt to reduce or stop taking Suboxone, they experience withdrawal symptoms similar to those of other opioids, including muscle aches, insomnia, sweating, and gastrointestinal distress​. According to the guideline on suboxone medication by the US Food and Drug Administration, Suboxone contains an opioid and has the potential to cause dependency. Therefore, FD advises people taking the medication to consult a physician before discontinuing it. 

2. Tolerance and Dependence: Over time, individuals develop a tolerance to Suboxone, requiring higher doses to achieve the same effect. Physical dependence also develops, leading to withdrawal symptoms if the medication is abruptly stopped​.

3. Drowsiness and Dizziness: Suboxone causes drowsiness, dizziness, and lightheadedness, especially when the individual stands up quickly from a lying or sitting position. These symptoms interfere with daily activities and increase the risk of accidents​.

Psychological Symptoms

1. Mood Swings and Depression: Suboxone addiction causes significant mood swings, irritability, anxiety, and depression. These symptoms exacerbate underlying mental health conditions or contribute to new psychological issues​ .

2. Cravings: Persistent cravings for Suboxone can dominate an individual’s thoughts and actions, making it difficult to focus on other aspects of life​. According to a 2022 article on Suboxone by Medical News Today, Suboxone dependence triggers drug-seeking behavior and cravings.

Behavioral Symptoms

1. Drug-seeking Behavior: Individuals addicted to Suboxone usually engage in drug-seeking behaviors, such as visiting multiple doctors to obtain additional prescriptions or using the medication in ways not prescribed (e.g., injecting or snorting). The FDA guideline on Suboxone advises against injecting or “shooting up” the drug as it is likely to result in serious withdrawal symptoms.

2. Neglecting Responsibilities: Addiction often leads to neglect of personal and professional responsibilities. Individuals miss work or school, perform poorly in their roles, or neglect personal hygiene and health.

3. Continued Use Despite Harm: Even when experiencing negative consequences related to Suboxone use, such as relationship problems or legal issues, individuals may continue using the medication.

What Are The Effects Of Suboxone Addiction?

Suboxone addiction impacts individuals’ physical health (dental problems, infections, hormonal imbalances), mental well-being ( depression, anxiety), and social relationships (social isolation and occupational problems).

1. Physical Health: Chronic misuse causes liver damage, hormonal imbalances, and an increased risk of infectious diseases if injected. According to a 2013 study by Suzuki, J., et al, “Sublingual Buprenorphine and Dental Problems: A Case Series”, published in The Primary Care Companion for CNS Disorders journal, Buprenorphine treatment is linked with tooth decay, cavities, and other dental problems.

2. Mental Health: Addiction often exacerbates existing mental health issues, leading to severe depression, anxiety, and cognitive impairments.

3. Social Impact: Relationships and social functioning deteriorate as addiction takes precedence over personal and professional responsibilities. This results in social isolation and occupational problems.

What Are The Causes Of  Suboxone Addiction?

The causes of Suboxone addiction are pharmacological (partial agonist effects, long-term use, and physical dependence ) and sociological (misuse in non-medical, inadequate medical supervision) factors.

Pharmacological Factors

1. Partial Agonist Effects: Buprenorphine, the primary component of Suboxone, binds to the same opioid receptors in the brain as other opioids like heroin and prescription painkillers but with less intensity. According to an article on Buprenorphine from the Substance Abuse and Mental Health Services .

Administration (SAMHSA), Buprenorphine binding produces euphoria and physical dependence, although to a lesser extent than full agonists such as methadone. The reduced euphoric effect can make Suboxone less likely to be abused compared to other opioids, but dependency can still develop with prolonged use​​.

2. Long-Term Use and Physical Dependence: For people in long-term treatment, physical dependence on Suboxone occurs. This dependence is often necessary to manage severe OUD effectively. However, when patients attempt to taper off the medication, they experience withdrawal symptoms similar to those of other opioids, which can lead to continued use or misuse​.

3. Self-Medication and Psychological Factors: Patients with co-occurring mental health disorders, such as anxiety or depression, might misuse Suboxone to self-medicate. The psychological relief provided by the medication leads to inappropriate use and dependency. Additionally, individuals with a history of substance abuse are more prone to misuse Suboxone​.

