H1: How Suboxone Works in the Brain: Mechanism, Withdrawal, and Cravings
I am Willian Conway, MD, FACP, FASAM. I have been treating patients with Suboxone since 2011 in Nashville
Suboxone works in the brain by making the reward pathways normal again. The brain receptors, mu receptors, are returned to normal by a constant supply of suboxone. Understanding how suboxone works can reassure you for a drug that is the foundation of your recovery. To benefit from this remarkable treatment optimally, you must have faith and understanding that you are making the right decision for you, Your recovery depends upon you.
H2: What You Will Learn About Suboxone?
- How Suboxone is special
- How Suboxone works in the Brain
- Suboxone stopping withdrawal
- How Suboxone is a Treatment
- Suboxone and recovery
- Duration of treatment with suboxone
- Treatment in Nashville with Suboxone
H2: What Happens in the Brain During Opioid Addiction
The reward pathways of the brain are a complex electrical chemical machine, intricately designed and operated. For the brain to function, chemical signals stimulate sites on cells specifically designed to respond to them. We call those sites receptors.
The body has an innate, or endogenous, chemical system that stimulates pleasure or relieves pain. The body has its own intrinsic opioid system called endorphins.
Opioid receptors are called mu receptors. These MU receptors have an intrinsic responsiveness to endorphins. These MUs can increase or decrease their level of responsiveness to Mu receptors.
When the brain receives a constant external supply of opioids such as hydrocodone, OxyContin, or Fentanyl, the MU receptors become much less responsive. This decrease in responsiveness is called tolerance. For the MU receptor to respond, a steadily increasing external opioid concentration is required. For the brain to feel normal, it requires constant external opioids. In the absence of external stimulation, the body goes into withdrawal.
- Tolerance is a mu receptor requiring more external opioids.
- Withdrawal is the MU Receptor not receiving sufficient external stimulation.
- Dependence is the MU receptor requiring constant external opioids.
Suffering from opioid addiction is not a weakness. The suffering occurs because the brain has been reprogrammed for survival around opioids.
H2: How Does Suboxone Work in the Brain?
The Mu receptor is key to understanding disease progression. The fundamental concept is that the normal person has a mu receptor, which is very responsive and sensitive to the body’s intrinsic opioid system, and to occasional opioids given for pain.
With constant use of hydrocodone, OxyContin, or Fentanyl, the receptor reduces its sensitivity, and the receptor requires a constant external ingestion of opioids to keep normal.
Suboxone contains Buprenorphine. Buprenorphine binds to the MU receptor very tightly. When binding to the MU receptor, Buprenorphine partially activates it.
Suboxone does the following:
- Receptors are occupied and stabilized.
- Prevents other options from attaching.
- Normal receptor responsiveness is reestablished.
H2: Why Does Suboxone Stop Withdrawal Symptoms?
With the consistent use of Hydrocodone, OxyContin, Fentanyl, or other opioids, the MU becomes much less responsive. The MU receptor, when less responsive, requires constant external administration of opioids to feel normal.
Withdrawal is under-stimulated Mu receptors. Suboxone, or Buprenorphine, provides enough activation of the Mu receptor to stop physical withdrawal.
When Suboxone relieves withdrawal, the following symptoms are relieved.
- Muscle aches
- Anxiety/restlessness
- GI distress
- Sweating
- Chills
For the patient with opioid addiction who is beginning Suboxone, rapid stabilization occurs within hours. The patient feels normal again. The patient is no longer getting “high.” The patient is returning to baseline function.
H2:How Does Suboxone Reduce Cravings?
Cravings are intensely uncomfortable. Cravings are receptor-driven or biological. Cravings are also learned behavior.
Suboxone keeps the receptors occupied, reducing withdrawal symptoms and the biological drive. If the patient slips and takes opioids, Suboxone blunts the reward of cravings.
Suboxone is a long-lasting drug. The long duration of action is produced.
- Stable blood levels
- Stable biological effect
- Eliminates the cycle of High, Crash, Craving, Use
With Suboxone, patients regain mental space.
H2: Suboxone vs Opioids: What Makes it Different?
Suboxone acts differently at the Mu receptor. In fact, Suboxone has unique qualities that provide effective, healing benefits for my patients.
Buprenorphine, the active component of Suboxone, is classified as a partial opioid agonist. This means:
- It activates the Mu receptor, but only to a limited extent.
- After a certain point, increasing the dose does not increase the opioid effect further.
- Buprenorphine does not stop breathing at high doses, unless it is mixed with benzodiazepine,
- The natural ceiling effect is central to its safety and effectiveness.
Buprenorphine is a long-acting drug. The half-life is almost seven days. The long half-life of its tight binding at the Mu receptor has the following profound effects, which my patients consistently demonstrate in the clinic.
- There is no cycle of intoxication and crash.
- The risk of death from respiratory depression is much reduced.
- The brain and the patient are stabilized rather than overstimulated.
Buprenorphine binds to the Mu receptor very tightly. This means.
- Other opioids cannot easily attach.
- If other opioids are used, their effect is blunted or blocked.
