The question, can suboxone be used to treat pain, often comes up with patients who suffer from addiction but are also experiencing pain. Patients with a history of addiction are often fearful of using opioids for fear of relapse. Suboxone is not currently FDA approved for pain but has been used off-label for the treatment of pain.
Off-label is a practice of prescribing medication for different indications from their FDA approval.
What is Suboxone?
Suboxone is FDA approved for the treatment of opioid use disorder. Suboxone contains buprenorphine and naloxone. Buprenorphine is a partial opioid agonist which means it partly activates opioid receptors. If someone takes an opioid before buprenorphine dosing, the buprenorphine can displace the opioid and precipitated withdrawal may occur.
It’s partial activation at the mu-opioid receptor also creates a ceiling effect which lowers the risk of respiratory depression (slowed breathing) compared to full opioid agonists.
Naloxone is an opioid antagonist that is activated when suboxone is not taken sublingually (under the tongue). Activation of Naloxone results in withdrawals. Naloxone blockade serves as a diversion safety mechanism to prevent suboxone misuse (injecting, snorting, etc.).
A review of medical literature has shown good outcomes in using sublingual buprenorphine for the treatment of chronic pain.
Prescribing Buprenorphine for Pain
Buprenorphine is 25-100 times more potent than morphine and has properties that make it a suitable candidate for chronic pain management. In addition to buprenorphine partial agonist activity at mu-opioid receptors, it is a kappa opioid receptor antagonist (which resists depression) and a nociceptin reception agonist (which is involved in pain relief).
Butrans and Belbuca are FDA approved buprenorphine products for pain management.
Butrans is available as a transdermal patch. It’s important to note that it is indicated for the treatment of chronic pain, and should not be taken as needed.
Belbuca is a buccal formulation (absorbed in inside the cheeks). It is FDA approved for severe, chronic pain.
Suboxone for Pain
When you’re prescribed suboxone for pain management only and not opioid use disorder, the prescription will indicate the pain diagnosis. In this scenario, an X number (unique number required to prescribe buprenorphine for opioid use disorder) is not needed, and it does not count towards the DATA 2000 buprenorphine patient limits.
For practitioners who are prescribing suboxone for pain and opioid use disorder, this would fall under DATA 2000 and go against buprenorphine patient limits.
Challenges to Prescribing Suboxone for Pain
Using medications off-label may result in health risks and potential legal implications. Also, some pharmacist may be hesitant to fill the prescription without an X-number in the setting for pain only.
Another challenge in prescribing suboxone for pain is insurance companies may not approve it for off-label use.
In conclusion, while suboxone has been prescribed off label for pain management, the decision must be weighed carefully. Consultation with an addiction specialist and pain management is strongly recommended.
Discuss any problems with your doctor.
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