Suboxone is composed of Buprenorphine and Naloxone in a sublingual or tablet form. Buprenorphine is a long acting partial opioid agonist which means that it binds loosely to the opioid receptors partially activating them. This helps to control withdrawal symptoms and cravings by producing less euphoria than a full opioid agonist. When on the correct dosage it does not allow any other full opioid agonists to bind to the receptors preventing their effects.
Buprenorphine is safer than other opioids as it does not produce respiratory depression which is the most common cause of death from overdose. It is commonly combined with Naloxone that produces withdrawal symptoms if a person were to attempt to crush, inject or snort the medication. There is a ceiling effect that occurs where past a certain point there is no further increase in the effects of the medication except increased withdrawal suppression and opioid blockade. These properties make it a common medication used in detoxification from opioids in detox and rehab centers.
The cost of the medication is about $8-$10 for an 8/2mg strip and is prescribed by a DATA-waivered physician. Dosing is usually 8-16mg per day with a maximum of 24mg per day.
Methadone is a long acting full opioid agonist developed in the 1940’s in Germany. It is an inexpensive drug that is commonly used in medication assisted treatment to help decrease cravings and withdrawals symptoms from heroin and other opiates. The average daily dose ranges between 80 - 120-mg and there is no maximum amount. It has a half-life of 15 - 60 hours which varies individually by genetic variability of the liver’s cytochrome enzymes that are involved in drug metabolism. Some people called ‘fast metabolizers’ may need to be on a higher dose while others may only need to take the medication every next day to get similar effects. It is usually given on a daily basis at special treatment centers that offer counseling and other social services. Because of it is a full opioid agonist it can be a good choice for people who are battling addiction and have chronic pain. As with other opioids, tolerance and dependence can develop which is why counseling is a vital part of the recovery process.
Methadone has been the drug of choice for pregnant women with opioid addiction to help minimize any withdrawal symptoms that may precipitate miscarriage or premature birth however the medication is not without risks. Similar to other opioids there is a risk of respiratory depression and overdose especially if mixing methadone with benzodiazepines. There is also risk of potentiating Long QT Syndrome which is why it is important for your physician to thoroughly review your current medications and past medical history before starting the medication.
The cost of participation in a methadone clinic which includes daily dosing and ongoing counseling ranges from $15-$20 per day.
Vivitrol is the injectable form of naloxone which is an opioid antagonist. It is a once monthly injection usually given after 7-10 days of detox. It works by competitive inhibition of the opioid receptor by displacing and further blocking any other opioid in the system. It binds so strongly that if that if a patient has not completely detoxed before getting the injection they may experience a ‘precipitated withdrawal’ when the medication competes and knocks off any existing opiates on the binding site. If a person relapses while on the medication the effects are not felt as the opioid receptors are occupied by the medication.
The ideal time to get a Vivitrol shot would be after completion of a rehab or detox. The medication costs ~$1400 and a prescription must be written by a doctor and ordered from a speciality pharmacy or through insurance.