Buprenorphine is a partial opioid agonist medication that can help to control withdrawal symptoms in people with opioid use disorders. It is one of many medication-assisted treatments.
Organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA) define medication-assisted treatment (MAT) as the combination of behavioral interventions, such as therapy and support groups, and medications in the treatment of substance abuse.
One of the most common uses of a MAT is addressing the withdrawal syndrome associated with a particular substance of abuse.
Individuals who have developed opioid addictions will inevitably go through some level of withdrawal, which will make them more susceptible to relapse. Relieving withdrawal symptoms can go a long way in helping an individual make it through the early stages of recovery.
Opioid drugs include a long list of prescription medications, such as Vicodin (acetaminophen and hydrocodone), OxyContin (oxycodone), and illicit drugs like heroin. Prescription opioids are primarily used to treat pain, but they may be used for other purposes, such as controlling coughing associated with the common cold or the flu.
Opioids are significant drugs of abuse. Therefore, the majority of them are controlled substances.
Individuals who abuse opioids will develop significant levels of tolerance to them and experience withdrawal from them once physical dependence has formed. The tolerance associated with opioid abuse develops rapidly, which causes individuals to begin using higher dosages to achieve the effects they seek.
Significant tolerance leads to the development of physical dependence, known as withdrawal syndrome. Withdrawal symptoms occur after the levels of the drug are depleted when they stop using the drug, throwing their system out of balance.
Eventually, many people begin to increase their use of opioids not to achieve a sense of euphoria but rather to avoid potential withdrawal symptoms and other adverse effects. This results in a serious cycle of addiction that has many detrimental effects, both on the person and society.
Opioid withdrawal symptoms are generally not considered to be potentially fatal, although an individual can certainly develop serious issues during withdrawal that can be dangerous.
For instance, someone can become dehydrated due to diarrhea and vomiting, whereas another person might become emotionally distraught and suicidal during the withdrawal process.
Individuals in recovery are more likely to relapse and overdose during withdrawal. In fact, because the potential to relapse is extremely high when an individual is undergoing withdrawal from opioids, physicians commonly administer medications to ease withdrawal symptoms.
For the reasons stated above, a physician-assisted medical detox program is now considered to be essential in the treatment of opioid addiction.
In a medical detox program, numerous medications can be used to address withdrawal symptoms. One of the most commonly used medications is buprenorphine.
Buprenorphine is a partial opioid agonist that is classified as a narcotic drug. The medication can be used for the management of pain or as an opioid replacement medication for withdrawal management. It is often marketed under the brand names Suboxone, Butrans, Belbuca, Sublocade, or Subutex.
As a partial opioid agonist, buprenorphine occupies the same receptors in the brain that other opioids attach to, often termed themu-opioid receptors or endogenous opioid receptors. However, the drug does not produce the full effects associated with other opioid drugs.
Buprenorphine may produce some mild euphoria, pain reduction, and other effects, but it does not result in the full effects of opioids of abuse. Since buprenorphine occupies the sites in the brain where other opioids normally attach, the individual avoids the experience of withdrawal.
Buprenorphine is relatively long-acting and only needs to be given every 24 hours. There are also extended-release versions of the drug.
The medication has ceiling effects, which means that after it has fully occupied the receptors in the brain, the administration of additional buprenorphine does not produce any additional effects.
How Buprenorphine is Used in Medical Detox
Medications containing buprenorphine are initially given in a dose that controls withdrawal from opioids. Then, the physician will slowly taper down the dosage at specific time periods to allow the individual to be weaned off it. The process can last anywhere from five days to several weeks, depending on the specific situation.
Eventually, the individual will not need any more medication and will not experience any withdrawal symptoms. This tapering strategy is hugely successful, and numerous research studies have indicated that it effectively helps individuals who are in the early stages of recovery get through the withdrawal process.
Buprenorphine does not “cure” an individual of their substance abuse issue. Individuals still need to be involved in a long-term treatment and aftercare program once they have completed withdrawal management. This program should include therapy, peer support group participation, and other interventions.
Meta-analytic research studies have determined that the dosage of buprenorphine used during the withdrawal management process is an important factor in the drug’s effectiveness.
The drug often needs to be given at relatively high doses, such as 16 mg per day, to be effective in reducing withdrawal symptoms. When the drug is given in sufficient dosage, the rate of relapse during medical detox is significantly lower.
Physicians may be concerned with giving high doses of buprenorphine to those in withdrawal management programs, but this concern may account for reduced rates of success in these programs.
Buprenorphine is a controlled substance (C II) and an opioid drug, which means it does have the potential for abuse. In fact, several brands of buprenorphine, including Suboxone (naloxone and buprenorphine), attempt to subvert abuse by containing the opioid antagonist naloxone in the pills. If the pills are crushed, the naloxone is activated, and individuals injecting or snorting the drug will immediately experience withdrawal effects.
Even with this safeguard, Suboxone is sometimes abused. Even so, the medicinal effects of medications containing buprenorphine far outweigh the potential for its abuse.
Because the drug is a controlled substance, it should be used only with a prescription and under the supervision of a physician. Individuals should not attempt to create their own medical detox program or use the drug without being under the supervision of a physician.
Similar to other opioids, there are potential side effects of using the drug. These include respiratory suppression, cardiac issues, and potential allergic reactions.
MAT and Recovery
According to the National Institute on Drug Abuse, medical detox programs and MAT are part of the overall components of an effective recovery program.
Opioid replacement medications like buprenorphine can be lifesavers for individuals with opioid use disorders. They need to be used in conjunction with therapy, however.