According to a 2018 article by Jennifer R.V., “Suboxone: Rationale, Science, Misconceptions”, published in the Ochsner Journal, Suboxone dependence usually develops when patients misuse the drug by self-medicating or combining it with other medications used for treating co-occurring disorders.

Sociological Factors

1. Misuse in Non-Medical Contexts: Despite its intended use for OUD treatment, Suboxone can be misused outside of medical supervision. Some individuals might obtain the drug through illegal means, using it to manage withdrawal symptoms from other opioids or to experience its milder euphoric effects. This non-medical use can quickly lead to addiction​.

2. Inadequate Medical Supervision: Proper medical supervision is crucial for safely using Suboxone. Inadequate monitoring, improper dosing, or lack of comprehensive treatment plans that include counseling and support can lead to misuse. Patients who do not receive adequate support may turn to higher doses or illicit sources of the drug​​.

What Are The Withdrawal Symptoms Of Suboxone?

Withdrawal symptoms of Suboxone include gastrointestinal problems, sleep disturbances, runny nose, dilated pupils, and flu-like symptoms. According to a 2012 report by Westermeyer, J., et al, “Course and Treatment of Buprenorphine/Naloxone Withdrawal.

An Analysis of Case Reports”, published in The American Journal on Addictions, people using Suboxone should gradually reduce their dosage over weeks or months. According to the report sudden cessation of Suboxone results in mild opiate withdrawal symptoms.

1. Gastrointestinal Issues: These include nausea, vomiting, diarrhea, and abdominal cramping.

2. Sleep Disturbances: Insomnia and restless legs syndrome significantly affect sleep quality.

3. Flu-like Symptoms: These include body aches, chills, sweating, and fever-like sensations.

4. Psychological Symptoms: Sudden cessation of Suboxone results in anxiety, irritability, mood swings, and depression.

5. Other Physical Symptoms: These include runny nose, yawning, dilated pupils, and increased heart rate or blood pressure.

The onset of withdrawal symptoms usually begins within 24-72 hours after the last dose of Suboxone, peaking at around 72 hours to a week. Symptoms can last for several weeks, with acute symptoms subsiding after about a month, but psychological symptoms like anxiety and cravings may persist longer.

What Are The Treatment Options For Suboxone Addiction?

Effective treatment for Suboxone addiction involves a combination of medication-assisted treatment (Lucemyra)), behavioral therapies  (cognitive behavioral therapy), and support systems (Narcotics Anonymous, family counseling).

Medication-Assisted Treatment (MAT)

MAT is the use of medications like buprenorphine, methadone, or naltrexone, combined with counseling and behavioral therapies. This approach aims to provide a “whole-patient” approach to treating substance use disorders​. A 2018 press release, “FDA Approves The First Non-Opioid Treatment For Management Of Opioid Withdrawal Symptoms In Adults”, by the Food and Drug Administration,  approved Lucemyra (lofexidine hydrochloride) to treat opioid withdrawal symptoms in adults. 

Behavioral Therapies

Cognitive-behavioral therapy (CBT) and contingency management are crucial in helping patients modify their behaviors and develop coping strategies to deal with cravings and triggers​. According to a 2010 study by McHugh, R. K., “Cognitive-Behavioral Therapy for Substance Use Disorders”, CBT is highly effective in treating substance abuse disorders. 

Support Systems

Support groups, such as Narcotics Anonymous, and family counseling provide a network for emotional support and accountability, which are essential for long-term recovery​.

Where To Find Treatment For Suboxone Addiction?

If you or your loved one is struggling with Suboxone addiction, you should contact the Substance Abuse and Mental Health Services Administration’s National Helpline at 800-662-HELP (4357) or the online treatment locator.

How To Treat Suboxone Overdose?

Treating Suboxone overdose involves contacting medical services, administering naloxone, and supportive care.

If you suspect a Suboxone overdose, you should call emergency medical services immediately. Upon arrival, medical professionals typically administer naloxone, an opioid antagonist, to reverse the effects of the overdose. According to a 2023 report by the Food and Drug Administration (FDA), “Information about Naloxone and Nalmefene”, FDA approved over-the-counter Naloxone nasal spray to reduce opioid deaths.

