The most commonly prescribed medication for teens with an opioid use disorder is Buprenorphine. Buprenorphine was approved in 2002 by the Food and Drug Administration (FDA) for use in medication-assisted treatment (MAT) for adolescents age 16 and over. One qualitative study of more than twenty-thousand teens and young adults in the U.S. showed that buprenorphine is eight times more likely to be prescribed to teens than other medications used in MAT. To learn more about how buprenorphine differs between the two other FDA-approved drugs for medication-assisted treatment, read our article here.
How Does Buprenorphine Help Teens Recover from Addiction?
Buprenorphine is a type of opiate called a partial opioid agonist, meaning it binds to the brain’s opioid receptors. This “tricks” the brain into accepting this new medication instead of heroin or other illegal drugs, and stops regular opioid cravings. It also eases the painful symptoms of withdrawal, so it helps teens limit or prevent relapse. This can be a lifesaving measure for teens who cannot stop using illegal narcotics (like heroin or other opioids) by traditional, abstinence-based means. However, the very same drug that produces pain-relieving effects to help teens overcome opioid addiction can also be abused by teens. These adolescents use buprenorphine in ways other than prescribed, including injecting buprenorphine to receive a stronger effect. For this reason, buprenorphine is risky. Unlike naltrexone, which is an opioid antagonist also used in MAT, buprenorphine has the potential for abuse. We’ll talk more about this below.
Physicians and pediatricians can prescribe buprenorphine in their offices after receiving specialized training and a waiver from the U.S. Drug Enforcement Agency (DEA). However, physicians can only treat one hundred patients at a time. For this reason, buprenorphine-prescribing doctors are few and far between. But if you do find one willing to take your teen as a patient, you’ll find that your teen may be prescribed Subutex, Suboxone, or Zubsolv. What’s the difference between each medication?
Suboxone Treatment for Teens
Offered in film strip form (formerly a tablet), Suboxone is four parts buprenorphine to one part naloxone. You may recognize naloxone: it’s the active ingredient in overdose-reversing nasal spray Narcan. The Naloxone in Suboxone won’t have any effect at all if taken as prescribed (i.e. letting the film strip dissolve under the tongue). Only the buprenorphine will be activated, which relieves withdrawal symptoms and reduces opioid cravings.
However, if teens inject it in order to get high, the naloxone will be activated—and it will cause immediate, painful withdrawal symptoms. In fact, manufacturers combined naloxone with buprenorphine for this very reason: to dissuade teens from abusing Suboxone. The added Naloxone is also meant to prevent combining drugs. If a teen uses heroin or other illegal drugs together with Suboxone, the naloxone will block the high.
Subutex Treatment for Teens
Subutex is pure buprenorphine, without the added-in naloxone. Since it’s generic, it’s usually the cheapest buprenorphine option on the market. Subutex is usually prescribed at the beginning of the detoxification process, for the first few days, to ease painful withdrawal symptoms. However, for longer-term medication-assisted treatment, most physicians generally prescribe Suboxone. That’s because Suboxone has added naloxone properties to prevent teens from trying to abuse the drug.
If taken as indicated, there is no difference between Subutex and Suboxone. The active ingredient of both is buprenorphine. The tiny amount of naloxone in Suboxone is only activated if a teen abuses the drug. Subutex is often a preferred option for those who cannot tolerate naloxone.
Zubsolv Treatment for Teens
The newest of the three MAT medications, Zubsolv was developed in 2013. While Suboxone is a film strip, Zubsolv is a small tablet with a slightly stronger buprenorphine/naloxone combination. It’s more potent than Suboxone, so less of the medication is needed to achieve the same effect. It’s minty, too, so some teens prefer it over Suboxone. Another difference is that it is absorbed faster under the tongue than Suboxone.
Suboxone (Buprenorphine) for Teens: The Controversy
No matter which of the three medications you choose, the use of buprenorphine for teens is still highly stigmatized. Many disagree as to whether to give a teen Suboxone or any other buprenorphine-containing drug to overcome opioid addiction. In particular, doctors and parents are concerned about the many teens who have become addicted to Suboxone, when it’s supposed to help them recover.
On one hand, the anti-Suboxone camp feels that using drugs to treat addiction is like jumping from the frying pan into the fire. Teens abuse, sell, and/or trade Suboxone among themselves. Adolescents can learn to sidestep the naloxone deterrent. They can find ways to combine it with other drugs, take it in ways other than directed, or use it to lessen withdrawal symptoms in between instances of heroin use. This is why many mental health professionals and parents emphasize a cold-turkey approach to detox. Many teens have died by abusing buprenorphine and fatally overdosing.
However, on the other side of the coin, many credit buprenorphine for saving their lives. Many parents of heroin-addicted teens found that their adolescent was only able to detox and stay off illegal opioids with the help of buprenorphine. For these teens, detox using an abstinence approach was simply impossible and led to relapse, time and time again.
This investigative article by the New York Times includes many anecdotal accounts of individuals who were either saved by Suboxone… or whose lives became worse because of it.
Should My Teen Be Placed on Buprenorphine?
Should your teen be placed on Suboxone or another buprenorphine program?
Our answer: it varies by the adolescent.
As in most cases involving health, there’s no simple, black-and-white answer. The choice to use medication-assisted treatment for overcoming drug addiction needs to be made by a competent physician. Your teen must be evaluated by a doctor specializing in drug treatment for adolescents. Their decision will depend on various factors, such as: severity of the addiction, relapse history, and clinical history.
In any case, realize that Suboxone, Subutex, and Zubsolv are not quick-fixes to recovery. While they do help teens curb their opioid use and ease the terrible pains of withdrawal, they each must be accompanied by therapy. MAT is called medication-assisted treatment for a reason: it’s there to complement counseling.
Teens Need Addiction Rehab Treatment
While Suboxone may help an adolescent tide through detox on a physical level, it won’t do anything to change the neural pathways that have become rewired due to addiction. The only thing that will help an adolescent overcome addiction completely? Immersive, high-quality behavioral therapy, preferably at a teen rehab center. At an adolescent drug rehab center, teens will learn coping skills and relapse prevention tools (like 12-step techniques) to help maintain their treatment progress.
Whether you start this therapy during, after, or even without the help of medication, the decision is between you and your doctor.