Buprenorphine / Suboxone®
Since its FDA approval in 2002, buprenorphine and buprenorphine with naloxone, more commonly known by the brand name Suboxone®, has been in clinical use for the treatment of opioid use disorder (OUD). Supported by counseling and other recovery services, medication-assisted treatment (MAT) with buprenorphine is a safe, effective treatment for OUD, or opioid addiction.
What Is Buprenorphine?
Buprenorphine is a partial opioid agonist, which can be used on a limited basis to treat chronic pain, but whose primary purpose is the treatment of opioid addiction. Partial agonists do not activate the opioid receptors in the brain to the same extent as a full agonist such as methadone. This is the primary difference between the two medications. Because those receptors are not fully engaged, buprenorphine has a “ceiling effect”. A ceiling effect is the point where the medication reaches its limit in its ability to be used to achieve a “high” or euphoric effect.
How does buprenorphine work?
While it does not activate the opioid receptors fully, buprenorphine and buprenorphine with naloxone are effective in treating opioid addiction. A partial agonist is able to prevent the body from experiencing debilitating withdrawal symptoms and cravings. Controlling physical symptoms can prevent relapse early in recovery, offering the ability for patients to stabilize and begin to work on the underlying causes of addiction.
What is Suboxone®?
Buprenorphine with naloxone is commonly known by the brand names SUBOXONE®, Bunavail® and Zubsolv®. Naloxone is an opioid antagonist that blocks the opioid receptors. Used independently, naloxone or its brand name Narcan® is used to reverse opioid overdose. When combined with buprenorphine, it provides all of the benefits of the stand-alone buprenorphine product, but adds a deterrent to misuse. If taken as prescribed there is no opioid effect. If injected, the naloxone causes the user to go into an immediate state of acute withdrawal, preventing intravenous misuse of the medication. Additionally, the naloxone prevents the effects of other illicit opioids if they are taken while a patient is taking SUBOXONE®.
“MAT programs provide a safe and controlled level of medication to overcome the use of an abused opioid. And research has shown that when provided at the proper dose, medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability.”
How do I get help?
Frequently Asked Questions
A single, effective does of buprenorphine for opioid addiction can last 24-60 hours. Over time, due to the long lasting nature of the medication, a medical provider may recommend decreasing the dosage or changing the frequency with which an individual takes the medication, achieving the same result with less medication required.
A proper dose of buprenorphine or Suboxone® varies for each person, but typically begins more aggressively than with methadone because of the ceiling effect. A therapeutic dose has been reached when the patient no longer experiences withdrawal symptoms and is also not experiencing euphoria.
It is possible to get addicted to any medication or drug that causes feelings of pleasure or reduces discomfort. However, it is uncommon for individuals to become addicted to buprenorphine in the same way as other opioids due to the ceiling effect of the medication. As a part of a medication-assisted treatment program, patients can be tapered off of the medication under medical supervision. The process of tapering limits the physical withdrawal symptoms.
Some medications may have dangerous interactions with buprenorphine or naloxone and patients should make their medical provider aware of all medications they are taking. Use of alcohol or benzodiazepines can be very dangerous, causing serious respiratory issues. Individuals using illicit opioids to get “high” while taking buprenorphine with naloxone are at risk for overdose due to the opiate blocking effects of naloxone and the amount of illicit opioid needed to reach the desired effect. However, if taken as prescribed, under medical supervision, buprenorphine is a safe and effective treatment for opioid addiction.
While methadone is the preferred treatment during pregnancy, buprenorphine can be safely taken during pregnancy when carefully monitored by a medical provider. It is far safer then detoxing or continuing to use opioids illicitly and does not cause any fetal abnormalities. Buprenorphine with naloxone should be avoided as there is not currently information about the safely of naloxone on unborn children.
Buprenorphine will not produce positive results on a standard test for opiates. It can only be detected if an individual is specifically tested for it, which is uncommon as it cannot be found in standard urine or saliva tests.
Buprenorphine itself does not block other opiates. It is a partial agonist, so it attaches to the receptors but does not fully activate them. Buprenorphine with naloxone, known commonly as Suboxone® does block other opiates. It is the naloxone in Suboxone® which blocks other opiates from attaching to the opioid receptors in the brain.
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