If you or a loved one are battling opioid use disorder, you may have heard of buprenorphine as a potential treatment option.
As a newer treatment option, less is commonly known about buprenorphine. In this article, we’ll uncover some need-to-know information about how buprenorphine works in opioid use disorder treatment and who the drug is most suitable for.
Keep reading to find out:
- What buprenorphine is
- How buprenorphine works
- Buprenorphine in opioid addiction treatment
- Forms and administration of buprenorphine
- Buprenorphine treatment: How it works and who can take it
- Access and regulation of buprenorphine
- Buprenorphine misuse potential
- Buprenorphine safety precautions
- Can pregnant or breastfeeding women take buprenorphine?
Let’s get started.
What is Buprenorphine?
Buprenorphine is a synthetic drug that works by mimicking the effects of opioids.
Buprenorphine is a partial opioid agonist, meaning that it isn’t as strong as other full opioid agonists such as methadone.
Buprenorphine is used both as a painkiller for severe pain relief and as a treatment for opioid use disorder, and it is FDA-approved for both of these purposes.
As a synthetic opioid, buprenorphine produces effects related to opioids such as pain relief, relaxation, euphoria, and sedation.
How Buprenorphine Works
As a partial opioid agonist, buprenorphine works in the body by partially binding to mu-opioid receptors. The drug then produces some feelings associated with opioids such as pain relief, decreased breathing rate, and euphoria.
However, as buprenorphine is a partial opioid agonist, this means that it only activates the mu-opioid receptors to a certain point.
After that point, no increases in pain relief, euphoria, or breathing rate decline will be experienced.
It is for this reason that buprenorphine is safer to consume than full opioid agonists such as heroin which do not have this ceiling effect.
Buprenorphine in Opioid Addiction Treatment
So, how does this relate to the treatment of opioid addiction?
Buprenorphine is used in what is referred to as medication-assisted treatment (MAT) for opioid use.
In this medication-assisted treatment, buprenorphine is used as a substitute for the drug of abuse.
Substituting drugs such as heroin or morphine with buprenorphine prevents the severe withdrawal effects associated with sudden cessation of these drugs.
It also does so in a safe way due to the ceiling effect of buprenorphine preventing dangerous effects such as respiratory depression occurring after ingestion.
Buprenorphine vs. Methadone
Many individuals are familiar with methadone as a commonly used therapeutic substitution drug for opioid use disorder. You may therefore be asking how buprenorphine differs from methadone.
While buprenorphine is a partial opioid agonist, methadone is a full opioid agonist (meaning its effects are stronger).
As a result, buprenorphine is generally recommended for mild to moderate opioid dependence, while methadone can be used for all levels of dependence.
Forms and Administration of Buprenorphine
Next, let’s take a look at the different forms and administration of buprenorphine.
Buprenorphine can be taken in three main forms: by injection, applied to the skin in patches, or as tables or buccal films taken orally under the tongue.
The form and dose of buprenorphine that is right for you is dependent on individual factors and should be determined by your health care professional.
Buprenorphine Treatment: How It Works and Who Can Take It?
When beginning buprenorphine treatment, there are several stages that occur during the therapeutic process. Let’s take a look at each of these in closer detail:
Induction Phase
During the induction phase, buprenorphine is administered under medical supervision.
It is important at this stage that the individual has abstained from opioid use for approximately 12 – 24 hours and is experiencing the first signs of withdrawal.
If the individual has not abstained for this amount of time and still has opioids in their system, this can create more acute withdrawal symptoms when buprenorphine is administered.
The Stabilization Phase
The stabilization phase occurs when the individual has ceased taking the abused opioid drug or has reduced consumption close to cessation.
The individual should also have stopped experiencing cravings. At this stage, the dosage of buprenorphine can be adjusted and can potentially be administered only every other day due to its long-acting nature.
The Maintenance Phase
The maintenance phase occurs when the individual has stabilized on the same dosage of buprenorphine.
From there, the patient may remain on the dosage for a longer period of time, or they may cease the drug under medical supervision.
Side Effects of Buprenorphine
There are several side effects associated with buprenorphine use that are important to be aware of. Many of these are fairly benign; however, a few are more serious and need to be heeded.
