Suboxone is a combination of buprenorphine (a narcotic) and naloxone. Naloxone is used to help withdrawal symptoms in opioid addicts and should keep users from becoming addicted. It is commonly used for patients in opioid recovery. Suboxone is often taken in a dissolvable strip that looks like a breath strip. It’s as small as a postage stamp and easy to carry around.

The New York Times reported, “The Food and Drug Administration approved Suboxone in 2002 as the first narcotic that doctors could prescribe for addiction to opiates. Considered a more convenient alternative to methadone, which can be dispensed only at federally licensed clinics, it blocks the effects of opiates while reducing cravings and easing withdrawal symptoms.”¹

Unfortunately, Suboxone strips cause euphoric highs that many people, including prison inmates, long to achieve. As a treatment drug to encourage weaning off street opiates and prescription painkillers, it can be helpful for treatment. However, Suboxone is finding its way to the streets and into the illicit drug trade. Now, it seems to have made waves in America’s prison system as one of the most popular smuggled and used drugs among inmates.

A History Drug and Suboxone Abuse in Prison

Drug abuse is common in the United States prison system. Much of this stems from the experiences inmates had before entering a correctional facility. Many prisoners are already addicts, distributors or smugglers. Until recently, however, marijuana remained unchallenged as the most popular drug smuggled into prisons. Suboxone is a new competitor in the prison drug smuggling business.

Buprenorphine is the narcotic contained in Suboxone. According to the Substance Abuse and Mental Health Services Administration, “Buprenorphine has unique pharmacological properties that help:

• Lower the potential for misuse
• Diminish the effects of physical dependence on opioids, such as withdrawal symptoms and cravings
• Increase safety in cases of overdose

Buprenorphine is an opioid partial agonist. This means that, like opioids, it produces effects such as euphoria or respiratory depression. With buprenorphine, however, these effects are weaker than those of full drugs such as heroin and methadone. Buprenorphine opioid effects increase with each dose until at moderate doses they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects. Also, because of the buprenorphine long-acting agent, many patients may not have to take it every day.”²

The Suboxone high is enough to get inmates interested in its effects despite its availability.

Suboxone Side Effects in Prison Inmates

Even though Suboxone was created to make withdrawal symptoms from opiates less painful than going “cold turkey,” it still has the potential to be abused. The drug’s makers do claim the drug does not have the same euphoric high as, say, heroin, but it does have SOME effect. For those who don’t use opioids regularly, the effect is even stronger.

Like most other opioids, here are some symptoms of Suboxone addiction:

• Headaches: Headaches are common with many opioids. Opioids can contribute to dehydration, so all that may be needed to get rid of a headache is drinking a glass or two of water. Caffeine and nicotine can also contribute to the dehydration, so be mindful of using these other drugs while taking Suboxone.
• Dry mouth: This doesn’t seem like a terrible side effect, but it can be bothersome and cause bad breath. Again, be sure to drink plenty of water. Also, you can use mouthwashes that keep your mouth from becoming damaged due to bacterial growth. Our saliva acts as a natural deterrent to bacteria that can cause issues like gum disease.
• Constipation: Long acting opioids like Suboxone, time-released oxycodone and methadone tend to cause constipation. It’s important for Suboxone users to drink plenty of water and eat fibrous foods if they want to avoid the pain of constipation. If left untreated, constipation can lead to using powerful laxatives or surgery.
• Difficulty sleeping: When a user comes off Suboxone or other opioids, they can experience sleeplessness. “Sleep disturbances and alterations of sleep quantity and quality have been reported. In addition, their sedative effects have been relatively well established and opioids can cause respiration to slow and become irregular, leading to hypercapnia and hypoxia. Consequently, their usage has been linked to irregular or ataxic breathing (Biot’s breathing) and their use has been associated with both central and obstructive sleep apnea.”³
• Difficulty maintaining responsibilities: Opioids including Suboxone have a way of preoccupying the mind and body of the person addicted whether they are currently high. When high, the drowsiness can cause slowed movements and mental processing.

