BenefitsSuboxoneof

Flexibility and Confidence

Contents

Introduction .................................................................................................... 3

Making the change ....................................................................................... 5

Symptom checklist ........................................................................................ 7

24-hour Symptom Diary ................................................................................ 8

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Why have I been given this booklet?You have already taken an important step towards gaining control over your opioid dependence. Your doctor now wishes to help you take the next step by giving you Suboxone, which offers a number of additional benefits to help you reach your treatment goals. This booklet has been created to assist you with the next step in your treatment.

What is Suboxone?Suboxone is a medication that – at the right dose – will help reduce your heroin use and stay in treatment by reducing your withdrawal symptoms and minimising your cravings for opioids. In this way, it can help you manage your opioid dependence and take the steps that are necessary to regain control of your life through counselling and/or other types of support.

Suboxone and Subutex have the same active ingredient – buprenorphine. However, Suboxone also contains naloxone in order to reduce the temptation to misuse the drug.

Why is naloxone added to Suboxone?You may already know of naloxone, a strong opioid antagonist, as something that can be used to reverse overdoses of opioids. It does this by knocking other opioids off the receptors in the brain. If Suboxone is crushed and injected or snorted, the naloxone will reduce the euphoric effects and cause withdrawal symptoms in a person dependent on full opioid agonists like heroin or methadone. However there is no reason for concern; if Suboxone is taken sublingually, the naloxone will NOT have this effect. Naloxone is NOT clinically active when the tablet is placed under the tongue as prescribed and does NOT interfere with the effectiveness of buprenorphine.

What are the benefits of Suboxone for me?There are several benefits of being on Suboxone. Firstly, Suboxone may provide your doctor with the confidence to allow you more flexibility in your treatment with alternate-day dosing or additional take-homes (where allowed). Not having to come into the clinic everyday should enable you to carry out the regular activities of your life. Talk to your doctor about flexible dosing options that may be available to you.

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MYTH “ Suboxone might cause withdrawal symptoms because of the naloxone component, even if taken as directed.”

FACTNaloxone was added to create opportunities for greater freedom in treatment because of its misuse-deterrent properties. If you take Suboxone under the tongue as instructed, the naloxone will NOT have a clinical effect. Suboxone and Subutex work in exactly the same way when taken as directed – ie, allowed to dissolve under the tongue.

MYTHbusTIng

Suboxone is effective at reducing withdrawal symptoms and cravings

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Secondly, Suboxone is less valuable on the street because it contains naloxone to deter misuse,1 so you are less likely to be pressured by others to sell your medication. Also, if you have a moment of weakness and are tempted to misuse your medication, the presence of naloxone may help you overcome the temptation, providing a form of silent support and encouraging you to stay on track with your treatment.

What are the side effects of Suboxone?

Buprenorphine– the active opioid ingredient in Suboxone – has similar side effects to those of other opioids. Reported side effects are usually mild and commonly include abdominal pain, diarrhoea, muscle aches, anxiety and sweating.

What is different about Suboxone vs subutex?• Suboxone will taste different to Subutex. It has a lemon–lime flavour to make it easier to take.

• It has a different shape and is a six-sided tablet instead of an oval tablet.

• As discussed above, Suboxone contains both buprenorphine and naloxone, whereas Subutex contains only buprenorphine.

Suboxone may offer additional flexibility for your opioid-dependence treatment.

Making the change

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How do I switch from subutex to Suboxone?You can transfer directly from Subutex to Suboxone. The buprenorphine content is the same and no dosage change should be necessary. If you do feel unsettled by the change for any reason, talk to your doctor. Although there is no medical reason why you should need a higher dose, it might help you to feel reassured in the early days following the switch.

It is advisable when beginning treatment with Suboxone, to stay in regular contact with your doctor to make sure that you are comfortable with your dose and progressing well with the treatment.