Buprenorphine is designed not to create a “high,” or euphoria.
The purpose of Buprenorphine is to
- Stabilize the brain.
- Restore function.
- Allow normal life to return.
My patients consistently tell me that Buprenorphine has given them their lives back. My patients consider Buprenorphine to be a “miracle drug.” Without exaggeration, I agree with their observation.
H2: Is Suboxone Addictive or Replacing Opioids?
This is a common misunderstanding. Suboxone is a treatment for opioid use disorder. Suboxone is not an addiction. In my practice, this belief is one of the most common reasons for failure of suboxone treatment.
H2: Is Suboxone Safe for Long-Term Use?
I have prescribed Buprenorphine to patients since 2011 in Nashville. I have studied Buprenorphine since 2011. Unlike methadone, Buprenorphine is a relatively new drug. We do not have 5o years of experience with Buprenorphine. The consensus opinion and the standard of care are that Buprenorphine can be used long-term safely without causing organ damage.
Patients often ask if Suboxone can be taken safely for years. The answer, based on both clinical and medical evidence, is yes.
Suboxone is the long-term treatment of opioid use disorder. Suboxone allows.
- Return to work, family life, and stability.
- Eliminates cycles of withdrawal and relapse.
- Reduces risk of overdose.
H2: How Long Should You Stay on Suboxone?
The duration of treatment with Suboxone for a given patient in Nashville is a matter of judgment and preference. In my experience, patients commonly choose one of the three courses.
- Discontinue in the first month.
- Discontinued in the first year.
- Discontinue in a few years.
- Long-term use with no plan for discontinuation
The objective of treatment is stability. When the patient believes that he has achieved stability, or when the patient decides that the costs of treatment exceed the benefits of treatment, then the patient elects to discontinue Buprenorphine.
The clinical effect of Buprenorphine changes over time, in my anecdotal, limited clinical experience with relatively few patients over a relatively short time. However, for those patients who elect to stay on Buprenorphine long term, each patient has decided that Buprenorphine is profoundly beneficial.
H2: Stages of Recovery While Taking Suboxone
In my experience watching patients recover in my practice, recovery can be divided into three distinct stages.
- Early recovery is concerned with stabilization.
- Middle recovery is concerned with comorbidities.
- Late recovery is involved with aging.
H2: What are the Risks of Suboxone?
In common, ordinary life in Nashville, Tennessee, Buprenorphine is dangerous in one of two circumstances.
- A combination of Buprenorphine can produce death from stopping breathing.
- Short-term use of Buprenorphine, followed by return to prior illicit opioid use, can result in death.
Benzodiazepines are sedatives. Benzodiazepines are alcohol in a pill. Benzodiazepines are highly addictive. The profound danger and profound addictiveness of benzodiazepines have long been recognized. Dr. Marie Nyswanager, MD, the co-investigator of methadone maintenance treatment, refused to admit any patient using benzodiazepines for treatment. My experience with patients with benzodiazepine addiction has confirmed to me the profound hold benzodiazepines have on patients, and the profound difficulty patients have achieving recovery from benzodiazepine addiction. The addition of a benzodiazepine to Buprenorphine changes a relatively safe treatment into a treatment with greater risk.
When patients participate in a buprenorphine recovery program, the brain’s reward pathways return to normal within a relatively brief period. The profound tolerance that the patient had to Fentanyl, OxyContin, hydrocodone, or other opioids quickly reduced. This means that the brain’s mu receptors and respiratory receptors will respond to much lower doses of opioids than before the patient entered buprenorphine recovery treatment. Death can occur in the following circumstances.
- The patient takes Buprenorphine in a recovery program.
- The patient discontinues the buprenorphine recovery program.
- The patient immediately relapses, taking the same dose of Fentanyl, OxyContin, or hydrocodone as before.
- Stopping breathing (respiratory arrest) occurs at the time of death.
The most common setting in America where this occurs is when patients in corrections who are on Buprenorphine in prison are discharged home, immediately discontinuing the Buprenorphine, and immediately beginning illicit opioids again.
If a benzodiazepine is not taken with Suboxone, and if the patient does not start illicit opioids after Buprenorphine, buprenorphine maintenance treatment is relatively safe.
H2: Suboxone Treatment in Nashville
My practice is designed to be private medicine. My primary care internal practice in Nashville is intentionally small, so that I can have ample time with everyone, allowing me to remember you, your medical history, and your preferences. If this fits you, please contact me
H2: Frequently Asked Questions about Suboxone?
- Is suboxone safe?
Suboxone is a very safe treatment if you comply with Tennessee rules
2. How do Xanax and suboxone mix?
They do not mix. The combination can produce death.
3. Is Suboxone a foundation of recovery from opioids
Yes, Suboxone is a foundation of recovery from opioids
4. How long should you remain on Suboxone?
It is best to remain on suboxone until you are stable and capable of maintaining a recovery. You have choices concerning your duration of treatmne
Conclusion
My work is to walk with you through those decisions — quietly, steadily, and without judgment. I am William Conway, MD, in Nashville. If you are in Suboxone, please contact me.
📞Call 615-708-0390
