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Does Withdrawal Have To Be This Bad?
The words of the bluegrass song say a lot about drug addiction: “Everybody wants to go to heaven but nobody wants to die.” For an addicted person, heaven can be equated to being off a drug or drugs and dying is the process that they experience when they withdraw from the drug or drugs.
It is not true that the great majority of people addicted to prescription drugs, and some street drugs, are not interested in handling their addiction. Many addicted people have attempted to withdraw from opiates like heroin, oxycodone and morphine and many other prescription drugs on their own. But a “cold turkey” withdrawal can be extremely uncomfortable, painful and even medically dangerous. Most who try to withdraw are unable to finish and are driven back to taking the drug to which they are addicted.
If operated properly, a medical detox facility can greatly ease the withdrawal from prescription drugs. One of the medications that can be used specifically to reduce the pain and discomfort from opiate withdrawal is Suboxone®, which was approved by the Food and Drug Administration in 2002 and administered in tablet form. Only doctors approved by the Substance Abuse and Mental Health Services Administration, a department in the United States Department of Health and Human Services, are allowed to dispense Suboxone®.
Suboxone® contains buprenorphine, an opiate that is an agonist. An agonist is a substance that binds to a specific receptor and the receptor, normally a protein molecule, triggers a certain response in the body. Heroin, oxycodone, morphine and similar opiates are full opiate agonists and trigger the maximum response in the body to create the feelings of euphoria associated with opiate use. Suboxone® contains buprenorphine which is a partial opiate agonist.
Most people develop a tolerance to full opiate agonists and require increasing amounts of the opiate to produce the same effects. Unlike the full agonist drugs, a partial agonist like buprenorphine increases the effect on the person only to a certain point and then no longer adds to the effect no matter how large the dose.
Suboxone® also contains naloxone, an antagonist. An antagonist binds to a receptor and slows or prevents the triggering of the receptors by an agonist. Naloxone is included in Suboxone® because buprenorphine is still a potent opiate and by itself can be abused—particularly if the tablets are crushed and injected directly into the bloodstream.
If Suboxone® is injected, the naloxone will go directly into the bloodstream and almost certainly cause the person to quickly go into withdrawal. However, if the Suboxone® tablet is placed under the tongue and allowed to dissolve gradually, the buprenorphine opiate agonist effect predominates, and very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine.
Suboxone® comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone. The Suboxone® drug label is available on the FDA Web site.
Suboxone® is used in medical detox to ease the pain and discomfort of withdrawal from oxycodone, heroin and other similar opiates. The medical doctor must determine that the opiate-addicted individual has abstained from using opiates for 12—24 hours and is in the early stages of opiate withdrawal before the first dose of Suboxone® is administered. This is because Suboxone® can precipitate acute and painful withdrawal symptoms if the patient still has other opiates in the bloodstream.
If the Suboxone® dose is properly tapered until its use is discontinued, the addicted person experiences a much milder and more comfortable withdrawal. Since many addicted people want to “go to heaven” and be free of the drugs and “don’t want to die”, Suboxone® is a tool that a medical detox facility should incorporate into its protocols for opiate withdrawal.
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