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slider3-image.pngWhat Is an Opioid?

Opioids are drugs that are either derived from opiates (drugs created directly from opium, such as morphine or codeine) or are chemically related to opiates or opium. Examples of opioids include some prescription painkillers (such as oxycodone, hydrocodone, buprenorphine, methadone, and heroin).

What Is Opioid Dependence?

An individual is generally considered opioid-dependent when 2 things occur: Repeated opioid use is needed in order to feel good or avoid feeling bad, and The opioid use continues in spite of its negative effects. For example, people who are opioid-dependent will feel a need to keep using opioids even if it hurts their health, job, finances, or family.

Is Opioid Dependence a Medical Condition?

Opioids, such as some prescription pain medications or heroin, attach to opioid receptors in the brain, which stimulate the release of dopamine and produce pleasurable feelings. When the opioid eventually detaches from receptors, people experience withdrawal and cravings and have a strong need to repeat the experience. Drug use often begins as a choice, but frequent use can cause the brain cells to change the way they work. The brain is “re-set” to think that the drug is necessary for survival. Researchers have discovered that many drugs, including opioids, cause long-term changes in the brain. These changes can cause people to have cravings years after they stop taking drugs. Can Opioid dependence affect behavior? The need to satisfy cravings or avoid withdrawal can be so intense that people who want to stop taking opioids find this difficult to do. Or, they may find themselves doing things they wouldn’t ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.

How Common Is Opioid Dependence?

Opioid dependence is more common than you may think. You are not alone. No one group of people is immune to opioid dependence. Men and women of all ages, races, ethnic groups, and educational levels can become dependent on opioids.

How Common Is Misuse of Prescription Pain Medications?

According to the 2003 National Survey on Drug Use and Health (NSDUH): 4.7 million people ages 12 and older were misusing pain relievers in 2003 By 2003, 31.2 million people ages 12 and older had used pain relievers nonmedically in their lifetime In 2001 alone, almost 2.5 million people used pain relievers nonmedically for the first time. This is a dramatic 335% increase from 573,000 new users in 1990

How Common Is Heroin Use?

In 2002, more than 400,000 people ages 12 and over reported using heroin in the previous yerar. An estimatied 3.7 million people reported having used heroin at some time in their lives. Recently, inexpensive, high-purity heroin has become more available. Rather than injecting, many new users are smoking or snorting heroin, with the misconception that these routes are less addictive. In addition, use among younger adults is growing in many suburban communities.

Why Are Some People More Likely to Become Dependent?

Substance such as opioids that produce euphoria are considered to have high reinforcement potential, whhich increase the likelihood that they will be taken repeatedly or abused, although a majority of people who take these powerfully reinforcing drugs do not become dependent on them. Although the specific causes vary from person to person, certain factors, such as the drug itself, genetics, and the individual’s environment, are know to be important in the development of opioid dependence. Some people appear to genetically predisposed to dependence, raising the possiblility that susceptibility t the disease may be hereditary. Also, individual absorption levels of the drug into the blood can vary widely for different people, thus causing different effects. Lasty, substance abuse, which can lead to dependence, is often influenced by societal norms and peer pressure.

What Is SUBOXONE?

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatement of opioid dependence in a private office setting. Buprenorphine is a partial opioid agonist that blocks other opiods from attaching to receptors in the brain. This treatment can help you stop misusing opioids. Treatment, including behavioral counseling, can help you rebuild you life. What Is a Partial Opioid Agonist? A partial agonist is an opioid that produces less effect than a full agonist when it binds to opioid receptors in the brain. The way different opioids work can be explained using a lock and key example. Receptors are like a lock to a door: Only the right key will fit the lock, and only opioid-like drugs fit opioid receptos.

with a full opioid agonist such as oxycodone, hydrocodone, morphine, methadone, or heroin, they key fits the lock, opens the door wide, and produces full opioid effects (the feeling of euphoria, or being high, as well as the side effects) With a partial opioid agonist such a buprenorphine, the key fits the lock but doesn’t open the door all the way. so it produces less than full opioid agonist effects and, at the appropriate dose, block other opioids from opening the door fully An opioid antagonist such as naltrexone of naloxone fits in the lock but does not open the door at all and, at the appropriate dose, blocks other opioids from opening the door At appropriate doses SUBOXONE can: Help to suppress withdrawal from prescription pain medications, heroin, or similar full opioid agonists. Help to decrease cravings for other opiods Reduce the effects of full opioid agonists

 How Does SUBOXONE Work?

