Buprenorphine and Opioid Addiction Treatment

Trade Names: Buprenex®, Suboxone®, Subutex®)

Buprenorphine is a synthetic opioid that was first approved for clinical use in 2002, and it is very different from commonly abused opioid painkillers.

 

Buprenorphine is the active ingredient in Suboxone and Subutex, both of which are best known for medication-assisted treatment (MAT), but buprenorphine can also be used to assist with detox from problem opioids without continued opioid maintenance.

Traditionally, low-dose benzodiazepines and clonidine have been the preferred medication courses for opioid withdrawal management. Although these medications can help with some severe symptoms of opioid withdrawal, buprenorphine treatments have led to more successful results.

What is Buprenorphine?

Buprenorphine is an opioid, but it is not derived from the poppy plant, as it is completely synthetic. It is formulated so that its binding properties are much stronger than all other opioids available today.

Another distinction of buprenorphine from other opioids of abuse is its length of action which ranges from 24 up to 72 hours.

All opioids bind to certain receptors in the brain, which facilitate the effects of the opioids. Since buprenorphine binds to these receptors more strongly than other opioids, it causes any other opioids present to be thrown off of the receptor sites.

What sets buprenorphine apart from other opioids is that fact that it is a partial opioid agonist. So, what does that mean?

Drugs like heroin, fentanyl, opioid painkillers and methadone are full opioid agonists because they bind to, and activate the opioid receptors in the brain, and produce the full range of opioid effects with no limit until overdose. Some examples of these effects include things like:

  • euphoria
  • flushing
  • constricted pupils
  • slowed breathing
  • decreased heart rate
  • slurred speech
  • extreme drowsiness

On the other hand, drugs like naloxone and naltrexone are opioid antagonists because they bind to the opioid receptors without activating them, and block all effects of opioid agonists. Naloxone is used by paramedics and medical professionals to reverse the effects of opioid overdose.

Buprenorphine is a partial agonist because it:

  1. binds to, and activates opioid receptors to a certain level (a ceiling) that is much lower than full opioid agonists
  2. blocks all other opioid agonists from binding to opioid receptors

Since buprenorphine acts as a partial opioid agonist, it also suppresses opioid withdrawal symptoms.

Some other effects of buprenorphine include the following:

  • some opioid-related euphoria, but less than other opioids
  • respiratory depression
  • headache
  • constipation
  • dry mouth

Contrary to other opioids, buprenorphine is formulated specifically for the treatment of opioid addiction with a significantly reduced risk of abuse and overdose. Although buprenorphine is an opioid, its unique formulation includes a ceiling that limits the degree to which a user can experience an opioid-induced euphoria. Buprenorphine is specifically for individuals who are tolerant to opioids and never prescribed for people who are opioid-naive.

How is Buprenorphine Used for Opioid Detox?

The goal of buprenorphine in medical opioid withdrawal is to rapidly achieve control of withdrawal symptoms, allowing patients to participate in addiction treatment.

Since the key feature of buprenorphine is its ability to suppress opioid withdrawal symptoms, it is ideal for easing the process of opioid detox.

Once someone begins to experience moderate opioid withdrawal symptoms, buprenorphine is administered at an appropriate dosage which varies, depending on the individual and the length of time for detox. Dosages are adjusted in consideration of inpatient versus outpatient detox.

Over the remaining days of opioid detox, buprenorphine dosages are steadily reduced as they continue to manage withdrawal symptoms. By the time problem opioids are out of someone’s system, withdrawal symptoms have faded and the person will be successfully withdrawn from all opioids, including buprenorphine.

Buprenorphine’s unique ability to bind to opioid receptors without euphoria allows it to have just enough impact to stave off withdrawal symptoms, and not create a continued need for more withdrawal efforts.

What Happens After Buprenorphine Detox

Buprenorphine assisted opioid detox allows opioid-dependent people to withdraw from opioids safely and comfortably, but detox is only the beginning of recovery from addiction.

After detox, it is necessary to participate in an addiction treatment and recovery program for lasting sobriety from opioid abuse.

Although buprenorphine is the preferred medication used in medication-assisted treatment (MAT), that course of treatment is not the only option. When all opioids have been expelled from the body, it is like having a clean slate to begin recovery from drug abuse and addiction.

Even though buprenorphine can make opioid detox much more comfortable, no one wants to re-experience opioid detox. The best way to increase the chances of not having to detox from opioids again is to participate in a customized and evidence-based addiction treatment program. Through a comprehensive drug rehab program, recovering addicts can gain and learn the skills and tools necessary to maintain a healthy life without future of drug abuse.

Some of the essential elements of drug rehab after buprenorphine assisted opioid detox to include the following:

  • Individual therapy helps to discover and begin addressing personal traumas and challenges that may have contributed to drug abuse
  • Group therapy provides necessary support and helps to conquer the shame many addicts feel once they are sober
  • Experiential therapies like hiking and other activities provide opportunities to discover and practice new healthy and sober-supportive passions to continue after treatment
  • Educational courses provide information about addiction, recovery, relapse prevention, and trigger awareness, all of which are tools necessary to abstain from future drug abuse
  • Aftercare provides recovering addicts with local resources and groups to serve as sober support in activities and accountability to stay in recovery

Drug treatment programs aim to establish a foundation for continued recovery from drug abuse and addiction. Countless opioid addicts have successfully detoxed with buprenorphine and remained drug-free after addiction treatment. However, relapse is always a significant risk associated with addiction, which is what MAT aims to address. Since MAT involves continued maintenance on opioids, there is another option for those who would rather remain opioid-free.

Vivitrol® is naltrexone, an opioid antagonist, and it is intended only for individuals who have been free from opioids for at least seven days. Like any MAT option, addiction counseling is necessary when receiving treatment with a naltrexone medication.

Read more about Naltrexone for opioid addiction treatment.

Source:

  1. SAMHSA – Medication-Assisted Treatment: Buprenorphine
  2. https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
  3. Image file is licensed under the Creative Commons Attribution 3.0 Unported license.
    https://creativecommons.org/licenses/by/3.0/deed.en