Buprenorphine is an opioid medication commonly used in the medication-assisted treatment (MAT) of opioid abuse and addiction. Medication-assisted treatment with buprenorphine helps individuals reduce or quit their use of heroin or other prescription opioids. Derived from thebaine, an alkaloid of the poppy plant, buprenorphine is a semi- synthetic opioid.
As a semi- synthetic opioid, buprenorphine can produce typical opioid side effects, such as euphoria and respiratory depression. However, the full effects of buprenorphine are less potent than those of non- synthetic opioids, such as heroin.
Some common buprenorphine products include:
- Bunavail (buprenorphine and naloxone) buccal film
- Suboxone (buprenorphine and naloxone) film
- Zubsolv (buprenorphine and naloxone) sublingual tablets
Is Buprenorphine Treatment Trading One Addiction For Another?
Successful buprenorphine treatment helps individuals overcome opioid cravings and the compulsive drug- seeking behavior frequently associated with opioid addiction, while also helping curve potential withdrawal symptoms. This is known as remission, not the switching of addictions.
To fully understand this concept, it is essential to know the difference between physical dependence, addiction, and tolerance.
Physical Dependence: is when someone’s body becomes dependent on the drug to function normally. The defining characteristic of physical dependence is when an individual experiences withdrawal symptoms after abruptly stopping their drug of choice.
Addiction: is a chronic brain disease that has psychological and environmental factors which can influence its development. Defining characteristics of addiction include one or more of the following:
- impaired control over drug use
- compulsive drug use
- continued drug use, despite self-harm or harm to others
- drug cravings
Tolerance: is a state in which exposure to the drug causes physical and chemical changes in the body that cause individuals to slowly stop feeling one or more of the drug’s side effects.
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Physical dependence and tolerance are expected bodily reactions. Addiction, on the other hand, is a disorder that can is damaging and requires treatment.
How Buprenorphine Works
Buprenorphine medications are also partly made up of the opioid- blocker, naloxone. The combination of buprenorphine (opioid) and naloxone (opioid- blocker) works to bind with the opioid receptors in the central nervous system (CNS) and produce mild opioid effects.
Buprenorphine medications essentially trick the brain into thinking it has received the addictive opioid, stopping the intense cravings for the drug and preventing potentially unpleasant withdrawal symptoms. Because buprenorphine has a higher affinity for these receptors, or this substance will block other opioid molecules from linking to free opioid receptors.
Even if someone were to take additional opioid medications with buprenorphine, they likely would not feel the effects of the additional medication.
Due to the unique pharmacological properties of buprenorphine, this medication can help:
lower potential misuse
diminish the effects of physical dependence on opioids, such as withdrawal symptoms and cravings
increase safety in cases of overdose
Side Effects Of Buprenorphine
Buprenorphine’s side effects are similar to those of other opioids. However, unlike other opioid medications, buprenorphine has a “ceiling effect.” Buprenorphine’s opioid effects increase with each dose until at moderate doses they level off, even with further dose increases.
Side- effects of buprenorphine medications may include:
- nausea, vomiting, and constipation
- muscle aches and cramps
- opioid cravings
- inability to sleep (insomnia)distress and irritability
Buprenorphine Abuse Potential
Due to the opioid effects of buprenorphine, it can be misused, especially by individuals who do not have an opioid dependency. Naloxone is added to buprenorphine to lessen the likelihood of diversion and misuse of the combination products.
When buprenorphine products are taken as sublingual or buccal films or tablets, the opioid effects of buprenorphine are more prevalent, and naloxone works to block opioid withdrawal. However, if the tablets are crushed to be snorted or injected, the effects of naloxone become more dominant and can bring on acute opioid withdrawals.
What To Expect During Buprenorphine Treatment
Before starting buprenorphine treatment, it is essential to establish a diagnosis of opioid dependence and a review the risks and benefits of treatment. Each person’s discontinuation of opioid abuse will be a unique process. Generally, buprenorphine treatment occurs in three phases:
1. The Introduction Phase
The first stage of treatment is the medically monitored start of buprenorphine treatment, which is performed in a qualified physician’s office or certified OTP (outpatient practice) using approved buprenorphine products.
Typically, individuals will need to wait 12 to 24 hours and be in the early stages of withdrawal before starting buprenorphine treatment. Buprenorphine can bring on acute opioid withdrawal in people who have other opioid substances in their system.
2. The Stabilization Phase
The second phase occurs after someone has discontinued or significantly reduced their opioid misuse, no longer has cravings for the addictive opioid, and experiences little to no side effects. During this phase, the dose of buprenorphine may start to be tapered off.
Due to the long- acting properties of buprenorphine, once an individual is stable, they may be able to switch to taking their dose every other day instead of once a day.
3. The Maintenance Phase
The third stage of buprenorphine treatment is when an individual is doing well on a regular dose of buprenorphine. The time each person spends in phase three depends on the individual, and could potentially be indefinite.
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Once stabilized, individuals may go into a medically supervised withdrawal from buprenorphine. Medically supervised withdrawal programs can make the transition from a physically dependent state smoother. From there, individuals can engage in further rehabilitation, to prevent future relapse.
Making The Decision To Start Buprenorphine Treatment
As is the case with all medications used in medication-assisted treatment (MAT), buprenorphine is prescribed as part of a comprehensive treatment plan that includes counseling and participation in various support programs. This is when buprenorphine treatment is most effective.
There are many factors which affect whether buprenorphine is a good choice for someone recovering from an opioid use disorder.