Suboxone is a combination medication containing both the opioid agonist buprenorphine and the antagonist naloxone. The U.S. Food and Drug Administration (FDA) has approved it to treat opioid dependence. The American Society of Addiction Medicine (ASAM) publishes that in the United States, more than 2.5 million people battled opioid addiction in 2015.
Suboxone can be a beneficial component of an opioid addiction treatment program. Opioid drugs bind to opioid receptors in the brain, which can serve to block pain sensations and flood the brain with dopamine, the “feel good” neurotransmitter. Opioids are therefore highly addictive, and difficult emotional and physical side effects can accompany withdrawal when they process out of the brain once drug dependence has formed.
Suboxone is helpful during opioid addiction treatment. It can aid in weaning a person off more powerful and potent opioids while lessening the intensity of withdrawal symptoms. Buprenorphine as a partial opioid agonist can activate the opioid receptors in the brain and, therefore, minimize cravings and more significant withdrawal symptoms.
Buprenorphine is also a longer-acting opioid, meaning it can stay active in the bloodstream for longer than a short-acting opioid like heroin; as a result, it can be administered less often. As a partial agonist, it also doesn’t create the same euphoric high that full agonists do, which can make it less of a target for abuse.
Suboxone typically comes in a sublingual filmstrip formulation that is placed under the tongue and dissolved. Dosage amounts vary, but each formulation of Suboxone contains four parts buprenorphine to one part naloxone.
Naloxone is an opioid antagonist that remains dormant when Suboxone is taken as directed. If it is abused or if a full agonist opioid is introduced while taking Suboxone, the naloxone component will activate and can precipitate withdrawal. This mechanism further helps to deter abuse and makes Suboxone a helpful tool in treating opioid dependence and addiction.
As an opioid drug, Suboxone does have some analgesic effects and therefore can be useful as a pain reliever. There are both pros and cons to taking Suboxone for pain relief.
Buprenorphine, as a synthetic opioid, was initially used as a pain-relieving medication in the 1970s, mostly following surgery or for cancer patients, according to the journal Current Drug Abuse Reviews. It seems to be well tolerated and has fewer side effects than other opioid and narcotic painkillers.
Suboxone as a combination medication is not currently meant to be used as a painkiller; however, the journal Anesthesiology reports that it is being used off-label to treat chronic pain in individuals who also struggle with opioid dependence.
One of the side effects of opioid dependence can often be opioid-induced hyperalgesia (OIH), which is an increased sensitivity to pain that is caused by the continued interaction of an opioid drug in the body. The combination of buprenorphine and naloxone that is contained in Suboxone may actually help to reverse OIH and, therefore, could manage pain in someone who is also battling opioid dependence.
Buprenorphine is actually a weak analgesic, or pain reliever, so it does not seem to be helpful for controlling pain in people who do not struggle with opioid dependence. When chronic pain is an issue for someone who is already dependent on other opioids, Suboxone may be beneficial to wean a person off opioid drugs and also aid in managing pain symptoms.
The journal Practical Pain Management publishes that when used by someone who has opioid dependence and also chronic pain, the Suboxone dosage may need to be split up to two or three times a day instead of the once or twice daily dosage that it is usually administered. Buprenorphine acts as an analgesic for about six to eight hours and, therefore, may need to be readministered more often in someone who struggles with chronic pain than when it is used solely to treat opioid dependence. Dosage is highly individual, and each person will need to be evaluated to determine what dosage will be effective for managing pain and opioid withdrawal.
Suboxone is a medication that is often used as a maintenance medication to treat opioid addiction, and it will need to be tapered off during a period before stopping use to keep withdrawal symptoms from returning. Suboxone is not recommended for use in treating acute pain or chronic pain in those who do not also battle opioid dependence.”
The use of Suboxone for pain management is a personal decision to be made with the help of trained medical professionals. Summarized here are some pros and cons to consider when deciding if Suboxone might be the optimal option.
Suboxone is still an addictive opioid medication that needs to be taken under close supervision by a trained medical professional. Other medications may be more effective than Suboxone in managing pain and should likely be considered first.
Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. from https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
(February 2018). Highlights of Prescribing Information. Indivior. from https://www.suboxone.com/content/pdfs/prescribing-information.pdf
(August 2011). Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review. Current Drug Abuse Reviews. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/
(May 2014). Buprenorphine-Naloxone Therapy in Pain Management. Anesthesiology. from http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1917779
(April 2015). Treating the Opioid-Addicted Chronic Pain Patient: The Role of Suboxone. Practical Pain Management. from https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/treating-opioid-addicted-chronic-pain-patient-role-suboxone?page=0,1