The guideline recommends that Suboxone (buprenorphine–naloxone) be used as a first-line treatment whenever possible to reduce risk of toxicity and death.
The drug is used as a replacement for opioids to prevent severe withdrawal symptoms, but has a much safer side-effect profile than methadone, the medication traditionally prescribed for opioid addiction.
“In British Columbia, in about one in four prescription opioid overdose deaths, methadone is actually the culprit,” said Dr. Evan Wood, director of the BC Centre on Substance Use and senior author of the guideline.
Suboxone blocks the opioid receptors in the brain, and produces less of a high than methdone.
It’s also harder to overdose on — but not impossible, especially when mixed with alcohol or other drugs.
“Methadone has an effect where by you can have a buzz. It’s something that can make you very tired and drowsy,” Andrew said.
“I’ve seen a lot of people continue to use on methadone, on drugs that can be cleared out of your system quickly.”
It can be crushed and injected and when combined with alcohol and other drugs [it] can be very, very dangerous.”
Methadone is a liquid that is diluted with a juice to be swallowed quickly. People on Suboxone could take as many as four tablets.
But there are far more doctors prescribing opioids than doctors prescribing treatment to get off those drugs.
“I think methadone will always be part of the treatment process,” he said.
“Experts tell me that there are a group of people for whom Suboxone simply won’t work and methadone is the drug for them. But it’s a second line treatment, not a first line treatment.”