Can Suboxone maintenance continue for your whole life? Yes, absolutely. Although the medication has only been in general use for OUD, opioid use disorder, for about 20 years, there is no reason yet discovered why Suboxone cannot be used in the long term. In fact, it’s the key to the continued and successful sobriety of many former opioid abusers. This is because Suboxone contains a powerful synthetic opioid called buprenorphine. Suboxone’s name comes from the two words sublingual and naloxone. Sublingual means under the tongue, which is how the medication is taken. Naloxone is the second ingredient in the combination product, contributing its last syllable to the brand name. Naloxone
is an opioid overdose rescue medication used in Suboxone to discourage intravenous abuse of the buprenorphine.
Opioid Abuse and the Brain
Why is it so hard to stop taking opioids and to stay clean from them for any length of time? The answer to this question lies in the nature of the brain’s response to the continual presence of opioid drugs. Regular use of opioids, whether they are abused or not, leads to significant changes in brain function. Opioids work in the brain by binding to special receptor sites called the mu, delta and kappa receptors. However, it’s the mu most closely involved with both analgesia and pleasurable opioid effects, such as euphoria and a highly pleasant state of exquisite, dreamy sedation called a nod. Regular use of opioids will cause the brain to grow extra receptor sites, creating an abnormal physiological state of currently unknown long-term significance.
Brain cells become less and less receptive to the actions of opioids on the molecular cellular level. This contributes to the development of tolerance or the need to take more and more of the opioid in order to maintain the effect. The liver is also involved in the tolerance process because it will create powerful enzymes to deactivate the substance before it can reach the brain in the first place. This is called the first-pass effect. It’s much more active with drugs taken orally.
What do These Changes Mean?
There is no way to know for sure just what these changes mean in the long term. There is no way to be sure what is causing the powerful urge to use opioids among users trying to quit, but we do know that irresistible drug cravings are universal among opioid users. Combined with physical withdrawal symptoms, the urges create a near-impossible situation for the user. They simply can’t stand how they feel without opioids. This feeling sometimes diminishes greatly over time but not for everyone. Some former detoxified opioid users report that the world looks like it has lost its colors. Life without opioids has become a dull substitute. These feelings must have a physical cause of some kind. Perhaps opioids permanently change the brain’s natural opioids endorphins or their production in some way. Perhaps it’s something else entirely. No one really knows.
Suboxone for MAT
MAT means medication-assisted treatment. For opioids, it includes Suboxone, Subutex, methadone and to a lesser extent, extended-release naltrexone preparations like Vivitrol. Both Suboxone and Subutex contain the synthetic opioid buprenorphine, but only Suboxone also has naloxone. Methadone is another synthetic opioid very well suited for opioid MAT. The main difference between methadone and buprenorphine is that methadone is a full agonist, while buprenorphine is a partial one. The term agonist for an opioid substance means that it has the ability to bind to the brain’s opioid receptors. However, this binding isn’t necessarily total. It can be partial or full.
There are also antagonist opioids like naloxone and naltrexone. These have a very high preference for the mu receptor, but they have no effect of their own. This is why they’re used for opioid overdose rescue. Their molecules go into the brain and give the molecular order to the opioids currently occupying the mu sites to essentially take a powder. “Get out of my way! I want to sit there!” The naloxone or naltrexone molecules then occupy the mu receptor, preventing anything else from sitting there but without having any dangerous breathing suppression effect of its own.
Suboxone and Pregnancy
Yes, Suboxone can be used for indefinite periods of time. It’s even reasonably safe to use during pregnancy. It’s certainly much safer than using illicit opioids like fentanyl-laced heroin, especially intravenously, or counterfeit prescription lookalike pills containing who knows what. In fact, these perilous pill pretenders often actually contain unknown levels of fentanyl illegally imported from rogue chemical labs in China. Fatal overdose is a real and constant threat.
If you’d like more information about Suboxone, let us help. It may be the answer for you. We’ll listen to your unique needs and guide you to the best solution for you. Just call us anytime at 833-497-3812. Your call is confidential and will be handled by a highly trained member of our professional drug counseling team.