Buprenorphine is an FDA-approved medication for the maintenance treatment of opioid dependence.
It is considered safe and effective when used under proper medical supervision and as part of a comprehensive treatment plan that also includes psychosocial support and counseling.
While oral formulations are the more common method of administering/receiving buprenorphine, the medication can also be delivered to the body via a subdermal implant.
This method can be highly effective and convenient; keep reading to learn more about buprenorphine implants for the treatment of opioid dependence.
What Are Buprenorphine Implants?
Buprenorphine implants are useful for the maintenance treatment of opioid dependence, prescribed for opioid use disorder (OUD) patients.
Buprenorphine implants are small devices that are inserted into a patient’s upper arm and designed to release stable blood levels of buprenorphine to the body over a six-month period.
Buprenorphine is a medication that works to reduce opioid withdrawal symptoms and strong cravings during detoxification from full opioids (such as heroin or fentanyl).
When an individual has been regularly using opioids for a sustained period and then suddenly stops using them, they will experience significant withdrawal. This is because they have formed a physical dependence.
In other words, the brain and body have become accustomed to regularly receiving opioids – so when they suddenly receive none, they react and produce intense withdrawal symptoms and strong cravings for the problem drug.
Physical opioid withdrawal can be debilitating and trigger relapse, which is part of the reason why opioids are so heavily addictive. This is where buprenorphine is highly useful.
Buprenorphine is a partial opioid agonist, meaning it targets the mu-opioid receptor in the brain in a controlled way. This produces effects similar to full opioids but to a more mild extent.
Because of this, withdrawals and cravings are reduced and managed.
Probuphine is the brand name of the implantable form of buprenorphine. During a simple surgical procedure, four implants are inserted subdermally into the inner side of a patient’s upper arm.
These implants contain 74.2mg of buprenorphine and deliver continuous, stable blood levels of buprenorphine to the patient for up to six months before being removed and/or replaced.
Are Buprenorphine Implants Legal?
Probuphine was cleared by the FDA in 2016 for the “maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on low-to-moderate doses of a transmucosal buprenorphine-containing product”.
Probuphine is the only buprenorphine implant that has been FDA-approved and is the only product on the market that provides stable blood levels of buprenorphine continuously for 6 months after insertion.
As with all buprenorphine products, Probuphine should be used as part of a comprehensive treatment program that also includes counseling and psychosocial support.
This increases the chances of a patient achieving a full recovery, leading to a renewed, positive, and active life.
Buprenorphine Implants vs. Other Forms of Buprenorphine
Buprenorphine for the treatment of opioid addiction comes in many forms.
Oral formulations are the more widely used form of buprenorphine for treating opioid addiction/dependence.
Commonly, patients undergoing buprenorphine treatment will be prescribed sublingual tablets or films which are placed under the tongue and dissolved, rather than swallowed or chewed whole.
The sublingual route allows the medication to be absorbed into the bloodstream more rapidly. Oral formulations are administered daily.
However, buprenorphine can also be delivered to the body in other ways such as through an extended-release injection form.
A buprenorphine injection is typically administered monthly and delivers stable levels of buprenorphine into the body gradually over the month.
Buprenorphine subdermal implants are another promising alternative that may be well suited to certain patients.
Buprenorphine implants are inserted into the upper arm through a simple medical procedure, and deliver continuous, stable blood levels of buprenorphine over the course of six months.
The Potential Benefits of Buprenorphine Implants
Decreased need for daily dosing
Implantable buprenorphine mitigates the need for daily dosing. Patients using oral/sublingual forms of the buprenorphine must self-administer the medication daily as instructed by their treatment provider.
This could be inconvenient or mentally challenging for certain patients. Further, if a dose is missed, a patient may accidentally go into a state of withdrawal.
Implantable buprenorphine removes these possible complications associated with daily dosing.
Continuous medication delivery
Once inserted, buprenorphine implants release the medication into the body for six months.
Continuous medication delivery means that a patient is not required to visit their doctor for checkups or repeat prescriptions as frequently as they would with an oral buprenorphine form.
