How Does Buprenorphine Treat Opioid Use Disorder?
Buprenorphine is used to treat people with an opioid use disorder (OUD) and relieve withdrawal symptoms during opioid detoxification. It’s also used to maintain abstinence during recovery and as a treatment for severe chronic pain.
What Is Buprenorphine and What Is Buprenorphine Used For?
Under the brand name Suboxone, buprenorphine is a promising alternative to traditional methadone maintenance therapy. A 2018 National Institute on Drug Abuse research report cited buprenorphine as a safe and effective treatment for opioid use disorder.
Nevertheless, this resource is greatly underutilized. Almost 50 percent of private-sector rehab programs do not offer buprenorphine treatment.
How Does Buprenorphine Work?
Buprenorphine is a partial opioid agonist. It binds to opioid receptors in the brain, but not as strongly as a full agonist would. An agonist binds to a target and activates it. An antagonist binds to a target and keeps agonists out.
Morphine is an opioid and a full agonist. It targets opioid receptors and fully activates them. Naltrexone is an opioid antagonist. It blocks morphine from entering the receptor and keeps it from affecting.
As a partial opioid agonist, buprenorphine reduces cravings and withdrawal symptoms without the full-out rush of euphoria that full agonists generate. It’s well-tolerated by patients with a history of opioid abuse.
Suboxone contains a combination of buprenorphine and naltrexone. Buprenorphine soothes withdrawal symptoms and maintains comfort while naltrexone helps to prevent relapse by making that process unpleasant.
It acts on opioid receptors in the brain and spinal cord. It also depresses brain respiration. Side effects can include nausea and vomiting, constipation, pinpoint pupils, sweating, and flushed skin.
Buprenorphine received full FDA approval in 2002. It was the first medication a certified physician would prescribe under the Drug Addiction Treatment Act. This made treatment more accessible by freeing patients from having to make daily visits to the nearest methadone clinic.
Under the 2016 Comprehensive Addiction and Recovery Act, qualified nurse practitioners and physician assistants can now prescribe buprenorphine-based medications through October 1, 2021.
The drug has been available in tablet form since 2002 and as a sublingual film since 2010. In 2016, the FDA approved a six-month subdermal buprenorphine implant. In 2017, a monthly injection was approved.
How Effective Is Buprenorphine As an Opioid Use Disorder Treatment?
There is plenty of evidence that buprenorphine reduces the risk of relapse by removing withdrawal symptoms. Patients receiving buprenorphine are more likely to find jobs and remain in treatment. They are less likely to overdose or to indulge in risky and criminal activities associated with illicit drug use.
Studies show that when dispensed in a dose that’s high enough and of sufficient duration, buprenorphine is as effective as methadone in reducing relapse rates.
Patients should receive at least 16 mg per day. If the prescribed dose is too low or the medication duration is too short, buprenorphine treatment is unlikely to be effective.
Buprenorphine Vs Methadone
Methadone has been a reliable treatment for opioid use disorder since 1947. Extensive studies support the effectiveness of methadone in reducing opioid use and improving the overall quality of life.
A 2009 Cochrane review revealed that methadone augmented with psychosocial therapy effectively reduces opioid use, crime, and disease transmission compared to controls receiving psychosocial treatment and a placebo.
In one study, the methadone group had 33 percent fewer positive drug tests than the controls. They were also 4.44 percent more likely to remain in treatment. Methadone treatment alone improves treatment outcomes significantly, even without counseling.
Buprenorphine and Naltrexone
Buprenorphine can be prescribed alone (Subutex) or in combination with the opioid antagonist naltrexone (Suboxone) to treat opioid use disorder.
A 2003 Swedish study revealed fewer relapses among patients detoxed with buprenorphine and maintained a daily dose of 16 mg.
Another study reported a 100 percent relapse rate for patients receiving placebos. Meanwhile, patients receiving buprenorphine had a relapse rate of only 25 percent. Leaving treatment early was associated with relapse. There was a mortality rate of 20 percent.
Recent studies suggest that combining buprenorphine with naltrexone may weaken buprenorphine efficacy. Moreover, naltrexone may not be as effective at preventing opioid abuse as previously thought.
Suboxone contains both buprenorphine and naltrexone. If a patient injects Suboxone, it can cause a full-blown withdrawal experience.
Nevertheless, the combination of these two medications is thought to offer more benefits than risks. Although naltrexone limits the euphoria induced by buprenorphine alone, the literature supports Suboxone as a safe and effective way to manage opioid use disorder.
When Is Buprenorphine Prescribed?