Buprenorphine, the active ingredient in SUBOXONE, works by strongly binding to opioid receptors.  How does SUBOXONE benefit you? SUBOXONE can decrease cravings and relieve withdrawal symptoms. This can help you remain in treatment and gain control over your dependence without the distraction of cravings and fear of withdrawal. SUBOXONE offers a way to treat opioid dependence (in a doctor’s office) with privacy, confidentiality, and safety. People treated with SUBOXONE generally don’t need to be hospitalized, make daily visits to a clinic, or go away from home for residential treatment. As a result, treatment with SUBOXONE may allow more time for work, family and other activities. How Effective is SUBOXONE? Buprenorphine, the primary active ingredient in SUBOXONE, has been studied extensively since 1978, when it was first proposed for the treatment of opioid dependence. A number of clinical trials have established the buprenorphine is effective for: Suppressing symptoms of opioid withdrawal Reducing cravings for opioids Reducing illicit opioid use Blocking the effects of other opiods Helping patients stay in treatment In all studies patients received regular counseling along with their medication. SUBOXONE, together with counseling, can help you remain in treatment. By having your withdrawal symptoms and cravings better controlled, your overall treatment can focus on resolving issues and gaining skills to avoid triggers — situations or stimuli that may cause you to relapse. You can also work with your physician to address issues that may have been contributing to your use of opioids, such as depression, anxiety, or other psychiatric conditions. How Long Has SUBOXONE Been Used To Treat Opioid Dependence? SUBOXONE has been available in the United States since 2003. Worldwide, it is estimated that more tan 400,000 people had their opioid dependence treated with buprenorphine. Does SUBOXONE Just Substitute One Dependence for Another? All opioid can cause physical dependence. But as you’ve seen in “What Is a Partial Opioid Agonist?” the peak level of euphoria experienced with SUBOXONE is limited compared with that of full agonists such as heroin. This experience has been associated with a lower level of physical dependence and limited development of tolerance compared with full agonist. SUBOXONE provides a level of reinforcement that assists in retaining patients in treatment, including counseling. When you no longer need SUBOXONE, your dose can be tapered slowly until medication is not required. You and your doctor will discuss the timing and appropriateness of tapering your doses. The withdrawal symptoms of SUBOXONE are milder than those experienced with full opioid agonist and can be managed with your doctor’s supervision.

Why Is It Important to Take SUBOXONE as Directed? It is important that you take your SUBOXONE or Subutex (buprenorphine HCI sublingual tablets) with you other medications exactly as directed by your physician. Abuse or misuse of your medication while on SUBOXONE or Subutex can cause death. A number of deaths have occured when dependent people have injected buprenorphine, usually together with benzodiazepines, tranquilizers, or sedatives unless they have been prescribed by your doctor: Do not drink alcohol while taking SUBOXONE or Subutex Can I Switch From Methadone to SUBOXONE? It is possible to switch to SUBOXONE from methadone treatment. Everyone’s situation is different, so talk to your doctor first to see if switching is right for you.

How Long Will I Stay on SUBOXONE? The length of therapy is up to your doctor, you, and sometimes, your therapist or counselor. Although short-term treatment may be an effective option for some people, it may not allow others enough time to address the psychological and behavioral components of their disease. Since physical dependence is only part of opioid dependence, the chance of relapsing can be higher with short-term treatment because patients have less time to learn the skill necessary to maintain an opioid-free lifestyle. Suppressing cravings with SUBOXONE (for as long as you need), combined with counseling and/or support, can often increase the level of treatment success. Stopping SUBOXONE abruptly will probably cause withdrawal symptoms. When you are ready, your doctor will work with you to taper the doses down to where you can stop taking SUBOXONE. You should be aware of signs of relapse or withdrawal symptoms. If you do discontinue taking SUBOXONE, your leftover pills should be discarded to ensure that they can’t be used by anyone else.

