Buprenorphine is a narcotic that is most commonly used in the treatment of opioid dependence or addiction but has been shown to have the ability to cause addiction after extended use. This article takes a closer look at this widely used and growingly abused drug and includes the pros and cons of taking it for opioid addiction treatment, what you can expect from taking it, and how extended use can be especially detrimental to your health. All drug facts are provided by the Mayo Clinic unless indicated otherwise.
Buprenorphine Classification
Buprenorphine is a Schedule III narcotic analgesic, more specifically a partial agonist opioid receptor modulator. This means that it interacts in such a way with the brain’s opioid receptors that allows them to be activated but not saturated. In this way, buprenorphine is effective at stopping cravings and withdrawal symptoms while not causing the euphoric effects of full opioid agonists like heroin, hydrocodone, oxycodone, morphine, and opium. Because of these properties, buprenorphine is commonly used in the treatment of opioid addiction. There are several buprenorphine products that have been approved by the FDA to treat opioid addiction:
- Bunavail buccal film – an easy-to-use, self-dissolving film applied to the inside of the cheek that delivers buprenorphine.
- Suboxone film (sublingual and buccal) – can be administered under the tongue (sublingual) or on the inside of the cheek (buccal) as well. The company used to offer a sublingual tablet but discontinued the product in 2012 due to concerns from stakeholders over accidental exposure to children.
- Zubsolv sublingual tablets – Zubsolv delivers buprenorphine to the system absorption under the tongue which, for some, can be a more pleasant experience than sublingual and buccal films.
- Probuphine implant – only approved in May, 2016, Probuphine consists of four small, flexible rods that administer a steady supply of buprenorphine over a 6-month period. This unique solution reduces the chances of abuse and overdose of buprenorphine in patients recovering from opioid addiction.
Buprenorphine can also be used to treat moderate to severe pain in some cases. Tablets and the injectable form of buprenorphine are typically used to treat short-term pain while films and patches are suited more for long-term pain. This use of buprenorphine may be preferable to using full agonist opioids to treat pain as it has milder withdrawal and is less likely to be abused by patients. Below is a list of FDA approved buprenorphine medications meant for pain relief:
- Butrans transdermal patch – used for the treatment of long-lasting pain when other medicines cannot meet a patient’s treatment needs.
- Belbuca buccal film and Subutex sublingual tablet – both are used to treat chronic, around-the-clock pain when other medicines do not do so effectively.
- Buprenex injections – used to relieve moderate to severe pain and is administered through an injection.
Precautions Before Taking Buprenorphine
Buprenorphine is a Schedule III drug and consequently should only be taken having knowledge of the full extent of it’s addictive qualities. Proper dosage guidelines and schedules should be followed as precisely as possible as moving outside of these guidelines could result in unnecessary dependency. Patients should provide their doctor with a comprehensive list of medical problems (like liver-related issues) and medications currently being used as not doing so may result in complications. Specific drugs that should not be used with buprenorphine include Naltrexone. Alcohol and other depressants that slow breathing should also not be taken with buprenorphine.
Buprenorphine Side Effects
As an opioid itself, the side effects of buprenorphine for an individual will likely be similar to that of other opioids though to a much lesser degree than some others. Some of the side effects that will more than likely clear up on their own include stomach pain, nausea, difficulty sleeping, vomiting, difficulty passing stool, and weakness. Other side effects, however, may be a cause of some concern. If you are experiencing any of these symptoms, check with your doctor immediately: painful urination, headache, flushing of the skin, feeling warm, fever or chills, dizziness, sweating, lower back or side pain, and sudden cough or hoarseness. The symptoms of buprenorphine overdose may include:
- Drowsiness
- Irregular breathing
- Blurred vision
- Confusion
- Pale or blue skin, lips, or fingernails
- Pinpoint pupils
- Sleepiness
- Unusual weakness
It is worth noting that while some of the overdose symptoms from buprenorphine may be similar to other opioid overdoses, it does not typically present symptoms like yellowing of the eyes or skin and darkened urine.
Buprenorphine Dosage
The dosages of buprenorphine will be different for everyone and patients should follow their doctor’s instructions when taking this drug. These dosage instructions are only meant as guidelines and, as such, should not be followed if they do not match your doctor’s instructions. Both the buccal and sublingual film form of buprenorphine can be used during the maintenance period of opioid addiction treatment. When using the buccal film to administer buprenorphine, adults will typically receive a single dose of 8.4 milligrams of buprenorphine and 1.4 mg of naloxone per day. For sublingual film dosage, adults will usually be prescribed 16 mg of buprenorphine and 4 mg of naloxone in one dose once a day. Sublingual tablets can be used for induction treatment, maintenance treatment, or general treatment for opioid dependence. For the first day of induction, your doctor may prescribe an initial induction dosage of 5.7 mg of buprenorphine and 1.4 mg of naloxone through multiple doses. On the second day, you may receive up to 11.4 mg of buprenorphine and 2.9 mg of naloxone in a single dose. During the maintenance period of treatment, you may receive 11.4 mg of buprenorphine and 2.9 mg of naloxone in a single dose once a day. And for general treatment of opioid dependence, adults will typically be prescribed 8 to 16 mg administered in a single dose once a day. Children taking buprenorphine for opioid dependence will be prescribed dosages based on their individual situation assessed by their doctor.
