Buprenorphine Treatment for Opioid Addiction

Buprenorphine is used to relieve withdrawal symptoms and cravings in people in recovery from opioid use. It’s a useful component of a comprehensive treatment plan.

Buprenorphine is an opioid replacement option for medically assisted detox and recovery from opioid use disorder (OUD). Buprenorphine relieves withdrawal symptoms and reduces cravings, allowing individuals to focus on treatment for their addiction.

There are two FDA-approved opioids used for opioid replacement therapy: buprenorphine and methadone. Buprenorphine treatment for opioid addiction has been shown to be as effective as methadone, perhaps better, and it has some advantages over methadone:

• It is less sedating
• It can be reduced and tapered off faster than methadone
• It has a longer half-life than methadone, so it can be dosed every other day or even twice a week, whereas methadone is dosed once a day
• It is available with naloxone to prevent abuse

What is Buprenorphine?

Buprenorphine is a semi-synthetic opioid used for the treatment of chronic, moderate-to-severe pain and for OUD. Buprenorphine is a high-affinity, long-acting partial agonist of opioid receptors, meaning that it attaches aggressively to the opioid receptors in the brain and blocks other opioids from taking effect.

As a partial opioid agonist, it does not activate receptors as much as other opioids do, so there is little euphoria and low overdose risk. People who have been using high-dose opioids generally feel no high whatsoever from buprenorphine. As such, it prevents attempts at abusing opioids, it relieves withdrawal symptoms in people detoxing from opioid use and reduces cravings in people in early recovery.

Buprenorphine Medication List

Buprenorphine medication comes in various brand-name formulations, either alone or in combination with naloxone, and with a variety of routes of administration available. These include:

• Bunavail: buprenorphine and naloxone, buccal film (dissolves in the inside of the cheek), used for OUD
• Buprenex: buprenorphine alone, intravenous solution, used for pain management
• Butrans: buprenorphine alone, transdermal patch, used for pain management
• Probuphine: 30-day subcutaneous (under the skin) buprenorphine implant for opioid addiction
• Subutex: buprenorphine alone, sublingual tablet, used for OUD
• Suboxone: buprenorphine and naloxone, sublingual tablet, used for OUD
• Zubsolv: buprenorphine and naloxone, sublingual tablet, used for OUD

How Does Buprenorphine Work?

Buprenorphine works by replacing harmful, high-dose opioids used in active addiction with a low-dose, less harmful opioid. In doing so, it prevents the shock to the brain and body that usually follows the cessation of opioid use.

Buprenorphine has such a strong affinity for opioid receptors in the brain that it actually removes other opioids, similar to how naloxone works. Furthermore, it remains attached to the opioid receptors for a long time, thus preventing the attachment of any other opioids.

How long does buprenorphine work? Buprenorphine has a long half-life (28 to 37 hours when dissolved under the tongue). The half-life is the time it takes the body to remove one-half of the drug. It takes three to five days before enough of the drug is removed from the body to produce withdrawal symptoms.

Induction Phase

The only agents that are FDA approved for buprenorphine induction (the initiation of therapy) are buprenorphine-only products (such as Subutex) and Suboxone. Because of Subutex’s high affinity for opioid receptors, it will displace other opioids and may precipitate premature withdrawal symptoms if started too early.

Induction should not be started until the initial appearance of withdrawal symptoms, or at least six to twelve hours after the last opioid use for short-acting opioids (such as heroin) and 24 to 72 hours for long-acting opioids (such as methadone).

Buprenorphine induction therapy is usually done in an inpatient detox center, but may be done in a physician’s office or even, in select cases, at home.

Stabilization Phase

Buprenorphine requires individualized testing to get the correct maintenance dose. The initial dose is low, but the dose is increased until there is a satisfactory effect. The level is based on individuals’ reports of symptom relief.

Once a proper dose has been established and treated, and individuals are satisfied with the buprenorphine stability, there is no set recommended time limit for the continuation of therapy.

Maintenance Phase

Buprenorphine maintenance treatment is individualized because the duration of treatment and decision to taper off the drug depend on having adequate supports in place to ensure ongoing recovery following discontinuation.

Discontinuation of buprenorphine maintenance may result in mild withdrawal symptoms beginning three to five days after the last dose, which may continue for several weeks. Following discontinuation, people can be switched to naloxone treatment within a few days, thus reducing the risk of relapse. People who experience a setback may be restarted on buprenorphine if appropriate.