Where Can I Find a Physician Who Can Prescribe SUBOXONE? Doctors need to be certified to prescribe SUBOXONE. Doctors who are already specialists in addiction medicine or who complete specific training can become certified to treat opioid dependence with SUBOXONE in the privacy of their office. Ask your doctor if he or she is certified. If not, you doctor may elect to become certified so that he or she can treat you, or your doctor may refer you to a colleague who is certified. You may also be able to find a physician who can treat you with SUBOXONE by calling your local hospital or mental health center and asking them if they have any doctors certified to use SUBOXONE to teat opioid dependence. Many certified physicians are listed on the Physician Locator that you can access at: Partida Corona Medical Center buprenorphine.samhsa.gov/bwns_locator/index.html suboxone.com What Will My Course of SUBOXONE Treatment Be Like?

How Do I Start SUBOXONE Therapy?

Once arrangements have been made for your appointment, your doctor will ask you to arrive in a state of mild-to-moderate withdrawal. Your doctor may ask you questions to better evaluate your history of dependence in order to provide you with the best treatment. The information you give will be held strictly confidential. You may also have blood drawn and be asked to provide a urine sample. Why Do I Need to Be in Withdrawal? It is important to be in mild-to-moderate withdrawal when you take your first dose of SUBOXONE because if you have high levels of other opioids in you system, SUBOXONE will compete with the other opioid molecules and knock them off the receptors. SUBOXONE will then replace those opioid molecules on the receptors. Because SUBOXONE has less opioid effects than full opioid agonists, you may go into withdrawal and feel sick. This is called precipitated withdrawal. By already being in the first stages of withdrawal when you take your first dose of SUBOXONE, the process will be easier, and SUBOXONE should make you feel better. Once your doctor has assessed you level of withdrawal and decided that you are ready to start SUBOXONE, you will begin the induction phase of treatment. What Happens During Induction? Your doctor or nurse will give you your first dose in their office. After that, they may have you either stay in the waiting area or take some time away from the office and return at a particular time. At that point, your doctor will assess you withdrawal symptoms and may have you take an additional dose of medication if you are still not feeling well. When you are ready to leave the office: Generally, your doctor will make arrangements for you to have SUBOXONE to take home. Typically, your doctor will give you a prescription for the amount of SUBOXONE that you will need until your next appointment, along with special instructions related to your care Your doctor may also prescribe other medications to help control specific withdrawal symptoms You may be asked to return to the office over the next several days in order to assess your symptoms and adjust your dosage. When your opioid receptors are filled with buprenorphine and your symptoms are controlled, your doctor will decide what your regular daily dose of SUBOXONE should be. Once your dose is established, you will begin the maintenance phase of treatment At this point, you and your physician may discuss the possibility of beginning medical withdrawal (detox) and explore other post treatment options What Happens in the Maintenance Phase? When you are receiving a stable daily dose of SUBOXONE and your condition is considered stable (your withdrawal) symptoms are relieved and your cravings are decreased or are gone altogether), your doctor may decide to see you less often You and your doctor will discuss counseling options that meet your needs Your doctor may request urine samples from time to time. Some doctors find urine testing a helpful part of treatment because they can use the results to verify the absence of opioids in you system and thus evaluate the effectiveness of your SUBOXONE dose. You can talk with your doctor about the role of urine testing in SUBOXONE treatment During your ongoing maintenance treatment, your doctor will want to know if you experience and withdrawal symptoms. If you do, your dose may need to be adjusted.

Points to Consider During Maintenance: If you miss a dose of SUBOXONE, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and take the next dose at the regular time, unless your doctor instructs you otherwise Injecting SUBOXONE is dangerous and can cause severe withdrawal symptoms, painful or collapsed veins, blood clots, and increased risk of infection Your friends and family should be advised that an ambulance should be called right away in the rare event that you become sleepy, the pupils of your eyes become like pinpoints, you feel faint or dizzy, or your breathing becomes much slower than normal Serious overdose and death may occur if benzodiazepines, sedatives, tranquilizers, antidepressants, or alcohol are taken at the same time as SUBOXONE or Subutex (buprenorphine HCI sublingual tablets).

