BL1 asked
My doctor considered it best for me to go back to Suboxone, which was prescribed for a month supply, when and if will I be able to receive a prescription for oxycodone, or another opioid, medication if the pain specialist sees fit?
Answer
Suboxone is a combination drug that contains both buprenorphine and naloxone. It is commonly prescribed for opioid dependence and in those who have had issues in the past misusing opioids. It is available as sublingual tablets or as sublingual films and comes in the following doses:
- Buprenorphine 2 mg/naloxone 0.5 mg
- Buprenorphine 4 mg/naloxone 1 mg
- Buprenorphine 8 mg/naloxone 2 mg
- Buprenorphine 12 mg/naloxone 3 mg
To better understand when it is safe to take other opioid medications, such as oxycodone after Suboxone, we discuss a little about how Suboxone works.
What Do The Drugs In Suboxone Do?
Buprenorphine
Buprenorphine is the medication in Suboxone that is responsible for the effects of the drug. Unlike commonly used opioids such as morphine, oxycodone and hydrocone, which are full opioid agonists, buprenorphine is a mixed agonist/antagonist. This means that it is an agonist (actually a partial agonist) at mu receptors and an antagonist at the kappa receptors.
The mu agonist effects translate to analgesia while the antagonistic effects at the kappa receptors produce less effects on respiratory depression, dysphoria and euphoria when compared to full opioid agonists like oxycodone. Basically, buprenorphine helps with pain relief and doesn't have the propensity to cause breathing issues or the effects that traditional opioids do.
Naloxone
Naloxone is a full opioid antagonist at the mu receptor. In fact, it is used for opioid overdoses as it reverses effects of opioids acting on the mu receptor.
When Suboxone is used as directed (sublingually or buccally), the effect of naloxone is minimal due to low bioavailability. It is added to Suboxone for the sole reason of deterring abuse. If Suboxone is injected, not only will the effect of buprenorphine will be reduced, it may even precipitate withdrawal.
It is important to note that naloxone in these formulations in NOT absorbed well and generally will NOT have any noticeable effect if taken as prescribed. Naloxone is simply added to Suboxone to prevent abuse of the drug.
When Can You Take Oxycodone And Other Opioids AFTER Suboxone
If you are currently on therapy with Suboxone (buprenorphine/naloxone), taking any opioid medication (e.g. oxycodone, hydrocodone) will often have little to no effect. In other words, the effects of taking an opioid will be greatly diminished if you are already taking Suboxone. This is due to how Suboxone interacts with the mu opioid receptors in the body.
Buprenorphine binds very strongly to the mu receptors. This binding to the mu receptor generally lasts for at least 24 hours. When buprenorphine binds to mu receptors, it essentially "blocks" other opioid drugs from binding to the mu receptor. Therefore, if you take any other opioid medication, it will be unable to bind to the receptor and thus will not produce any effect.
Based on how buprenorphine works, you could begin taking other opioid medication, such as oxycodone, with good effect once buprenorphine is no longer bound to the opioid receptors in the body, about 24 hours.
In regard to when you will be prescribed an opioid medication other than Suboxone for your pain, that certainly will be based on a conversation that needs to take place between you and your doctor.