Buprenorphine Treatment for Opioid Addiction

While buprenorphine treatment is used for treating opioid addiction, it is important to understand that it does not constitute treatment for addiction. Rather, buprenorphine relieves withdrawal symptoms and reduces cravings, allowing individuals to better focus on treatment for their addiction.

Simply getting through detox and abstaining from drug use does little to mitigate the risk of relapse. The underlying causes and the adverse physical, mental, social and psychological effects of drug use and related behaviors must be identified and addressed. That is the function of addiction treatment programs.

Buprenorphine maintenance treatment should be viewed as a piece of an overall addiction treatment plan; a tool which can be used to enhance individuals’ opportunity for success during treatment and in early recovery. Individuals should take advantage of their time while on buprenorphine to get treatment and make a plan of action for long-term, successful recovery.

Detox Centers

Detox is one of the first steps toward recovery from opioid addiction. Buprenorphine for opioid withdrawal is usually offered at any detox center that offers medication-assisted treatment.

Treatment Centers

The use of buprenorphine in the treatment of opioid addiction is common among treatment centers that offer medication-assisted therapy. Buprenorphine for opioid use disorder is one of the many tools available to give individuals their best opportunity for success in treatment.

Private Treatment

One of the advantages of buprenorphine is that it offers the option of office-based buprenorphine treatment of opioid use disorder. Physicians must be specifically licensed to prescribe buprenorphine and should be experienced in treating addictions to initiate or maintain therapy from their office.

Related Topic: Opioid Addiction Treatment

Buprenorphine Effectiveness

Data shows that people are more likely to remain on buprenorphine than they are on methadone. Buprenorphine is associated with a one-year retention rate of 75% in a recovery program and 75% negative urine drug tests, compared to 0% on both measures in people taking a placebo.

Buprenorphine is highly effective, and has been associated with:

• Reduced mortality
• Reduced relapse rates
• Reduced HIV and Hepatitis C transmission rates
• Improved outcomes in pregnancy
• Improved retention within recovery programs
• Improved quality of life.

Buprenorphine Side Effects

Buprenorphine side effects are similar to those of other opioids but are usually somewhat less pronounced because the drug is only a partial opioid agonist. Side effects include:

• Mild euphoria
• Constipation
• Confusion
• Insomnia
• Muscle aches
• High body temperature, sweating
• Light-headedness, dizziness
• Nausea
• Headache
• Swelling in the legs
• Urinary retention
• Respiratory suppression
• Withdrawal (if the drug is discontinued suddenly)

Buprenorphine is unique among opioids in that it has a ceiling effect, meaning that once its euphoric effect and respiratory suppression reach a certain level they don’t increase with further drug intake.

Warnings

While the adverse effects of buprenorphine are lower than those of other opioids, some risk is still present. Some warnings to consider prior to buprenorphine use include:

• Risk to opioid users – Buprenorphine has such a strong affinity for opioid receptors that it will actually displace other opioids, similar to naloxone. People who resume opioid use while participating in buprenorphine maintenance are at increased risk of relapse because they may take high doses of the abused opioid to try to overcome the blocking effects of buprenorphine, and then overdose when the buprenorphine wears off.
• Pregnant Women – Taking buprenorphine during pregnancy has been shown to result in some rare complications, but overall has been shown to have positive outcomes when used in pregnant opioid users. Positive outcomes include reduced neonatal withdrawal syndrome, fewer high-risk behaviors during pregnancy and motherhood, improved fetal outcomes and no adverse effects of Subutex use on infant development.

Drug Interactions

There are 588 drugs that are known to have adverse buprenorphine drug interactions, including 177 major interactions and 406 moderate interactions. It is therefore important to give prescribers an accurate list of prescription medications, over-the-counter medications, herbals, and illicit drugs being used before taking buprenorphine. Always consult with a medical professional before taking a new medication.

TRVPB Offers Buprenorphine Treatment to Help You Recover

The Recovery Village Palm Beach at Baptist Health offers buprenorphine treatment for opioid addiction as one of many options. Treatment plans are highly individualized. All treatment options are detailed and discussed with clients so they can be as comfortable as possible during the addiction treatment process.