Supportive care, such as ensuring adequate ventilation and monitoring vital signs, is crucial. In a hospital setting, additional treatments include intravenous fluids and medications to manage symptoms like respiratory depression. Continuous monitoring is essential, as Suboxone has a long half-life, requiring extended observation to prevent relapse of overdose symptom

What Are The Different Forms Of Suboxone?

Suboxone comes in several forms (sublingual film, buccal film, implants) and has various street names including subs, strips, and boxes. According to the Food and Drug Administration’s prescribing information, the sublingual film and buccal film are approved by the agency for treating opioid dependence.

1. Sublingual Film and Tablets: The most common form is the sublingual film, which dissolves under the tongue. This form is also available as generic versions approved by the FDA to enhance access to treatment​.

2. Buccal Film: Another form is the buccal film, which is placed inside the cheek and absorbed through the oral mucosa​.

3. Implants: Probuphine is an implantable version of buprenorphine that delivers a steady dose over six months. This form requires surgical insertion and removal by a trained healthcare provider​.

4. Extended-Release Injections: Sublocade is an injectable form of buprenorphine that provides a sustained release over a month, making it convenient for patients who prefer less frequent dosing​.

What Are The Different Slang Names For Suboxone?

On the street, Suboxone is known by several slang names. These names often arise from its appearance, effects, or the context in which it is used. 

According to a 2018 intelligence report by the Drug Enforcement Administration  “Slang Terms and Code Words: A Reference for Law Enforcement Personnel”, popular street names for Suboxone include boxes, bupes, oranges, sobos, stop signs, stops, and subs. Common Suboxone slang names include:

1. Subs: A shorthand for Suboxone, often used informally among users and dealers.

2. Strips: Refers to the sublingual film form of Suboxone, which looks like a small strip of paper​.
3. Boxes: Derived from the packaging of Suboxone film or tablets, which come in small boxes.

4. Orange Guys: Refers to the orange color of Suboxone tablets or film.

What Are The Facts And Statistics On The Prevalence Of Suboxone Addiction?

Facts and statistics on the prevalence of Suboxone addiction include 2.1 million Americans who used opioids in 2020, high treatment rates for Suboxone treatment, and more than 2,500 law enforcement agencies issuing officers with the medication to deal with opioid overdose incidents.

According to a 2024 study by Dydyk AM, et al, “Opioid Use Disorder”, published in StatPearls,  opioid use disorder (OUD) affects 16 million globally and 2.1 million in the United States.

1. Prevalence: Approximately 2.1 million Americans had an opioid use disorder in 2020, with a significant number receiving buprenorphine-based treatments like Suboxone​. 

2. Treatment Success: Extended Suboxone treatment has shown better outcomes compared to short-term detoxification and counseling, reducing the likelihood of relapse and illicit opioid use​​. A 2008 study, “Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults”, published in the Journal of the American Medical Association, demonstrated that Suboxone yielded better results compared to those treated using detox and psychotherapy.

3. Law Enforcement Data: A 2019 article “Law Enforcement Looks to Research to Help Fight the Opioid Crisis” by the National Institute of Justice, required that over 2,500 law enforcement agencies equip officers and first responders with naloxone, highlighting the critical role of first responders in addressing opioid overdoses​​. 

Where And How Is Suboxone Typically Manufactured And Produced?

Production Locations

Suboxone is manufactured in various locations around the world to meet global demand. Key production sites include:

1. Reckitt Benckiser Pharmaceuticals (United States ): The primary manufacturer of Suboxone in the United States, Reckitt Benckiser has facilities dedicated to the production of both tablets and sublingual films. These facilities are located in Richmond, Virginia, and they adhere to stringent FDA regulations to ensure product quality and safety.

2. Reckitt Benckiser Facilities (Europe): In Europe, Reckitt Benckiser also operates manufacturing sites, particularly in the United Kingdom. These sites are responsible for supplying Suboxone to the European market and comply with the European Medicines Agency (EMA) standards.