As with other opioids, side effects including nausea, loss of interest and cravings for Suboxone are common when withdrawing. In the long term, users of Suboxone will need to go through opioid detox to achieve sobriety.

How America’s Opioid Epidemic Affects the Prison System

America’s opioid epidemic has become a national emergency. According to the National Institute on Drug Abuse (NIDA), “The abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of all societies. It is estimated that between 26.4 million and 36 million people abuse opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin. The consequences of this abuse have been devastating and are on the rise.  For example, the number of unintentional overdose deaths from prescription pain relievers has soared in the United States, more than quadrupling since 1999.  There is also growing evidence to suggest a relationship between increased non-medical use of opioid analgesics and heroin abuse in the United States.”⁴

Given the statistics regarding opioid use, it’s no surprise that the opioid epidemic has a role to play in the prison system. The US Department of Health and Human Services states 15 percent of prison and jail inmates are addicted to heroin. Although Suboxone could provide an important medical need in prisons, it seems that many prisoners go without treatment. In the cases of Suboxone being smuggled into prisons, it seems that although some use the drug to curb their opiate withdrawals, many more just use it recreationally. People who ingest Suboxone regularly do not tend to get the Suboxone side effects that include euphoria.

Prisoners that are experiencing heroin or other opioid withdrawal need much more medical supervision than many correctional facilities can provide. The dangers of withdrawal can include the contraction of HIV or other blood-borne pathogens. This is caused by inmates injecting smuggled heroin. Another possible danger is accidental overdose caused by a user not having the drug for a longer period and then attempting to do the drug again. Lastly, those addicts not treated in prison may go on to commit another crime in the name of their addiction.

America’s opioid epidemic is a leading contributor to Suboxone abuse in correctional facilities.

A Dangerous Black Market Drug in American Prisons

All over the United States, Suboxone abuse is extremely common in prisons. How is it possible that Suboxone is making its way into penitentiaries all over the US? Prison administrators and correctional officers agree, the frequency in which Suboxone is smuggled into prisons is staggering and dangerous. As a drug for opiate addicts to kick the habit, this easy-to-conceal drug is sweeping prison communities. This improper use of the Suboxone is giving the medication a bad name.

Smugglers take advantage of the drug’s size and ingestion method (sublingual). With some clever thinking, many smugglers mail Suboxone into the prison. The drug has been found hidden on the back of a stamp, on children’s coloring pages (all the inmate must do is eat the paper), in books, and in greeting cards. It barely leaves behind a stain, and its presence often goes unnoticed by the untrained eye. Although Suboxone pills do exist, the dissolvable film is far more common in prisons.

The New York Times reported, “Law enforcement officials say that Suboxone, which is prescribed to treat addiction to heroin and powerful painkillers like oxycodone, has become a drug of abuse in its own right, resulting in prison smuggling efforts from New Mexico to Maine. Addicts buy it on the street when they cannot find or afford their drug of choice, to stave off the sickness that comes with withdrawal. But some people are also taking it for the high they say it provides.”¹

What Can be Done to Fix This Suboxone and Opioid Issue?

There aren’t distinct answers to this problem. Prison does offer an opportunity to see how medications and therapy can work together to help opioid addicts, but little has been done to explore this on a large scale. Between legislation and society, everyone needs to pull together to keep opioids off the streets.

Whether you or someone you love is addicted, when they are no longer incarcerated, it’s extremely important that sobriety is worked toward using conventional methods. Northpoint Washington offers various therapy and detox options for opioid users that help people achieve sobriety. Our facility is familiar with the withdrawal and addictive effects of Suboxone, and our rehabilitation program offers all the latest strategies to help patients achieve their goals. If you have any questions, you can contact our rehab and detox experts to help you get the information you need.

Resources:

¹The New York Times. (2011). When Children’s Scribbles Hide a Prison Drug. Retrieved from: http://www.nytimes.com/2011/05/27/us/27smuggle.html

²Subtance Abuse and Mental Health Services Administration. (2017). Buprenorphine. Retrieved form: https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine

³ US National Library of Medicine National Institutes of Health. (2012). Non-analgesic effects of opioids: opioids’ effects on sleep (including sleep apnea). Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/22747542