Suboxone® is one of two medications for the treatment of opioid use disorder (OUD) approved by the FDA for use outside of methadone clinics. Treatment experts and patients alike consider Suboxone® a lifesaving medication. Suboxone® can help people move past the negative cycles of addiction and achieve sustainable recovery.
Suboxone®: Office-Based Opioid Treatment (OBOT)
People seeking treatment for opioid addiction should understand three things about Suboxone®:
- It’s safe.
- It’s very effective.
- It’s available in outpatient, office-based opioid treatment programs that meet federal, state, and local regulations.
Those three things are important for family and friends of people with OUD to understand as well. They need to know their friend or loved one is receiving the best possible support for their addiction disorder.
The Benefits of Suboxone®
Suboxone® is part of an overall approach to addiction treatment called medication-assisted treatment (MAT). Within MAT, Suboxone® has a strong evidence base spanning over thirty years. It’s approved by the Food and Drug Administration (FDA). It’s recommended by the Substance Abuse and Health Services Administration (SAMHSA) as an evidence-based treatment for people with opioid use disorder. Clinics that dispense Suboxone® must be supervised by a licensed prescriber who meets the clinical guidelines outlined by SAMHSA and the Department of Health and Human Services (HHS). Prescribers who participate in Suboxone® treatment include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives.
Benefits of treatment with Suboxone® include:
- Decreased risk of drug-related death
- Decreased rate of relapse
- Decreased transmission of infectious diseases such as HIV and hepatitis
- Increased time-in-treatment
- Increased quality of life
- Improved psychological functioning
- Improved social functioning
Suboxone® is unique among other MAT medications – such as methadone – because it’s designed to simultaneously reduce cravings and symptoms of withdrawal while blocking the action of other opioids in the brain. What this means is that a person on a stable dose of Suboxone® does not get high from Suboxone®. And if they take other opioids while on Suboxone®, those opioids will have no effect. That’s why the federal government eased restrictions on Suboxone® in 2018. The ingredients in Suboxone® made it an ideal medication to reduce barriers to treatment and expand access to MAT for opioid use disorder.
What is in Suboxone®?
Suboxone® is a combination of two medications – buprenorphine and naloxone – that work in tandem. The two medications help people with opioid use disorder manage the symptoms of opioid withdrawal, block cravings for opioids, and reduce negative behavior associated with opioid addiction.
According to the Substance Abuse and Health Services Administration (SAMHSA):
“Buprenorphine is a safe and effective alternative medication for people with OUD…for whom treatment in a methadone clinic is not appropriate.”
Buprenorphine is a partial opioid agonist. It works by binding to the same chemical structures in the brain as opioids, including illicit opioids like heroin and black-market fentanyl, or prescription opioids such as hydrocodone. Evidence for the effectiveness of buprenorphine in addiction treatment dates back to initial research performed in the mid-1980s and early 1990s. This evidence been verified and confirmed by more recent research performed over the past five years. The benefits of buprenorphine treatment reported in those studies are the same as the benefits of Suboxone® we list above.
Now let’s talk about the second medication in Suboxone®, naloxone.
According to the Substance Abuse and Health Services Administration (SAMHSA):
“Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone.”
Naloxone is the drug most people know of as the medication first responders, law enforcement agents, and emergency room nurses and doctors use to prevent overdose death. In the context of MAT for OUD, naloxone has a different function. In Suboxone® it has almost no pharmacologic effect and was added to deter misuse.
Now let’s talk about how treatment for Suboxone® works.
Office-Based Opioid Treatment: Suboxone®
The federal guidelines that expanded access and reduced barriers to treatment of people with OUD included an updated set of best practices designed for physicians and staff who provide office-based MAT for OUD. These guidelines require providers to:
- Fully assess the need for treatment. Assessments must include:
- Full medical and psychiatric history
- Full prescription drug history
- Complete physical examination focusing on addiction complications
- Comprehensive lab testing to assess opioid and other drug use
- Educate potential patients about Suboxone®.
- Providers must discuss the benefits and risks associated with Suboxone®, including risk of overdose, risk of relapse, and risk of using other drugs while on Suboxone®
- Evaluate the need for medically managed withdrawal.
- Initiation of any buprenorphine treatment – including Suboxone® – cannot begin until an individual is in the initial stages of withdrawal. Initiation must be directed by a federally licensed medical provider.
- Screen for co-occurring disorders.
- Any treatment plan including MAT must consider the role of mental health disorders in addiction treatment and recovery
- Integrate treatment methods.
- When possible, providers are strongly encouraged to provide access to psychosocial services, such as mental health counseling
- Refer patients to a more intensive level of care as needed.
- If a provider determines office-based MAT is not effective for an individual, they’re encouraged to refer that individual for more intensive or specialized level of care.
What these guidelines tell us is that, like the role of methadone in an opioid treatment program:
Suboxone® treatment is not only about the Suboxone®.
It’s true. Restrictions have eased. And while rules requiring counseling and therapy are not as strong as they were before 2018, they’re still there. The guidelines prioritize an integrated, whole-person approach to addiction treatment. However, to help as many people as possible, reduce harm, and mitigate the negative effects of opioid addiction in as many communities as possible, the new SAMHSA advisory makes it clear:
“Buprenorphine [Suboxone®] should be part of a comprehensive management program that includes psychosocial support. Providers should not withhold treatment in the absence of psychosocial support.”
That means the positive effects of Suboxone® are persuasive. Lawmakers and the medical community determined that, based on the latest evidence, Suboxone® is safe to administer in office-based treatment centers. The new rules allow suboxone treatment even when access to professional mental health treatment and auxiliary support is not available.
That’s a big step forward.
How did we get here?
MAT and Suboxone®: From Stigma to Essential Support
The past twenty-two years have brought significant changes to medication-assisted treatment (MAT) for opioid use disorder. Three federal laws expanded MAT beyond the standard methadone treatment previously allowed by federal law only in licensed Opioid Treatment Programs (OTPs):
- The Drug Addiction Treatment Act of 2000 (DATA 2000). This law allowed physicians to prescribe medication for opioid use disorder in office-based settings.
- The Comprehensive Addiction and Recovery Act of 2016 (CARA). This law increased the number of patients that individual physicians could offer MAT.
- The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities or SUPPORT for Patients and Communities Act of 2018 (SUPPORT Act). This law allowed more providers to prescribe medication for OUD. The expanded list includes Nurse Practitioners (NPs), Physician Assistants (PAs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetist (CRNAs), and Certified Nurse-Midwifes (CNMs).
- The Mainstreaming Addiction Treatment Act of 2022 (MAT 2022). This law reduced restrictions around buprenorphine prescribing, increases access to MAT in underserved communities, and established policies to reduce stigma surrounding MAT.
The first law responded to advances in the use of MAT for OUD and reflected the decreasing stigma around MAT. The second law was our first nationwide response to the opioid crisis, and gave more people access to MAT. The third law doubled down on our nationwide response to the opioid crisis. It reduced barriers to treatment by increasing the number of providers allowed to evaluate and prescribe medications for opioid use disorder, including Suboxone®. The fourth law made permanent many of the changes established during the COVID-19 pandemic and establishes a structure for implementing a nationwide harm-reduction approach to the opioid crisis.
Suboxone® Treatment at Pinnacle Treatment Centers
In our Office-Based Opioid Treatment Programs, we use every tool available – including Suboxone® – to help as many people as possible achieve sustainable recovery and rebuild a full, vibrant, purpose-driven life beyond opioid addiction.
About The Author
