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Are Partial Opioid Agonists Drugs Addictive?

You can become addicted to partial opioid agonists. Certain formulations are more likely to be abused.

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Partial opioid agonists are the scientific name for medications like buprenorphine, tramadol, butorphanol, and pentazocine. You have most likely heard of buprenorphine because of its applications to treat opioid use disorder. Other partial opioid agonists are commonly used to treat pain.

These medications are called partial opioid agonists because they can influence opioid receptors in the brain, but their effects are much weaker than full-fledged opioid agonists like fentanyl, codeine, or heroin.

Data shows that people can misuse some of these medications. Let’s look at how these medications are used so we can better understand what makes it easy for people to misuse them.

Substance Abuse and Mental Health Services Administration (SAMHSA) shows that buprenorphine use has increased substantially over the past decade.

Why Partial Opioid Agonists Are Taken

Each partial agonist is taken for different reasons.

  • Buprenorphine is used for pain relief, but it is most often used to replace opioids in those who misuse heroin and prescription narcotics. Buprenorphine helps avoid withdrawal symptom from manifesting when these other opioids are stopped being taken.
  • Butorphanol is available as both an injection and nasal spray. Both the nasal spray and injection are used to relieve pain. The injection is sometimes used to assist with pain associated with labor.

    The spray and injection can be administered at home. People who use butorphanol spray should not stop using it cold turkey, as it can cause feelings of withdrawal.

  • Tramadol affects the chemical messengers in the brain that send pain signals. Per the U.S. National Library of Medicine, it is sold as either a capsule or tablet, and it can become habit-forming. People who use tramadol should not stop using it suddenly to avoid potential sever withdrawal symptoms.
  • Pentazocine is prescribed for people experiencing moderate to severe pain levels. The National Institutes of Health states that it is known to relieve pain, but it is not associated with euphoric or other feelings that can produce a high. This means it is considered a medication with low potential for abuse.It is sometimes combined with naloxone or acetaminophen, which experts believe can also deter people from misusing the medication. Naloxone is also used to block the effects of opioids and acetaminophen is used to treat mild to moderate pain.

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Pros and Cons of Medication-Assisted Treatment (MAT)

The National Institute on Drug Abuse (NIDA) states that medication-assisted treatment (MAT) can help people who misuse opioids, such as heroin or prescription pain medications.

NIDA explains that two medications have been approved for use in MAT. They are:
  • Methadone. This is a full opioid agonist. It affects the exact same receptors as opioids like heroin and prescription painkillers. Methadone works a lot more slowly, thus making it less habit-forming than the drugs it is meant to replace. People can successfully use it to suppress cravings, but methadone is only available in specialist centers.
  • Buprenorphine is the drug of choice for medication-assisted treatment (MAT) in people who misuse heroin, morphine, or other opioid-based pain medication, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). This medication can be given by physicians in correctional facilities, community centers, hospitals, and treatment centers. It is more accessible than methadone, a popular MAT medication, because patients do not have to visit specialized centers to get it.
Buprenorphine decreases feelings of withdrawal in people who are trying to stop misusing opioids, improves outcomes in cases of overdose, and diminishes cravings. The medication is known to have a decreased misuse potential, but the possibility for misuse still exists.

MAT is most successful when partnered with supplementary strategies that can help people quit misusing opioids and other drugs, such as therapy. Family or individual counseling, inpatient or outpatient rehabilitation, and self-help groups are additional tools that can help people get to the bottom of their drug misuse, while MAT can substitute for whatever drug they are misusing.

Some benefits of MAT include the following:
  • The medications work much slower than illicit drugs or prescription narcotics, which decreases cravings.
  • Therapy and other strategies used at the same time can help people stay away from problematic drug use.
  • MAT may make overdose less likely.
Disadvantages of MAT include the following:
  • Medication can be difficult to access. Methadone can only be distributed in approved centers.
  • The cost of medication may cause patients to delay or avoid treatment. The National Institute on Drug Abuse (NIDA) estimates that buprenorphine treatment can cost approximately $115 per week or $5,980 annually, though insurance may cover it.
  • It may require visits to a physician twice per week.
  • The risks of misuse still exists.

Is Buprenorphine Misuse Possible?

The Substance Abuse and Mental Health Services Administration (SAMHSA) states that buprenorphine can be misused by people who are not currently addicted to opioids. People are warned not to use other drugs when taking buprenorphine

A September 2015 study from the Journal of Addiction Medicine mentioned that diversion of buprenorphine is a concern.

The study looked at people all over the world and found that some people misuse or diver buprenorphine by:

  • Obtaining it from friends.
  • Removing all or part of the dose from the mouth to use later (when not under medical supervision).
  • Injecting it intravenously.

When buprenorphine is combined with naloxone in a combination medication, rates of misuse are lower.

Treating Misuse of Partial Opioid Agonists

Abuse of buprenorphine and other partial opioid agonists can be treated, but clinicians must assess the person’s situation. If you are misusing buprenorphine, it is likely that you have had some contact with treatment for substance misuse already.

When dealing with buprenorphine misuse, treatment providers may:
  • Ask clients to come in for checkups more often.
  • Provide smaller doses of buprenorphine if it is part of MAT.
  • Help the person set up a support system to prevent relapse.
The Journal of Addiction Medicine suggests switching a person to methadone or buprenorphine that is combined with naloxone.
Other traditional therapies for misuse can also help, such as:
  • Contingency management. This aims to provide people with reinforcements that incentivize healthy choices.
  • Group therapy is known to promote abstinence and allow clients to share struggles and strategies with others.
  • Individual counseling can help clients deal with stresses, learn new skills, cope with cravings, and develop a plan for recovery.
  • Dealing with underlying issues. Treatment for drug misuse should always deal with the whole person and their unique needs. This may mean testing for HIV or hepatitis C, providing legal assistance, and addressing employment or academic preparation.

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