I’m biased as I’m a big advocate of MAT and suboxone in particular but there are some key qualities of suboxone (and buprenorphine generally) that make it advantageous. For one, yes we can acknowledge that it is possible to abuse, misuse, or divert suboxone. However, in the context of a harm reduction model I think this is a risk that we can all accept. Bupe is a partial opioid against so it has a ceiling effect for both pleasurable/euphoric effects as well as respiratory depression whereas full agonists (methadone, heroin, fentanyl, etc) have no such ceiling effect. So bupe is much much safer (lower overdose risk) and much less likely to be abused than the full agonists. In my clinical experience most people who do “abuse” bupe or use it illicitly don’t do so to get high but merely to avoid withdrawal. If the goal is to get high then there are many other opioids that are far superior than bupe to achieve this goal. And if someone is going to abuse drugs, by administering them IV as you note, personally I’d prefer them to abuse bupe than almost any other opioid because they have a much lower risk of dying by overdose if they do so. Now, this is obviously not the goal of MAT but just my two cents.
These properties are why suboxone has generally fewer restrictions than methadone and why it can be prescribed virtually (though my guess is that this last point is subject to different state laws).
korndog4227 karma
I’m biased as I’m a big advocate of MAT and suboxone in particular but there are some key qualities of suboxone (and buprenorphine generally) that make it advantageous. For one, yes we can acknowledge that it is possible to abuse, misuse, or divert suboxone. However, in the context of a harm reduction model I think this is a risk that we can all accept. Bupe is a partial opioid against so it has a ceiling effect for both pleasurable/euphoric effects as well as respiratory depression whereas full agonists (methadone, heroin, fentanyl, etc) have no such ceiling effect. So bupe is much much safer (lower overdose risk) and much less likely to be abused than the full agonists. In my clinical experience most people who do “abuse” bupe or use it illicitly don’t do so to get high but merely to avoid withdrawal. If the goal is to get high then there are many other opioids that are far superior than bupe to achieve this goal. And if someone is going to abuse drugs, by administering them IV as you note, personally I’d prefer them to abuse bupe than almost any other opioid because they have a much lower risk of dying by overdose if they do so. Now, this is obviously not the goal of MAT but just my two cents.
These properties are why suboxone has generally fewer restrictions than methadone and why it can be prescribed virtually (though my guess is that this last point is subject to different state laws).
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