Do you feel any pain if you’re taking Suboxone? That depends. Suboxone, a combination drug product containing the semi-synthetic narcotic buprenorphine and the opioid overdose rescue drug naloxone, is intended mainly for use in MAT or medication-assisted treatment for opioid addiction. Suboxone works by occupying the same brain receptors as other opioids do. These receptors are known as the mu, the delta and the kappa. Although all three are thought to play roles in pain relief, it’s the mu that’s most responsible for pain relief, sedation, euphoria, death from respiratory depression, and addiction.
Meet the Mu Opioid Receptor
The most effective pain medications, including oxycodone, fentanyl, and morphine, target the mu receptor and activate it fully. This is the main reason for their effectiveness as pain killers. Methadone also targets the mu receptor fully and is perhaps the most effective oral pain killer ever made. However, it has a long half life and works very slowly. This is why it tends to produce far less euphoria than other full narcotics. It’s also why it’s used in opioid MAT. Other reasons include its long half-life of at least 36 hours. This means it takes the body 36 hours, a full day and a half, just to break down one-half of the dose taken. This is why is keeps opioid addicts free from withdrawal symptoms and drug cravings for at least a full day. After a certain blood level is reached, some methadone patients can get by with only one dose every other day.
Full and Partial Narcotic Agonists
There are two types of narcotics: Full and partial. A full agonist activates the mu receptor completely and produces the best analgesia and sedation. Unfortunately, this activity at the mu receptor also produces tolerance, physical dependence, and in prone individuals, addiction as well. It also puts the user at risk of fatal outcomes if more drug is taken than the person can tolerate. When opioids are taken in the long term, the body will build up a tolerance. This means the user must take more and more of the drug to get any effect. It also means that this user can take truly amazing amounts without respiratory depression.
For example, a typical dose of oxycodone for a new or what is called naive user would be typically no more than 10 milligrams. This would produce profound effects on this person. However, someone with a very high tolerance developed over many months or years might be able to take as much as a hundred or more milligrams without any threat of overdose! That’s what an opioid tolerance can do. Other drug classes produce tolerance, too, but not to the extreme of opioids.
A partial opioid agonist means the drug activates the mu receptor, but only partially. Examples include pentazocine, kratom, nalbuphine, and buprenorphine in Suboxone. Partial agonists are highly limited in their ability to produce the euphoria opioid addicts so covet. The idea behind Suboxone therapy is to activate the mu receptor just enough to reduce or prevent withdrawal symptoms and allay the drug cravings that cause relapse.
This partial activity at the mu receptor is a dual-edged sword: It may prevent withdrawal symptoms, but because it cannot fully activate the mu, partial agonists like buprenorphine tend to be rather unacceptable for pain relief when compared to full agonists. Most opioid-tolerant people will not get much pain relief from Suboxone, although the drug is sometimes prescribed for that purpose alone. Overall, Suboxone isn’t a good choice for chronic pain or any kind of pain, especially if it’s moderate to severe. Although some people will report good pain relief from Suboxone, most will not. If you’re taking Suboxone as part of an MAT program, you will likely not get enough pain relief from it. Suboxone is a far better MAT agent than it is an analgesic.
Suboxone also blocks the mu and other opioid brain receptors. For MAT, this is a desirable effect because if someone takes a full agonist while the buprenorphine is active on the brain’s opioid receptors, there will likely be no high. This is because buprenorphine has a higher preference for the receptors. As long as the buprenorphine molecule is occupying the receptor, nothing else can. Buprenorphine can also kick other opioids with less affinity or preference of the receptors so it can occupy them themselves.
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If you’re struggling with opioid addiction, we understand what you’re going through. Call us anytime at 844-903-2111 for compassionate assistance with finding treatment solutions in your area. We look forward to helping you.