Mansoor Shah, MD

What is an opioid?

Opioids and opiates are synthetic and natural drugs that are related to drugs found in opium; many, such as heroin, are addictive narcotics.

Many prescription pain medications are opioids, such as:

• codeine,
• Vicodin^®*(hydrocodone bitartrate and acetaminophen),
• Demerol^®† (meperidine hydrochloride, USP),
• Dilaudid^®* (hydromorphone),
• morphine,
• OxyContin^®‡ (oxycodone hydrochloride controlled-release), and
• Percodan^®§ (oxycodone and aspirin tablets, USP). Methadone and buprenorphine are also opioids.

A small amount of naloxone is in Suboxone. Naloxone is added to discourage misuse of Suboxone. If Suboxone were to be crushed and injected, the naloxone would cause the person to go into withdrawal.

Why are opioids used to treat opioid dependence?

Many family members wonder why doctors use buprenorphine to treat opioid dependence, since it is in the same family as heroin. Some of them ask, “Isn’t this substituting one addiction for another?” But the two medications used to treat opioid dependence—methadone and buprenorphine—are not “just substitution.” Many medical studies since 1965 show that maintenance treatment helps keep patients healthier, keeps them from getting into legal troubles, and reduces the risk of getting diseases and infections that are transferred when needles are shared.

What is the right dose of Suboxone?

Dependence is a developed need to have the opioid receptors in the brain occupied by an opioid. Finding just the right amount of Suboxone to fill the receptors at the right rate is an important part of the induction process.

Every opioid can have stimulating or sedating effects, especially in the first weeks of treatment. The right dose of Suboxone is the one that allows the patient to feel and act normally. It can sometimes take a few weeks to find the right dose. During the first few weeks, the dose may be too high, or too low, which can lead to sickness, daytime sleepiness, or trouble sleeping at night. The patient may ask that family members help keep track of the timing of these symptoms, and write them down. Then the doctor can use all these clues to adjust the amount and time of day for buprenorphine doses.

Once the right dose is found, it is important to take it on time in a regular way, so the patient’s body can maintain consistent medication levels to avoid experiencing withdrawal symptoms.

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