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How does Suboxone work to treat addiction to heroin or oxycodone


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Dee Bonney M.D. - Greenwood Suboxone Doctor
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How does Suboxone work to treat addiction to heroin or oxycodone?

To answer how Suboxone works, I need to explain a little physiology. Our body has receptors that, when bound by a substance, cause an effect on the rest of the body. The substance that binds to a receptor is called an agonist. When an agonist binds to a receptor, there are things that occur, depending on the type of receptor it is. When the opiate receptor is bound by an agonist such as heroin there can be pain relief, euphoria (feeling high), sedation, and breathing can slow or stop altogether.

One effect of opiates on the brain is a surge in dopamine. Dopamine is a reward neurotransmitter. It is the reason we like food and sex. When heroin or oxycodone binds to the brain’s opiate receptor, dopamine is released and there is a feeling of intense euphoria. When the agonist is no longer sitting on the receptor, the dopamine levels return to normal. However, over time as a person continues to use heroin, for example, the brain starts to not make dopamine on its own unless the person takes an opiate. When dopamine levels are below normal, the person feels drug sick and has withdrawal. That’s why the cycle of addiction is so hard to break.

Suboxone is an opiate that is a partial agonist compared to heroin, fentanyl, hydrocodone, and oxycodone, which are full agonists. Even though Suboxone is itself a controlled substance and an opiate, treating addiction with this substance is not “trading one addiction for another.” For a deeper dive into why this is, see my other blog here.

A partial agonist binds to the same opiate receptor in the brain as its full agonist counterpart. However, as the name implies, a partial agonist only partially engages the receptor, and, therefore, does not cause all the effects of a full-bound receptor like when heroin or oxycodone attach. As a partial agonist, Subxone’s effect on sedation and respiratory depression has a ceiling: taking more does not cause more sleepiness or lack of breathing. However, when a full agonist, such as heroin, is taken, its effects continue to increase the more it is taken. This is the reason why when a person overdoses on heroin his or her breathing stops. This can be reversed with naloxone.

Not only is Suboxone a partial agonist and, therefore, not prone to cause over-sedation, but it also has a high affinity for the opiate receptor in the brain. This affinity means that it binds tighter to that receptor than a chemical with a lower affinity. When Suboxone is sitting on the opiate receptor, drugs like heroin, oxycodone, or hydrocodone cannot get to the receptor because their affinity is much lower. As a result, when a person is taking Suboxone, there is a protective effect from relapse: using heroin while on Suboxone has little or no effect and is very unlikely to cause a person to stop breathing.

If you or a loved one is struggling with an opioid or alcohol addiction, please give us a call at 317-300-4091. We have physicians, nurse practitioners, and counselors who are interested in helping you get free from the bondage of addiction.