Health Canada has released Suboxone® for the substitution treatment of opioid drug dependence in adults. Suboxone® combines the partial agonist buprenorphine, a proven therapy for opioid dependence, and the opiate antagonist naloxone, which limits intravenous misuse and the potential for diversion. The naloxone component of Suboxone® has limited sublingual and oral bioavailability, and is inactive when Suboxone® is taken as prescribed.
Although it is not felt that Suboxone® will replace methadone for the treatment of opioid dependence, there are situations when this treatment modality might be preferred. Suboxone® sublingual tablets should only be prescribed by physicians who have experience in substitution treatment of opioid drug dependence. For this reason, Suboxone® may only be prescribed under the following circumstances:
- The physician must hold an exemption to prescribe methadone for opioid dependence.
- Physicians must have completed the online education module by Schering-Plough Canada available at www.suboxonecme.ca. Completion of this module is based on an honour system, and will not be verified except in unusual circumstances.
- Suboxone® must be prescribed on a duplicate prescription pad.
- Daily witnessed ingestion (DWI) for the first two months or until such time as stability is established by the usual criteria. (Refer to the College's Methadone Maintenance Program: Clinical Practice Guideline.)
Emergency physicians are reminded that patients with a Suboxone® overdose may present to the emergency department with an opiate toxidrome unresponsive to Narcan®.