Key Points

  • Opioids are used to relieve pain, but they are highly addictive. Examples include hydrocodone, oxycodone, codeine, fentanyl, methadone, morphine, and heroin
  • Opioid addiction produces painful cravings that often cause individuals to relapse
  • Reducing drug cravings and withdrawal symptoms helps people stay sober
  • Suboxone is a medication that helps reduce withdrawal symptoms and diminishes cravings for opioids
  • Suboxone is a combination of buprenorphine and naloxone
  • Buprenorphine blocks the action of opioids, while naloxone prevents the misuse of opioids

Opioid Use Disorder (OUD) afflicts over 2.5 million adults in the US.[1] It’s a complex illness, and the urge to start using again can feel overwhelming. That’s because of drug cravings. These are intense urges to use opioids that can last for months or longer. Drug cravings are a major driver of relapse that feeds the cycle of addiction.

Fortunately, medication-assisted treatment (MAT) is a viable option for some recovery treatment plans.[2] MAT for OUD uses Suboxone, a medication that helps reduce cravings and makes long-term recovery possible.[3]

How Does Suboxone Work?

Suboxone is used in medication-assisted opioid treatment. It is an FDA-approved medication for the relief of withdrawal and cravings from opioid drugs.[4] Sublocade, Brixadi, and Subutex are also brand names for Suboxone. It’s a prescription-only combination of two medications: buprenorphine and naloxone.[5]

Opioid drugs work by binding to the mu-opioid receptors in your brain.[6] When these receptors are on, dopamine floods your brain, increasing feelings of pleasure and well-being. Additionally, when opioids are bound to these mu-opioid receptors, pain signals are suppressed.[7]

It works like this with typical opioids:[8]

  1. A person takes an opioid drug.
  2. Once the opioids reach the brain, they attach to mu-opioid receptors in the brain.[9]
  3. These receptors are located on specific neurons that slow down the action of other brain cells.
  4. When opioids activate the receptors, they stop those “slowing down” neurons from working.[10]
  5. Because the “slowing down” (inhibitory) effect is removed, other neurons that release dopamine become more active.
  6. This increased activity causes a rush of dopamine into areas of the brain associated with pleasure and reward.[11]

Opioid drugs don’t create new dopamine. Instead, they take the brakes off the systems that regulate dopamine levels, causing them to skyrocket.[12]

Buprenorphine

Buprenorphine is a little different from other opioids.[13] It doesn’t cause intense euphoria. Although there may be a mild “lift” from taking it, it’s not highly intoxicating.[14] That’s because buprenorphine only partially binds to the receptor sites.

Think of it like a key stuck in a lock. The lock won’t open, and the means of opening the lock are blocked. Nothing can slide into the keyhole until it is unblocked. Buprenorphine sticks to the brain’s opioid receptors so firmly that other opioids can’t act on them.

Naloxone

Naloxone helps prevent Suboxone from being misused.[15] By itself, buprenorphine can magnify the euphoric effects, but paired with the opioid antagonist naloxone, it prevents this form of misuse.

If Suboxone is misused by being injected, it triggers precipitated withdrawal, preventing buprenorphine’s full opioid effect–in other words, no euphoria.[16] Precipitated withdrawal can be painful, even debilitating, which discourages misusing Suboxone.

How-Does-Suboxone-Work-understanding

How Buprenorphine and Naloxone Work Together

You might wonder if naloxone is so good at knocking opioids out of the brain’s mu-opioid receptors, why isn’t buprenorphine affected?

Naloxone doesn’t “kick off” buprenorphine from the opioid receptors, especially when Suboxone is taken as prescribed (under the tongue).[17]

There are a few key reasons for this:

First, when Suboxone is taken sublingually (under the tongue), very little of the naloxone is absorbed into the bloodstream.[18] This means it doesn’t reach the brain in high enough amounts to have a significant effect on the buprenorphine that’s already there.

Second, buprenorphine has a very high “affinity” (which means it sticks very strongly) to the opioid receptors. It binds so tightly that it’s difficult for other opioids, even naloxone, to dislodge it once it’s attached.[19]

Third, buprenorphine has a long “half-life,” meaning it stays in the body and on the receptors for a long time (24 to 70 hours). Naloxone, on the other hand, has a very short half-life (around 30-40 minutes).[20] Even if some naloxone were to temporarily displace buprenorphine, its effects would be very short-lived.

However, if Suboxone is misused by injection or snorting, more naloxone is absorbed, and in these cases, the naloxone can indeed become active and trigger precipitated withdrawal.[21] This is why naloxone is included in Suboxone.

So, the difference is:

  • Buprenorphine: Attaches and partially activates the receptor, reducing cravings and withdrawal.
  • Naloxone: Attaches and blocks the receptor, preventing or reversing opioid effects.

How Do People Take Suboxone?

Suboxone comes in several forms, including a thin sublingual film.[22] You put it on the inside of your cheek (sublingual) or under your tongue. As it dissolves, it enters your bloodstream through the mucosal lining of your oral tissues.

Suboxone also comes in sublingual tablets. It may also be given as an injection.[23]

How Suboxone Works in Addiction Treatment for Opioid Use Disorder

Suboxone helps people manage two painful problems that come from opioid use disorder: withdrawal and cravings.[24] Cravings to use opioids can feel irresistible. Withdrawal symptoms range from uncomfortable to debilitating. Withdrawal symptoms and opioid cravings diminish over time, but they are major relapse triggers until they do.[25]

When someone takes higher doses of opioids for longer than prescribed, their body builds tolerance.[26]This means they need more of the drug to feel the same effects. Over time, the brain reduces production of its natural chemical signals, including those that regulate dopamine.

Consequently, the person becomes dependent on the opioid drug to function normally and feel balanced.

Buprenorphine helps to reduce withdrawal symptoms and cravings, while naloxone blocks the effects of opioid drugs if someone attempts to misuse the medication. This combination allows patients to feel relief from withdrawal while also providing an extra layer of protection against relapse.

Addiction treatment of opioid dependency with buprenorphine produces the best results in combination with counseling services. Counseling services can include different forms and intensities of behavioral therapy and self-help programs.[27]

If you or a loved one is struggling with opioid use, help and healing are available. With tools like Suboxone, professional, compassionate therapy, and support, you can live the life you want.