Therefore, implantable buprenorphine may be a convenient option for patients who do not have frequent or easy access to their treatment provider.
Reduced risk of diversion
Oral buprenorphine formulations, such as sublingual tablets, can easily be diverted, meaning that patients can use the medication inappropriately.
For instance, individuals may transfer or sell the tablets to other individuals to whom the medication was not prescribed.
On the other hand, buprenorphine implants are administered through an in-office procedure by a certified medical professional. A patient cannot simply transfer it to someone else as would be possible with tablets.
Lower potential for misuse
Similarly, implantable buprenorphine carries a lower potential for misuse. With oral formulations, individuals may purposely consume more than the recommended dose in an attempt to feel more intense opioid effects.
Due to buprenorphine implants delivering a stable and continuous flow of the drug, it is nearly impossible to misuse the medication in this form (unless patients attempt to supplement it with oral buprenorphine).
Improved medication adherence
Medication adherence may be improved with implantable buprenorphine because once the device is in the body, the drug stays in the system for up to six months.
On the other hand, patients may simply stop taking prescribed oral formulations.
Reduced cravings and withdrawal
As with all buprenorphine-containing medications, implantable buprenorphine effectively works to reduce opioid withdrawal symptoms and cravings.
The drug binds to the opioid receptors in the brain in a targeted way to produce similar effects to other opioids but to a milder extent.
Enhanced treatment outcomes
Due to the convenience and longer duration of implantable buprenorphine, this method may produce enhanced treatment outcomes.
The convenience of having a simple procedure once every six months, as opposed to daily oral dosing, may simplify the treatment process for individuals, and allow them to go about their normal life without giving the medication too much thought.
How To Get Buprenorphine Implants
Implantable buprenorphine requires a prescription from a medical professional who has received certification and training through the FDA’s Probuphine Risk Evaluation and Mitigation Strategy program.
Only physicians who have acquired this specific certification (or a waiver) are able to prescribe and implant buprenorphine.
Speak to your doctor or treatment team about the availability of buprenorphine implants, if you believe that this form of treatment would be appropriate and beneficial to you.
It’s important to note that buprenorphine implants are an expensive alternative to transmucosal (oral) or injectable formulations of buprenorphine, priced at approximately $5,175.
However, you may be able to have this cost covered by an insurance provider.
Who Can Use Buprenorphine Implants?
Buprenorphine implants are not suitable for patients who are just beginning buprenorphine treatment.
This is partly because buprenorphine implants should only be used in patients who are considered opioid tolerant to reduce the risk of adverse effects.
Buprenorphine implants are typically used in patients who have already achieved and sustained clinical stability on low to moderate doses of an oral buprenorphine-containing product.
To start taking oral buprenorphine, individuals must meet the criteria for an opioid use disorder (OUD) diagnosis and must be in a state of withdrawal from other opioids (i.e. their problem drug).
Once a patient has stabilized on oral buprenorphine, they may then be able to switch to an implant formulation of the medication depending on advice from their treatment provider.
Potential Side Effects of Buprenorphine Implants and How To Manage Them
The potential side effects of buprenorphine implants are similar to those of other buprenorphine-containing products and tend to be mild.
Patients may experience headaches, nausea, insomnia, vomiting, and constipation. Speak to your doctor or treatment team if you are experiencing any unwanted side effects.
Patients may also experience adverse effects temporarily after having the implants inserted, such as pain and irritation at the site. These effects typically subside after a few days.
The most dangerous potential side effect of any form of buprenorphine is respiratory depression.
This occurs when an individual’s breathing becomes short and shallow, leading to increased levels of carbon dioxide in the blood (which can be fatal).
If you notice changes to your breathing while undergoing buprenorphine treatment, seek medical attention as soon as possible.
Conclusion
Buprenorphine implants can be a highly convenient option for the maintenance treatment of opioid dependence.
The implant method of buprenorphine mitigates the risk of diversion or misuse, effectively reduces withdrawal symptoms and cravings for other opioids, and helps individuals achieve a complete recovery from opioid use disorder.
Speak to your doctor or treatment team if you believe buprenorphine implants are a suitable treatment for you.
