Jun 12

Drug Fact Sheet: Methadone and Suboxone

Methadone and Suboxone Treatment Programs in Canada: Vancouver, Victoria, BCNorth America is in the grips of an opioid epidemic and on the front lines of pharmaceutical relief are Methadone and Suboxone. Many Canadian cities, especially Vancouver, Calgary, and Toronto are feeling the effects of hundreds of deaths due to opioid overdoses.  This fact sheet will help decipher exactly what Methadone and Suboxone are, how they help opioid users during detox, and what changes are happening in Canada to help more people access these medications. Interested persons can browse this website for a listing of the best public and private drug rehab and alcohol treatment centres in their province of city.

What are Methadone and Suboxone?

A 2013 Canadian review outlines what Methadone and Suboxone are and how they differ. Methadone is an opioid receptor agonist. Suboxone is a combination of an opioid receptor agonist (Buprenorphine) and an opioid receptor antagonist (Naloxone). Methadone attaches to the opioid receptors in the brain and blocks the high from opioids like codeine and heroin. It was originally developed in 1937 to help those suffering from extreme pain. Methadone today allows people to manage the often painful opioid withdrawal symptoms while also preventing them from experiencing a high if they do go back to illicit substances. Without pharmaceutical intervention like this, over 80% of people who detox from opioids go back to using substances very shortly after.

Buprenorphine, a component of Suboxone, helps aid in the relief of withdrawal symptoms as well, but is not as strong as methadone. Combined with Naloxone it creates Suboxone. The addition of Naloxone is to prevent abuse of the medication. If someone were to inject Suboxone instead of taking it as prescribed (ie. tablet form) the Naloxone gives sudden severe withdrawal symptoms. The addition of Suboxone to doctor’s repertoire is clearly needed. In 2013 in the USA, Suboxone sales outpaced both Adderall and Viagra combined. Suboxone only became legal in Canada and the USA in the last ten to fifteen years so studies on its effectiveness are young. However, researchers so far believe it to be much safer than Methadone due to it being harder to abuse.

Recent Prescribing Changes

Until March 2018, accessing Methadone could be difficult for Canadians in rural areas like Northern Alberta and the Atlantic provinces. The federal government had Methadone classed in a way that doctors needed to apply for an exemption in order to prescribe it. Thankfully, the Health Minister recently announced changes so that doctors can prescribe methadone and prescription heroin without an exemption. Before this, only certain provinces like BC, Saskatchewan, Ontario, and Quebec had provincial guidelines that allowed for more leeway.

This was not the only interesting announcement to come out in March. A brand new set of guidelines were released on behalf of the Canadian Research Initiative in Substance Misuse that gave doctors in Canada a much better idea of what they can do to help those with opioid problems. The new guidelines recommend that family physicians should be prescribing Suboxone as the first line of treatment (with Methadone as a secondary option); that they should treat patients with opioid addiction as chronic condition patients like those with diabetes and heart conditions; and that detox should not be recommended unless the patient can go immediately into long term evidence-based treatment.

Withdrawing from opioids, even with medical supervision, puts the substance user in a position to overdose should they relapse, and many do. The guidelines note that many residential treatment facilities are abstinence-based, and so do not allow people stabilized on Methadone or Suboxone to enter treatment. The recommendation is that these inpatient rehabs use these medications to stabilize their clients while they go through the various other therapies. While most facilities are still abstinence-based, there are a few evidence-based rehabilitation centres, like Sunshine Coast Health Centre in BC, that use Suboxone for their opioid clients. If you are trying to come off of opioids and need help finding a treatment facility, please contact our specialist for options.

 

References:

JMC 2018.05.24

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