Many people believe that Subutex can be effective in preventing addiction to opiates like morphine and heroin. Another is that the drug can treat opiate addiction.
The hit television series, Mr. Robot, is one endorsement of these ideas in popular culture. In the series, the main character, Elliot Alderson (played by Rami Malek) suffers from dependence on morphine – a drug he uses for his anxiety and depression. To prevent addiction, Elliot believes taking Subutex alongside morphine is an effective remedy.
However, does using Subutex with morphine prevent addiction to the opiate?
What is Subutex?
Subutex is a common brand name under which the drug buprenorphine is marketed. The drug is a partial opioid agonist. This means the drug binds to the same receptors in the brain as opiates, thus blocking the ability of opiates to manifest their full effects.
Because of this agonist property, Subutex is applied in opiate treatment therapies to reduce the intensity of withdrawal symptoms and alleviate addiction-related cravings. This was the primary reason for the FDA approval of the drug in opiate treatment in 2002. Quickly, buprenorphine replaced methadone as the primary opiate addiction treatment option.
Morphine and Subutex Interactions
Like in Mr. Robot, the most probable reason to use morphine alongside Subutex is to “prevent” addiction or manage the withdrawal symptoms of morphine.
A morphine and Subutex combination may cause some risks that vary based on various modalities. First, both drugs are clinically used for the treatment of chronic pain. Apart from treating addiction to opiates, buprenorphine is a primary medication in treating cancer and non-cancer pain. On the other hand, in their use as a medication, opiates like morphine are usually prescribed for pain relief.
Though Subutex and morphine are both opiate derivatives, they are significantly different in their chemical profile. Subutex interacts with opioid receptors similarly to how opiates do. However, its pharmacokinetic profile’s complexity allows it to be more effective and distinctly safer in pain management.
As aforementioned, the interactions of Subutex involve displacing opiates from opioid receptors, thus limiting the full effect of the drugs.
Besides its agonistic property against opiate binding, Subutex also possesses a significantly higher potency than opiates. Normally, the substance buprenorphine is about 25-100 times stronger than morphine and is significantly slower to dissociate from opioid receptors than morphine.
Because of its high potency, Subutex can easily displace morphine, thus causing its addiction treatment attributes. Also, because of its slow dissociation from opioid receptors, Subutex can prolong its therapeutic effect, thus effectively managing dependence on opioids as well as pain.
Is it Safe to Combine Morphine and Subutex?
The simple answer is: it depends on the dosage and duration of morphine use. Where morphine is taken to manage pain, Subutex, because of its higher potency, will suppress the pain-relieving effects of morphine. This also goes for any other pain management medication.
The nature of the interaction between morphine and Subutex depends on the length and dosage of opiate use. For people using morphine for a long time, or in larger dosage, combining dosage with Subutex may cause the manifestation of withdrawal symptoms. The same is true for an increase in Subutex dosage.
Naturally, increasing Subutex dosage may cause its analgesic effect to plateau eventually. Further increasing dosage in the case of prolonged morphine use will not improve treatment or manage pain better. Instead, this may cause an increase in the effects of morphine’s withdrawal symptoms.
By comparison, if you have used morphine for a relatively short time and at low dosage, Subutex may provide significant relief from the effects of the drug. In this case, Subutex is less confrontational in its receptor binding, thus presents low intrinsic activity at the opioid receptor while exhibiting a high affinity for it.
At lower dosage and for a short time, Subutex may help you beat the side effects of morphine. However, taking both simultaneously inhibits the potential of morphine to work effectively on alleviating your pain. Even then, you still suffer the risk of becoming addicted to Subutex if you start abusing it.
Will Combining Morphine and Subutex Prevent Addiction?
While Subutex can help you reduce the effects of withdrawal symptoms associated with taking morphine, it is not explicit that it will prevent you from developing morphine addiction. It is important to remember that buprenorphine, just like morphine, is an opiate derivative. Also, the drug has a high risk of abuse. Based on this similarity, abusing it can produce euphoric effects like morphine and other opiates.
As with any other drug, misuse, and abuse of Subutex when treating morphine dependence can cause addiction. With high morphine dosage accompanied with a corresponding high dosage of Subutex indicating abuse, side effects may show. Like opiates, signs and symptoms of abusing Subutex may involve:
The loss in sexual drive
Deterioration in social and personal behavior
Because of the high risk of abuse, Subutex is not an effective means to prevent addiction and is by no means a way to use morphine while keeping addiction at bay.