3. Contract Manufacturers (Asia): In Asia, Suboxone production is often outsourced to contract manufacturing organizations (CMOs). These CMOs are based in countries like India and China, where they follow Good Manufacturing Practices (GMP) to produce high-quality pharmaceutical products. These manufacturers are regularly audited by the drug companies to ensure compliance with international standards.

Manufacturing Process of Suboxone

Suboxone comprises two active pharmaceutical ingredients: buprenorphine and naloxone.

1. Buprenorphine: A partial opioid agonist, buprenorphine is synthesized through a series of chemical reactions starting from thebaine, an alkaloid found in the opium poppy. Thebaine undergoes several modifications, including hydrogenation and chemical derivatization, to produce buprenorphine.

2. Naloxone: An opioid antagonist, naloxone is synthesized from a precursor called noroxymorphone. This process involves the selective reduction and methylation of noroxymorphone to yield naloxone.

Formulation

Once the APIs are synthesized, they are combined to produce the Suboxone medication. This involves:

1. Mixing: The APIs are mixed with excipients, substances that aid in the stability and delivery of the medication. Excipients in Suboxone include lactose monohydrate, mannitol, and citric acid.

2. Blending: The mixture is blended to ensure a uniform distribution of buprenorphine and naloxone throughout the formulation.

3. Compression: The blended mixture is compressed into tablets or processed into sublingual films, depending on the final product form. Sublingual films are made by spreading the mixture onto a film-forming base and drying it to create a thin, dissolvable film.

4. Packaging: The final product is packaged into unit doses, ensuring that each package contains the precise dosage required for effective treatment.

What Are The Law Enforcement Efforts And Legal Implications Of Suboxone?

Law enforcement agencies play a vital role in combating opioid addiction through Naloxone Programs, Diversion Programs (Angel” initiative and Law Enforcement Assisted Diversion), and partnerships and data sharing.

1. Naloxone Programs: According to the 2019 NIJ requirements, many law enforcement agencies provide naloxone to officers to reverse opioid overdoses on the spot, saving countless lives​.

2. Diversion Programs: Programs like the “Angel” initiative and Law Enforcement Assisted Diversion (LEAD) divert individuals from the criminal justice system to treatment programs, offering a rehabilitative rather than punitive approach​. In a 2019 press release “White House Drug Policy Director Statement on New Actions to Expand Access to Treatment and Save Lives.
   
   The Office of National Drug Control Policy made sweeping changes to make it easy for addicts to access treatment. These include making treatment of substance abuse more accessible, allowing take-home doses of methadone, and expanding the number of healthcare providers prescribing medication for opioid use disorder. 

3. Partnerships and Data Sharing: Collaboration between law enforcement, public health agencies, and community organizations enhances the effectiveness of interventions and ensures a coordinated response to the opioid crisis​.

What Is The Role Of Law Enforcement Agencies In Stopping Suboxone Distribution And Use?

Prescribing Suboxone as a Controlled Substance: Suboxone is a prescription medication regulated under the Controlled Substances Act. It is classified as a Schedule III drug due to its potential for abuse and dependence. The Drug Enforcement Administration (DEA) oversees the legal distribution of Suboxone, ensuring that it is prescribed and dispensed per the law.

According to the Drug Addiction Treatment Act of 2000, (DATA 2000) health practitioners must have a special waiver to prescribe Suboxone.

Law Enforcement’s Role in Monitoring Prescription Practices: One of the primary roles of law enforcement in stopping Suboxone misuse is monitoring and regulating the prescription practices of healthcare providers. The DEA works closely with state and local agencies to ensure compliance with federal and state laws.

The Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that track the prescribing and dispensing of controlled substances, including Suboxone. These databases help law enforcement agencies identify patterns of over-prescribing or suspicious prescribing practices, which can indicate potential abuse or diversion.

What Are The Legal Consequences For Using And Selling Suboxone?

1. Unauthorized Use and Possession: Possessing Suboxone without a prescription is illegal. Individuals found in possession of Suboxone without a valid prescription face criminal charges, which vary by state but typically include fines and imprisonment. For example, in many jurisdictions, possession of a controlled substance without a prescription leads to misdemeanor or felony charges, depending on the amount and intent.

