Buprenorphine is an FDA-approved, prescription-only medication that can be a safe and effective method for treating opioid addiction (otherwise known as opioid use disorder or OUD).
Buprenorphine should be administered as part of a comprehensive treatment program that also includes psychological support and behavioral therapy.
This article outlines what buprenorphine is, how it works, and how it is implemented into a treatment program.
Understanding Opioid Addiction
Opioid addiction is a worldwide problem that affects people of many different demographics, their families, and communities.
Addiction to opioids is commonly referred to as opioid use disorder (OUD).
OUD is the chronic misuse of opioid drugs (such as heroin, fentanyl, or methadone) that causes impairment or clinically recognized distress and significantly impacts the user’s quality of life.
However, opioid addiction can be managed, and a complete recovery is possible with the right tools and methods.
Treatment of OUD under proper clinical supervision can lead to a renewed sober, healthy, and positive way of life.
A treatment plan for OUD typically involves a combination of prescription medication and a cognitive-behavioral approach through therapy and psychological support programs.
What is Buprenorphine?
Buprenorphine is an FDA-approved medication used for the treatment of opioid use disorder (OUD).
When a patient abruptly stops taking an opioid drug that they have been using/abusing for a long period of time, they will experience painful withdrawal symptoms and have strong cravings for the drug.
These withdrawal symptoms and cravings can be so debilitating and intense that the patient is unable to live a normal life, and may relapse into using their problem drug. In these situations, buprenorphine is highly useful.
How Does Buprenorphine Work?
Buprenorphine acts as a partial opioid agonist, meaning it targets the opioid receptors in the brain in a controlled way.
It produces similar effects to other (full) opioid drugs but to a much milder extent. Therefore, it helps a patient to manage painful opioid withdrawal symptoms and reduces the desire to use the problem drug.
Importance of Medical Supervision
Buprenorphine is a prescription-only medication. Doctors require specific training as well as a DEA registration or waiver to prescribe the medication.
It’s important that treatment using buprenorphine is supervised by a certified medical professional so that the patient’s progress can be monitored and supported.
Medical supervision reduces risks of overdose or relapse, increases the treatment’s effectiveness, and ensures that the patient is working towards a comprehensive recovery both physically and psychologically.
Because buprenorphine is a partial opioid agonist itself, stopping the medication abruptly or significantly reducing the dose can produce painful withdrawal symptoms that are similar to those of other opioids.
Doing so may trigger relapse, and this reinforces the importance of using buprenorphine under proper medical supervision.
When you are ready to stop using the medication, your doctor will work with you to ‘taper off’. This involves gradually reducing your dose to minimize unpleasant withdrawal symptoms and reduce the risk of harm or relapse.
Buprenorphine Treatment Protocols
The treatment of opioid use disorder with buprenorphine can be divided into the following three phases:
Induction Phase
The induction phase begins with an initial assessment in which your doctor will evaluate the need for treatment.
Your doctor will determine the severity of your substance use disorder, the effect of opioid use on your physical and psychological functioning, and identify any underlying or co-occurring conditions.
Your doctor or treatment team will inform you about the medication, protocols, and associated risks, as well as educate you about overdose prevention before obtaining informed consent.
Patients must be in a state of withdrawal from opioids before starting buprenorphine. Generally, you will start buprenorphine between 12-48 hours after your last opioid use.
Your doctor will determine your starting dose of buprenorphine based on your recent opioid use, individual tolerance, and the severity of withdrawal at the time of starting treatment.
The initial dose will be administered under the direct observation of your doctor. Over the next several hours, you will be closely monitored for severe opioid withdrawal symptoms or excessive opioid agonist effects. Your dose will be adjusted as necessary.
The remainder of the induction phase typically lasts 3-7 days and involves close supervision and monitoring from your doctor to ensure your body is responding favorably to the medication.
Stabilization Phase
The next phase of buprenorphine treatment is stabilization.
This generally lasts 1-2 months and involves adjusting the medication dose frequently to establish the minimum dose required to eliminate withdrawal symptoms, reduce cravings, and minimize side effects.
During this period, you will stay in frequent contact with your doctor to facilitate dose adjustment. Any side effects you may be experiencing will be addressed.
During the stabilization phase, it is important to continue to engage with psychological support programs and behavioral counseling.
The mental toll of treatment can be just as significant as the physical changes. As such, engaging with therapy can improve your willpower and equip you with healthy coping strategies.
Maintenance Phase
The maintenance phase of buprenorphine treatment is a long-term, indefinite process. The length of time you stay on the medication will be determined based on individual factors influencing your treatment and recovery journey.
Your doctor will continue to monitor your response to the medication, including your level of withdrawal and cravings.
Upkeeping psychological support strategies, and engaging with therapy during the maintenance phase will ensure you are managing triggers that may lead to relapse and are working towards a complete mental and physical recovery from opioid use disorder.
Eventually, the decision to discontinue buprenorphine mandates an in-depth discussion with your doctor and a ‘tapering off’ plan designed to minimize unpleasant withdrawals, avoid relapse, and increase your safety and comfort.
Forms of Buprenorphine
Sublingual Tablets and Films
The most common form of buprenorphine is sublingual tablets and films.
A sublingual tablet or film is a medication that is dissolved under the tongue rather than swallowed whole or chewed. The sublingual route allows the drug to be absorbed into the system more rapidly.
A commonly prescribed sublingual tablet for OUD treatment is Suboxone. Suboxone contains both buprenorphine and naloxone.
The presence of naloxone prevents abuse or overdose because it produces an onset of painful withdrawal symptoms in people who attempt to misuse the medication by injecting it.
Implantable Devices
Probuphine is a subdermal implant device containing buprenorphine. Probuphine implants are generally placed on the inside of the upper arm and provide patients with a continuous stream of buprenorphine for up to six months before removal.
Probuphine implants can address issues associated with oral buprenorphine, such as failure to comply, misuse, and diversion.
Injectable Forms
Buprenorphine can also be administered through an extended-release injection form.
This works by slowly releasing buprenorphine into the body over a one-month period and is typically given monthly.
FAQs
When should a patient start buprenorphine?
A patient should start using buprenorphine when they are already in a state of withdrawal from other opioids.
They will typically receive their initial dose between 12 and 48 hours after their last opioid use. A doctor will determine the need for buprenorphine treatment and monitor the patient closely.
How long is buprenorphine effective?
The effectiveness duration of buprenorphine is dependent on the form used.
Sublingual tablet forms of the medication typically work for at least 24 hours and are administered daily. On the other hand, injectable or implant forms of the medication provide a slow, continuous release of the drug.
What to avoid when taking buprenorphine?
Avoid taking any painkiller containing codeine whilst using buprenorphine. These can increase the chance of experiencing unpleasant side effects.
What is the first stage of treatment with buprenorphine?
The first stage of treatment with buprenorphine is the induction phase in which the doctor evaluates the need for treatment, examines previous medical history and drug use, and determines the appropriate dose for individual needs.
What are the bad side effects of buprenorphine?
Buprenorphine can cause skin reactions, constipation, headache or dizziness, fatigue, nausea, vomiting, and loss of appetite.
Buprenorphine affects everyone differently, and your experience with side effects may be dependent on your history of opioid use, your dose, weight, metabolism, general health, and other factors.
Like other opioids, buprenorphine can cause breathing problems (respiratory depression). If you experience any issues or changes with your breathing, consult your doctor immediately.
