Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this selective EBM review is to determine whether or not the use of the drug Buprenorphine and Naloxone (Suboxone) is effective in suppressing opioid dependency and its withdrawal symptoms, or is it simply a surrogate for the opiate with the same addictive results.

STUDY DESIGN: Review of three primary studies in the English language published in 2010 and 2011.

DATA SOURCES: Randomized, controlled and double blind clinical trials evaluating the effectiveness of Suboxone in signs and symptoms of opioid withdrawal were found using the EBSCO Host and Lexi-Comp databases.

OUTCOMES MEASURED: Likability of the drug versus the placebo using Visual Analog Scale (VAS), side effects, withdrawal symptoms using Clinical Opiate Withdrawal Scale (COWS), abuse potential, and drug questionnaires.

RESULTS: Three randomized controlled trials were included in this review. Suboxone was shown to be effective in the prevention of signs and symptoms of withdrawal. However, when compared to heroin participants, were significantly less willing to take low or high dose Suboxone again. Previous studies reported that addition of naloxone to bupornephrine reduced the potential of misuse.

CONCLUSIONS: All three RCT proved the effectiveness of Suboxone in the management of signs and symptoms of opioid withdrawal with no reports of misuse. Limitations in Middleton’s study resulted in difficultly determining if the observed difference in abuse potential between intranasal buprenorphine and Suboxone was accurate with the studies done. Strain’s study showed that there was a significant decrease in observable withdrawal signs after administration of Suboxone when compared to baseline. The higher progressive ratio breakpoint for high dose Suboxone was similar to low dose bupornephrine in Comer’s study. This suggested that the naloxone component attenuated the euphoric effects of buprenorphine, resulting in decrease misuse potential.