What Are Some Important Directions About SUBOXONE Use?

Intravenous use of buprenorphine, usually in combination with benzodiazepines or other CNS depressants (including alcohol), has been associated with significant respiratory depression and death. SUBOXONE Combined With Medications/Drugs It can be dangerous to mix SUBOXONE with drugs like benzodiazepines, alcohol, sleeping pills and other tranquilizers, certain antidepressants, or other opioid medications, especially when not under the care of a doctor or in doses different than prescribed by your doctor. Mixing these drugs can lead to drowsiness, sedation, unconsciousness, and death, especially if injected. It is important to let you doctor know about all medications and substances you are taking. Your doctor can provide guidance if any of these medications are prescribed for the treatment of other medical conditions you may have. Potential for Dependence SUBOXONE and Subutex(buprenorphine HC1 sublingual tablets) have potential for abuse and produce dependence of the opioid type, with a milder withdrawal syndrome than full agonists. Contact Your Doctor If You feel faint, dizzy, confused, or have any other unusual symptoms, or if your breathing becomes much slower than normal. These can be signs of taking too much SUBOXONE or of other serious problems You experience an allergic reaction. Symptoms of a bad allergic reaction include difficulty breathing, hives, swelling of your face, asthma (wheezing), or shock (loss of blood pressure and consciousness) You suspect liver problems due to any of these symptoms: Your skin or the white part of your eyes turn yellow (jaundice) Your urine turns dark Your bowel movements (stools) turn light in color You don’t feel like eating much food for several days or longer You feel sick to your stomach (nauseated) You have lower stomach pain Cytolytic hepatitis and hepatitis with jaundice have been observed in the addicted population receiving buprenorphine. Your doctor may do blood tests while you are taking SUBOXONE to ensure that your liver is okay: You’ve recently experienced a head injury (SUBOXONE can alter pupil size and cause changes in the level of consciousness that may interfere with patient evaluation) Pregnancy There are no adequate and well-controlled studies of SUBOXONE (a Category C medication) in pregnancy. SUBOXONE should not be taken during pregnancy unless your doctor determines that the potential benefit to you justifies the potential risk to your unborn child. Contraception should be used while taking SUBOXONE. If you are considering becoming pregnant or do become pregnant while taking SUBOXONE, consult your doctor immediately. Many women also have changes in menstruation when they use opioids. This may continue while you are taking SUBOXONE. It is important to remember that you can still become pregnant even with irregular periods. Breast-feeding Buprenorphine will pass through a mother’s milk and may harm the baby, so SUBOXONE is not recommended if you are breast-feeding. Your doctor should know if you are breast-feeding before you start treatment for opioid dependence. Driving and Operating Machinery SUBOXONE can cause drowsiness and slow reaction times. This may occurr more often in the first few weeks of treatment, when you dose is being changed, but can also coccur if you drink alcohol or take other sedative drugs when you are on SUBOXONE. Caution should be exercised when driving cars or operating machinery Commonly Reported Side Effects Side effects of SUBOXONE are similar to those of other opioids. The most commonly reported adverse events with SUBOXONE include: headache (36%, placebo 22%), withdrawal syndrome (25%, placebo 37%), pain (22%, placebo 19%), insomnia (14%, placebo 16%), nausea (15%, placebo11%), and constipation (12%, placebo 3%). You may already be experiencing some of these side effects because of your current use of opioids. If so, let your doctor know. Your doctor can effectively treat many of these symptoms. SUBOXONE can cause blood pressure to drop. This can cause you to feel dizzy if you get up too fast from sitting or lying down. Your doctor will determine if you need to stop taking SUBOXONE due to side effects. To report an adverse event caused by taking SUBOXONE, please call 1-877-782-6966. You are also encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. SUBOXONE Use in Children SUBOXONE can be used in people ages 16 and older. It hasn’t been approved for use in children younger than 16. Accidental overdose in children is dangerous and can result in death.

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