Besides chronic and severe pain management, buprenorphine is prescribed for detox from opioid drugs and opioid replacement therapy after detoxification is complete. During detox, buprenorphine relieves withdrawal symptoms while you are slowly weaned from illicit opioid drugs.
Patients receive a monthly prescription for buprenorphine. When dispensed by a qualified medical professional, this FDA-approved treatment is a safe and reliable alternative to illicit drugs.
As a treatment for opioid detox or medication replacement therapy, buprenorphine is prescribed as a sublingual tablet or a sublingual film. Suboxone, which contains buprenorphine and naltrexone, is currently the medication of choice for treating opioid addiction.
Buprenorphine provides relief by enhancing overall comfort levels and reducing cravings that can lead to relapse. It allows the patient to focus on and benefit from other healing modalities and psychosocial therapies.
Methadone has been used to treat opioid addiction for four decades. However, it is a highly regulated substance and may be difficult to get. Although buprenorphine was originally used as a treatment for heroin addiction, it has since been used to treat opioid prescription drug abuse.
Naltrexone and the off-label antihypertensive clonidine have both been used to treat opioid misuse and found to be largely ineffective.
Like methadone, buprenorphine was originally developed to treat heroin addiction. However, given the current surge in opioid addiction cases and opioid-related deaths, buprenorphine is being used to treat addiction to any opiate. That includes illicit street opiates like heroin as well as prescription medications like morphine and fentanyl.
What Is Buprenorphine for Pain Dosage?
As an opiate partial agonist, buprenorphine may be prescribed when a patient has severe chronic pain against which other medications and as-needed pain relievers are ineffective. For severe chronic pain, buprenorphine is dispensed in the liquid form delivered intramuscularly or intravenously.
Suboxone, which includes both buprenorphine and naltrexone, is widely used as an off-label treatment for chronic pain. A recent study suggested that patients taking the combination experienced improved mood and increased energy compared to those taking methadone.
Overall, Suboxone has weak analgesic properties when used to treat chronic pain in non-opioid-dependent patients. On the other hand, Suboxone does reduce pain for opioid-dependent patients.
An important advantage of treating chronic pain with Suboxone or with buprenorphine alone is that both preparations have a neutral effect on the immune system compared to morphine and fentanyl.
Because Suboxone has a ceiling effect, it’s less likely to be abused than morphine and fentanyl. Suboxone also contains naltrexone, so injecting it can cause instant withdrawal. These two factors make patients less likely to ingest more than the prescribed dose.
Severe pain, especially chronic severe pain, can make you feel desperate for relief. However, mixing alcohol or benzodiazepines with buprenorphine can be fatal.
The liver processes buprenorphine very slowly. Therefore, it can take longer to feel enough pain relief. In this situation, patients are more likely to increase or supplement their doses without consulting a doctor.
The National Alliance of Advocates for Buprenorphine Treatment (NAABT) does not support the use of buprenorphine for pain dosage. Although buprenorphine is FDA-approved, that approval is for opioid use disorder treatment rather than chronic pain. Additionally, the different buprenorphine formulations may be subject to problems with scheduling and delivery.
How Long Does Buprenorphine Stay in Your System?
Buprenorphine stays in your blood for up to 48 hours and your urine for almost one week. It’s present in saliva for up to three days and in your hair for up to three months.
How long does buprenorphine stay in your system? It can take up to two weeks or longer before it’s completely flushed out of your body.
How Long Does Buprenorphine Block Opiates?
This medication reaches maximum blood concentration levels within 45 minutes to 3.5 hours after ingestion. The effects can last for up to three days.
That’s considered a long half-life for an opioid compared to other opioids. Morphine and fentanyl have much shorter half-lives than buprenorphine. Naltrexone has a shorter half-life than buprenorphine. It only lasts for two to 12 hours.
How long does buprenorphine block opiates? The answer is that the longer the half-life of a drug, the longer its effects will be felt.
What Are the Benefits of Buprenorphine Vs Methadone?
Both of these treatments can significantly reduce the use of illicit opioids. Methadone is somewhat better at reducing illicit opioid use than Suboxone. However, Suboxone is easier to get.
Methadone and buprenorphine have been compared in many studies. In one long-term study, patients were treated with either methadone maintenance or buprenorphine. Five years later, 60 percent of methadone patients were still drug-free based on negative toxicology screens and self-reported abstinence.
Do You Still Have Questions About Buprenorphine?
Miracles Recovery Center is a drug and alcohol rehab in Port Saint Lucie, FL. We provide a wide range of treatment options for those with opioid use disorder or chronic pain. If you would like additional information, please contact us today.