Buprenorphine Treatment for Opioid Addiction Withdrawal
Opioid addiction is quickly becoming one of the country’s largest drug epidemics in recent history. Of the 47,055 overdose deaths in 2014, almost 61% were directly caused by opioids. Beyond that, the problem is only getting worse. For example, 2015 saw the highest number of opioid-related deaths yet at 33,091 dead. It’s obvious, then, that opioid abuse is increasingly becoming more of a problem with each passing year. This surge is attracting more and more attention and, as such, is leading to the development of additional treatment options for opioid addicts. Buprenorphine is one of these treatment options. While also being used for the treatment of acute and chronic pain due to its status as an opioid, buprenorphine is more commonly used in the treatment of opioid addiction because of its classification as a partial opioid agonist. It works like this: our brains have a wide distribution of opioid receptors that help with pain and reward regulation. When an individual uses an opiate, these receptors are flooded with agonists that activate these receptors and typically saturate them, resulting in the immense pain relief and euphoria associated with many opiates. Over time, our brain gets used to these chemicals being in our bodies and both builds up a tolerance and becomes addicted to them. When an opiate abuser is in treatment for their addiction, the body goes through withdrawal symptoms because their receptors are not being activated by the same number of opioids. For many people, these withdrawal symptoms can be quite intense and long-lasting and are often the reason many opiate addiction sufferers end up relapsing. That’s where medication-assisted treatment (MAT) comes in. In this type of treatment, the withdrawal symptoms are lessened by replacing the abused drug with another, less harmful substance. For opioid addiction, the go-to MAT drug used to be methadone but, due to its highly addictive properties as a full agonist, is now being replaced more and more with buprenorphine. Buprenorphine is becoming more common because it can stimulate these opioid receptors in the same way an opiate would, only to a lesser degree (hence the partial agonist classification). That way, withdrawal sufferers will feel less of the negative effects like anxiety, muscle aches, and fatigue but will not get the same “high” as a full agonist. As such, patients will be more likely to stick to a carefully constructed treatment plan that helps them ween off of buprenorphine over time without as much of a risk for relapsing. Methadone, however, has been shown to be more effective for individuals that have had a higher degree of physical dependency when compared to buprenorphine. As such, your doctor will help you decide which treatment is right for you.
A Buprenorphine Treatment Plan
Buprenorphine treatment for opioid addiction will typically involve three separate phases:
- The Induction Phase – this phase of treatment begins 12 to 24 hours after the patient has ceased using opioids completely and is experiencing the early stages of withdrawal. This time frame is particularly important since administering buprenorphine with other opioids in the system can actually bring on acute withdrawal.
- The Stabilization Phase – this phase begins once the patient no longer has cravings for the opioid and isn’t experiencing the effects of withdrawal.
- The Maintenance Phase – the final phase of buprenorphine treatment, the maintenance phase is dependent on the unique situation of a patient and could last months, years, or indefinitely. In this phase, a steady and reduced amount of buprenorphine is administered regularly.
After patients have reached the maintenance phase, they can then move on to treatment for physical dependence on buprenorphine to lessen the risk of relapse.
Long-Term Risks of Buprenorphine Abuse
As with all medically-assisted treatment plans for substance abuse, the primary risk in using buprenorphine is that patients may develop a long-term addiction to the drug. In situations where patients might have a long history of opiate abuse, for example, many doctors will prescribe medication for an extended maintenance period, sometimes lasting months or even years. While buprenorphine is beneficial in that it provides a method for reducing dependency on opiates which are particularly harmful, this type of long-term treatment is essentially just switching one addiction for another. And when doing so is considered a permanent solution rather than a temporary one, an addiction sufferer doesn’t have the chance at a full recovery. Instead, some facilities (like Northpoint Recovery) use short-term buprenorphine treatment options. In these cases, buprenorphine is used primarily to combat the immediate effects of withdrawal during opiate detox rather than as a long-term maintenance plan. Additionally, addiction is treated through a variety of behavior-addressing treatments such as talk therapy, group work, stress management, and counseling. These supplementary treatments get at the real heart of addiction rather than simply focusing on the physical aspects.
Conclusion
The first step to recovery is noticing the signs of addiction, both in yourself and in others. If you think you or a loved one are addicted to buprenorphine, it’s important to get the help you need by consulting with a professional addiction specialist. Choosing to get help can be incredibly difficult, but doing so will put you on the path towards a clearer, more fulfilling life.