A friend sent me a link to an article that suggests an anti-smoking effect from naltrexone. Naltrexone is an opiate antagonist similar to naloxone (the second ingredient in Suboxone); naloxone is active intravenously, and naltrexone is active orally.
Naltrexone is indicated for treatment of cravings in alcoholism; it is also used (but not ‘indicated’) for early treatment of opiate addicts in traditional recovery, as a ‘back-up plan’– an addict knows that even if he DID use, the effect would be blocked. Naltrexone is NOT that helpful for opiate cravings, which is why there is a niche for buprenorphine to fill.
A couple weeks ago I read a study that found increased release of endorphins in the brain of rats after they were given alcohol; the endorphins were released in parts of the basal forebrain that have been shown to be involved in addictive behaviors. This fits nicely with the effects of naltrexone on alcohol cravings. Buprenorphine is a ‘partial agonist’, meaning it has both activating and blocking activities at opiate receptors. In other words, buprenorphine has a ‘naltrexone-like’ effect at opiate receptors– suggesting a role for buprenorphine in the treatment of alcoholism.
Consistent with that idea, a number of my patients taking buprenorphine report less interest in alcohol and less drinking since starting Suboxone. This is a nice ‘side benefit’, as there is something called ‘cross addiction’ where stamping out the addiction to one substance can result in a new addiction in a different substance; I believe that the effects of buprenorphine on alcohol cravings helps prevent patients from changing substances when they start Suboxone.
Now there is evidence that patients on Suboxone are more likely to stop smoking– consistent with the belief that there is a common pathway through the front part of the brain for most if not all addictions. If the naltrexone effect holds to be true, it would be possible that buprenorphine could work in a similar fashion, as is the case with alcoholism. What do the smokers think?
If you smoke and take Suboxone, have you noticed any change in your smoking habits since starting Suboxone? Any reduction in the pleasure you get from smoking? Have you been smoking fewer cigarettes per day? More?