Subutex Abuse and Addiction

Subutex is the trade name given to a semi-synthetic opioid, known as Buprenorphine. It was specifically manufactured to treat the withdrawal symptoms in people recovering from the opioid addiction. The drug relieves the withdrawal symptoms and thus, helps in preventing a relapse. Its mechanism of action is similar to other opioids such as morphine and heroin. It is also used for the treatment of moderate to severe pain. Similar to other opioids, prolonged use of Subutex can develop the tolerance, which can lead towards addiction. The drug also has a high potential for abuse, misuse, and overdose. Accidental exposure in children can be fatal. The misuse during pregnancy can lead to neonatal opioid withdrawal syndrome; that can be life-threatening. The medicine comes with a proper guide and instructions to avoid the cases of overdose.  It was discovered in 1970 and was labeled as a very harmful medicine if used incorrectly.

Subutex is a partial opioid antagonist used for the treatment of opioid dependence. It is utilized during the process of detoxification and as a maintenance medicine in the cases of opioid addiction. It inhibits some of the effects of morphine and heroin by interacting with the same receptors as these drugs interact with. Subutex also produces euphoric effects like other opioids but they are very mild in intensity. The main ingredient of the drug is Buprenorphine. The drug is manufactured in the form of a white oval tablet having a sword logo and alphanumeric printing on each of the two sides. Each tablet of Subutex also contains mannitol, lactose, povidone K30, cornstarch, citric acid, magnesium stearate and sodium citrate. The drug can be crushed in a white powder form, which is easily soluble in methanol, alcohol, and water. The various street names given to the drug include:

• Bupe
• Suboxin
• Box/boxes
• Oranges
• Subs
• Sobos
• Stops

The drug attaches to the opioid receptors in the brain. It produces 3 main effects: euphoria, pain relief and depression of respiratory rate. Subutex acts as a partial antagonist, which means it binds to the opioid receptors and partially blocks the full fledged effects of opioids. The drug stays bound to the receptors for a longer duration compared to other opioids. The binding capacity can last up to three days; therefore, it can mitigate the additional effects produced by opioids such as intense euphoria.

The drug is used for the following purposes:

• Treatment of individuals addicted to heroin or oxycodone, during the detoxification and long-term opioid replacement therapy.
• Management of severe pain.
• The transdermal patch is used as antiemetic in individuals who are intolerant to oral formulations.

The adult dose for Subutex for treating opioid dependence:

• 1^stday: 8 mg sublingual tablet.
• 2^ndday: 16 mg sublingually.

For pain:

• Initial dose: A dose of 0.3 mg is given via IM or IV injections slowly over the duration of 2 minutes.
• Maintenance dose: Repeat 0.3 mg IV or IM dose at 6 hours interval.
• Maximum dose: 0.3 mg for IV and 0.6 mg for IM administration.

Like the other opioids, Subutex is an addictive drug. Buprenorphine is more addictive than the other drug Suboxone, which is a combination of Buprenorphine and Naloxone. The sublingual form of the drug is kept under the tongue which slowly dissolves and produces its effects over a period of 5 to 10 minutes. When the user starts to misuse the drug by taking the higher doses, the potential for dependence and addiction increases tremendously. The doctors closely monitor the doses of Subutex consumed in the rehabilitation centers to prevent the development of dependence. When used recreationally, tolerance is developed quickly. Over the time, abuser begins to increase the doses to achieve the desired effects; it results in the physical and psychological dependency on the drug. After the development of addiction, quitting the drug is associated with the appearance of severe withdrawal symptoms like nausea, agitation, irritability, and headaches. If the doses are correctly taken according to the prescription, the chances of dependency and hence, the withdrawal symptoms, are negligent.

It is a common practice for addicts to combine other drugs with Subutex to achieve a better High. Since it is an opioid, combining it with other drugs can be life-threatening. The three most common substances taken along with Subutex are Benzodiazepines, Cocaine, and Alcohol. Benzodiazepines act as the central nervous system depressant by eliciting the sedating effects and Subutex also carries the same properties. Taking the drugs together can exacerbate the depressant effects and the person can suffer from impaired judgment, incoordination, respiratory failure, and death. On the other hand, cocaine is a stimulant; Subutex can suppress the effects of Cocaine which can lead to a Cocaine overdose. Alcohol is also a depressant so it acts in a way similar to benzodiazepines but since it is more potent, its use is associated with a greater risk of developing respiratory depression and coma.