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In 2002, the U.S. Food and Drug Administration approved two drugs for the treatment of opioid dependence: Subutex and Suboxone^®. Subutex contains only buprenorphine and is used during the induction period. To guard against misuse of buprenorphine, Naloxone was later added to buprenorphine, creating Suboxone^®, which is used in the maintenance phase of treatment.^1,2 There are a number of advantages to this unique medication, including the following:

• It can be prescribed by a qualifying physician in-office, eliminating the need to make scheduled trips to a regulated clinic.
• It suppresses withdrawal symptoms, cravings, and does not cause euphoria.
• The abuse potential is significantly lower than when using methadone and naltrexone.³

Medication-assisted treatment is a comprehensive program that includes the use of Suboxone^® along with education, counseling, and other support measures.^3,4 Therefore, while using Suboxone^® alone can diminish cravings and withdrawal, it is also important that patients receive a combination of individual, family, and/or group therapy counseling on the road to recovery.

What you can do

There is growing concern with the misuse and diversion of buprenorphine. Distribution to pharmacies, hospitals, narcotic treatment programs, and other dispensing establishments has increased from 13,475 in 2003 to 1,451,503 in 2010. The number of patients receiving Subutex or Suboxone^® from outpatient retail pharmacies in the United States has increased from slightly less than 20,000 in 2003 to more than 600,000 in 2009. In 2009, 97 percent of these prescriptions were for Suboxone^®, up from 77 percent in 2003.⁵

As part of the direct supervising process for providers, working with a single pharmacy can be advantageous with prescription monitoring. Random drug screens should be obtained to oversee compliance with Suboxone^® and abstinence from other substances (e.g., sedatives and other opiates). Sedatives, such as benzodiazepines, taken in combination with buprenorphine can lead to significant respiratory depression and death.⁶ Patients should be warned about the dangers of the drug-drug interaction.

Many individuals will face a relapse, resuming substance abuse. Recovery meetings through Alcoholics Anonymous and Narcotics Anonymous offer unique support and advice by allowing people to vent, listen, and compare their individual experiences – all in hopes that they will find the inspiration they need to travel the road to recovery.⁷ When additional help is needed, providers should instruct patients to contact their mental health/substance abuse services provider. Members with Magellan Healthcare, Inc. coverage for mental health/substance abuse services can call 1-800-424-4238. Please discuss the importance of these resources with your patients.

¹ https://www.naabt.org/faq_answers.cfm?ID=2
² http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm191523.htm
³ http://psychcentral.com/lib/how-is-suboxone-treatment-different-than-drug-abuse/
⁴ http://www.samhsa.gov/medication-assisted-treatment
⁵ http://www.cesar.umd.edu/cesar/pubs/20110915%20Buprenorphine%20CESAR%20FAX.pdf
⁶ http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf
⁷ http://www.addiction-recovery.com/AA-meetings-NAmeetings.php

Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most Independence Blue Cross members.

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