2. Penalties for Unauthorized Use: The penalties for unauthorized use of Suboxone are severe. According to the United States Drug Enforcement Administration (DEA), possession of a Schedule III substance without a prescription results in up to one year of imprisonment and a minimum fine of $1,000 for a first offense. Subsequent offenses carry harsher penalties, including increased fines and longer imprisonment.

3. Selling Suboxone Illegally: Selling Suboxone without proper authorization is a more serious offense. Distribution or trafficking of Suboxone without a DEA registration or outside of a medical setting constitutes illegal drug trafficking under federal law. This offense carries substantial penalties, including long-term imprisonment and hefty fines.

4. Federal Penalties for Distribution: Federal penalties for distributing Suboxone illegally are severe. According to the DEA, individuals convicted of distributing a Schedule III controlled substance face up to 10 years in prison and fines of up to $500,000 for a first offense. If the distribution results in serious bodily injury or death, the penalties increase to a minimum of 20 years imprisonment.

How Are The Effects of Suboxone Addiction And Fentanyl Addiction Different Or Similar?

Similarities

1. Both are opioids: Both Suboxone and Fentanyl bind to opioid receptors in the brain, affecting the central nervous system.

2. Dependence and Withdrawal: Both drugs lead to physical dependence and withdrawal symptoms, though the severity and nature of these symptoms differ. According to the Drug Enforcement Administration fact sheet on Fentanyl, the medication is 100 more potent than Morphine and 50 times stronger than Heroin. 

3. Risk of Overdose: Although the mechanisms differ, both drugs carry the risk of overdose. Suboxone’s risk is lower due to its ceiling effect, while fentanyl’s high potency makes it particularly dangerous.

Differences

1. Purpose and Use: Suboxone is used primarily for treating opioid addiction and preventing misuse, while fentanyl is used for pain management. Suboxone’s design includes naloxone to deter injection misuse, whereas fentanyl’s design prioritizes pain relief with high potency.
   
2. Addiction Potential and Abuse: Fentanyl has a much higher potential for abuse and addiction due to its potency and rapid onset of effects. Suboxone’s potential for misuse is mitigated by its partial agonist nature and the presence of naloxone.
   
3. Withdrawal Severity: Withdrawal from fentanyl is typically more acute and intense compared to Suboxone. The symptoms of fentanyl withdrawal can appear rapidly and be highly debilitating, often leading to a quick relapse​. According to Fentanyl DrugFacts from the National Institute on Drugs Abuse (NIDA), Fentanly cessation results in severe cravings, uncontrollable leg movements, muscle and bone pain, cold flushes, and nausea.

What Are The Implications Of Suboxone Addiction For Public Health?

Suboxone addiction poses significant public health challenges, including increased healthcare costs due to treatment of addiction and associated health issues, and the potential for an increase in opioid overdose deaths if Suboxone is misused. According to a 2014 study by Lavonas, E. J., “Abuse and diversion of buprenorphine sublingual tablets and film”, published in the Journal of Substance Abuse Treatment,  37.8% of patients who participated in the study endorsed recent misuse of Buprenorphine.

Will I Need To Use Suboxone in The Long Term?

Yes, if you are using Suboxone to manage opioid withdrawal symptoms. However, unlike other medications used to treat substance abuse disorders, the possibility of developing dependence on Suboxone is quite low. According to the 2022 article by Healthline possibility of developing dependence is low because Suboxone has a ceiling effect.

Is Suboxone Right For Me?

Suboxone is a safe medication approved by the U.S. Food and Drug Administration in 2002 for the treatment of opioid use disorder.

What Happens If I Miss A Dose?

If you miss a dose of Suboxone, take it as soon as you remember. However, if it’s close to the next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Avoid doubling doses.

Does Suboxone Interact With Other Medications?

Yes, Suboxone, just like other prescription or illicit substances, interacts with other drugs. According to the article “Buprenorphine/Naloxone (Oromucosal Route, Sublingual Route)”, from Mayo Clinic, it is not recommended to take Suboxone if you are using Naltrexone, Cisapride, Fluconazole, and Sparfloxacin.