Tips for success with SuboxoneWhen: Take your Suboxone at the same time every day, exactly as your doctor recommends. Be sure to set up a routine that works for you and follow it consistently from day to day.

How: Place the Suboxone tablet(s) under your tongue and wait until they are fully dissolved.

• If your dose is two tablets, place both of them under your tongue, one on the left and one on the right of the centre.

• If you take more than two tablets, put the next tablet under your tongue after the previous

tablets have dissolved completely.

Tip your head forward and try not to swallow until the tablet is fully dissolved.

Why: Chewing or swallowing the tablets will reduce your body’s absorption of the medication and lessen its effect. By keeping the tablets under your tongue until they dissolve completely, you ensure that you get the full effect of your prescribed dose.

Suboxone and subutex are equally effective with the same duration of action.

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Dissolve time

Dissolve time depends on the moisture in your mouth and your dose (8-mg tablets take longer than 2-mg tablets because they are larger).

Set up a routine and stick to it. Once you have set up a routine that works for you, taking Suboxone in the same way each time will help make sure that you get a consistent dose.

Make your routine easy to follow. While the tablet is dissolving, do something relaxing to keep yourself occupied, such as listening to music or watching TV.

TasteIf you find the taste of Suboxone bitter, or worry about having a dry mouth or bad breath, a few simple changes to your routine can make a difference.

• Drink more water beforehand if your mouth gets dry.

• Try a breath-freshener or sugar-free lozenge after your dose.

Focus on the big picture: Suboxone can help you take the next step in your treatment.

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symptom checklistTracking any symptoms of withdrawal or intoxication will help your doctor to get to the right dose quickly. Use these to fill out your 24-hour Symptom Diary, which will help you communicate accurately how you felt after the initial doses. If you feel your symptoms are too unbearable, contact your physician. They can be easily treated with additional medications if necessary – ask your doctor for more information.

If you take too much SuboxoneWhen taken alone, symptoms of Suboxone intoxication are usually mild, and should not be life-threatening, but may require medical attention. Contact your clinic or visit your local hospital if you think you may be experiencing any of the following:

• Difficulty or slow breathing

• Confusion

• Problems with coordination

• Constipation

Reference1. Alho H, Sinclair D, Vuori E, Holopainen A. Abuse liability of buprenorphine-naloxone tablets

in untreated IV drug users. Drug Alcohol Depend. 2007; 88(1):75–78.

Early symptoms of withdrawal:

• Agitation

• Anxiety

• Muscle aches

• Increased tear production

• Insomnia

• Runny nose

• Sweating

• Yawning

Late symptoms of withdrawal:

• Abdominal cramping

• Diarrhoea

• Dilated pupils

• Goose bumps

• Nausea

• Vomiting

use this diary to monitor your symptoms after your first dose. Mark what time you took your first dose and fill out the table, beginning from your first dose, noting whether you experienced any of the following:

• Cravings – Rate your cravings on a scale of 1–5, with 1 corresponding to no cravings whatsoever, and 5 corresponding to a very strong desire to use.

• Withdrawal symptoms – refer to the symptom checklist (p11) and write down which symptoms you are currently experiencing. If you find them particularly uncomfortable, make a note of this.

• Intoxication symptoms – follow the same instructions as above.

Write down here anything else that you are feeling, for example when you feel happy, sad, anxious, angry or tired etc.

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24-HouR sYMpToM DIARY

Additional suboxone doses

1st dose:

Time:

2nd dose:

Time:

3rd dose:

Time:

4th dose:

Time:

number of 2 mg/0.5 mg

tablet(s)

number of 6 mg/ 2 mg

tablet(s)

Craving?(scale 1-5)

Withdrawal symptoms

other notesIntoxication symptoms

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Write down any questions or concerns that you would like to discuss with your doctor.

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Notes

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12Designed and produced by Pharmacom Media UK Ltd

Code: SBX-EU-PM-PCM1435-10/10-v1