Common side effects include dizziness, dry mouth, loss of appetite, headaches, sleepiness, sweats, insomnia, sore muscles, shakiness, vision changes, heart palpitations, tooth decay, and gastrointestinal symptoms such as vomiting, nausea and constipation.
More serious adverse effects include decreased breathing, dependence and withdrawal, and opioid overdose.
Access and Regulation of Buprenorphine
Individuals can now access buprenorphine through their doctors, who can prescribe and monitor its use throughout treatment.
Previously, doctors had to obtain waivers to access the drug; however, these regulations have now been removed to improve accessibility to treatment for individuals with opioid use disorder.
Buprenorphine Misuse Potential
Like all other opioids, buprenorphine is not immune from misuse. This may be especially the case for individuals with lower-level opioid abuse who overuse buprenorphine.
However, due to the ceiling effect of the drug, the level of abuse likely is lower than that of other full opioid agonists such as methadone.
Buprenorphine Safety Precautions
While taking buprenorphine, it’s important you follow standard safety precautions. These are outlined below in more detail:
Use only under medical supervision
Buprenorphine should only be used under the supervision of a medical professional.
Acute withdrawal symptoms are possible if taken with other opioids, or if taken in high doses. Buprenorphine may also interact with other medications.
Follow prescribed dosage
Always follow the dosage outlined by your doctor to prevent side effects and withdrawal symptoms.
Avoid alcohol and sedatives
Buprenorphine causes adverse effects with other drugs such as alcohol and sedatives. Do not consume these while on buprenorphine therapy.
Store safely, out of reach
Always keep your medication safely out of reach from others.
Dispose of properly
Ensure you safely dispose of any used needles and any unused medications.
Inform healthcare provider of medications
Before you start buprenorphine therapy, you must inform your healthcare provider of all current medications you take.
Avoid driving or operating machinery
As buprenorphine may cause sleepiness and impaired attention, you should not drive or operate machinery when under its influence.
Monitor for allergic reactions
All drugs have the potential to cause allergic reactions. Monitor for any signs of these such as a rash, swelling, itching, or difficulty breathing. Contact a medical professional if you suspect an allergic reaction.
Keep appointments for check-ups
Make sure you follow through with all your appointments to ensure you stay healthy and avoid withdrawals.
Can Pregnant or Breastfeeding Women Take Buprenorphine?
Currently, there is limited information available on the safety of buprenorphine for pregnant or breastfeeding women.
While no adverse effects have yet been documented in pregnant or breastfeeding women, the possibility of risk has not been completely ruled out.
As a result, methadone is currently the preferred treatment for pregnant women with opioid use disorder as the FDA has deemed methadone therapy to be low-risk.
Conclusion
As we’ve seen, buprenorphine is a mediation-assisted therapy used to treat opioid use disorder.
Unlike methadone, buprenorphine is a partial agonist, meaning it can be taken in large doses without risking dangerous side effects and has lower abuse potential.
As a result, buprenorphine may be an attractive treatment for many individuals struggling with opioid addiction.
Due to its less powerful effect, buprenorphine is generally more suited to individuals with mild to moderate opioid dependency. Speak to your doctor for more information on buprenorphine and whether it’s right for you.
Frequently Asked Questions
Is buprenorphine used as a painkiller?
Yes, buprenorphine is used as a painkiller. As it is an opioid, it is reserved for more severe pain such as after an operation, or cancer-related pain.
How long is the effect of buprenorphine?
Buprenorphine starts to take effect after approximately 30 – 60 minutes. The total duration of effect depends on dosage, but typically lasts up to 12 hours on a low dose, and 72 hours on a high dose.
What is the other name for buprenorphine?
Buprenorphine is also known by its brand names Suboxone, Belbuca, Brixadi, Buprenex, Butrans, and Probuphine.
Sources
- https://www.ncbi.nlm.nih.gov/books/NBK459126/
- https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids
- https://psychopharmacologyinstitute.com/section/buprenorphine-for-opioid-use-disorder-mechanism-of-action-2037-4002
- https://psychiatry.uams.edu/clinical-care/cast/buprenorphine/
- https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf
- https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine
- https://www.nbcnews.com/health/health-care/buprenorphine-opioid-addiction-medication-access-expanded-rcna69740
- https://www.justice.gov/archive/ndic/pubs10/10123/10123p.pdf
