Because buprenorphine has fewer side effects than other opioid drugs, it can be less risky to use during opioid withdrawal. It is less likely to be abused than other opioid maintenance medications, like methadone.
But buprenorphine is still an opioid drug. It does have a risk for diversion, abuse, and addiction.
Monitoring Is Necessary
Opioids are highly addictive. More than 2 million people in the United States struggle with opioid misuse and dependence. As a result, buprenorphine use needs to be closely monitored.
When buprenorphine is used to treat opioid addiction through medication-assisted treatment (MAT), it should be part of a complete treatment program that also includes therapies and supportive care.
What Is Buprenorphine?
Buprenorphine is a semisynthetic opioid that is derived from thebaine.
Opioid drugs work to block pain receptors by binding to opioid receptors in the brain. When they do this, they slow down the central nervous system, lowering heart rate, blood pressure, body temperature, and breathing rate. As a result, they make you feel mellow and relaxed.
Buprenorphine is regularly used as a maintenance medication to treat opioid addiction. It is one of three FDA-approved drugs for MAT. Since it is a partial opioid agonist, it has fewer risk factors than other full agonist opioid drugs do.
Buprenorphine comes in several forms, such as:
- Subutex, a sublingual buprenorphine film strip.
- A generic sublingual film strip.
- Probuphine, a subdermal implant.
- Sublocade, a buprenorphine extended-release injection.
- Bunavail, a combination buprenorphine/naloxone sublingual tablet.
- Suboxone, a combination buprenorphine/naloxone sublingual film or tablet.
- Zubsolv, a combination buprenorphine/naloxone sublingual tablet.
- Cassipa, a combination buprenorphine/naloxone sublingual film in a higher dosage strength.
Risk of Addiction
Opioid drugs are highly addictive, as misuse of an opioid can create a pleasurable high. They can also quickly lead to tolerance and dependence, and they trigger very difficult withdrawal symptoms once you try to stop taking them.
Even as a partial opioid agonist, buprenorphine is still a central nervous system depressant, and it can be misused for a more mellow high. Buprenorphine abuse can also induce drug dependence, cause withdrawal symptoms, and lead to addiction.
According to the 2016 National Survey on Drug Use and Health (NSDUH), more than 700,000 Americans misused a buprenorphine product in the month leading up to the survey. Misuse of buprenorphine increases your risk for drug dependence and addiction.
Buprenorphine & Other Opioids
Buprenorphine is not a full agonist like other painkillers, such as OxyContin (oxycodone) or heroin. This makes it less potent and its associated high less extreme.
People who are addicted to other opioids, like heroin, may use buprenorphine to counter the comedown from these stronger drugs. Buprenorphine can blunt the harsh comedown effects and help the person feel somewhat stable until they can get their next fix.
As a partial agonist, buprenorphine doesn’t activate the opioid receptors as completely as a full agonist does. It also has a “ceiling effect.” This means that after you take a certain amount of it, the pleasurable effects stop and it won’t do anything else for you.
Overall, buprenorphine is a much safer drug. If you use buprenorphine, you are less likely to overdose, stop breathing, or have intense withdrawal symptoms than if you use heroin or other full agonist opioids.
Buprenorphine vs. Other MAT Medications
Methadone is another MAT medication that is a full opioid agonist. It is used to treat opioid dependence due to its long-lasting effects.
Methadone can be prescribed in low doses less often since it remains active for up to a full day. It has a long half-life.
Methadone needs to be prescribed through federally regulated clinics, however. It has a higher potential for abuse, diversion, overdose, and addiction than buprenorphine.
The other MAT medication, naltrexone, is an opioid antagonist. This drug works to block the effects of opioid drugs and keep them from binding with receptors in the brain. In this way, it acts as a deterrent and compliance medication. It can keep you from wanting to abuse opioids or suffering a relapse as you won’t feel the high anyway.
Unlike buprenorphine, naltrexone will not help to curb cravings or minimize withdrawal symptoms.
In light of the pros and cons of each medication, buprenorphine is often the MAT preferred by treatment providers. Talk to your supervising physician about which medication is best in your situation.
Possible Side Effects of Buprenorphine
Even with its benefits over other medications, buprenorphine use is not without risk. Misuse of buprenorphine can still cause these issues:
- Stomach pain
- Back pain
- Muscle aches
- Appetite changes
- Decreased sex drive
- Drug dependence and withdrawal symptoms
It is also possible to suffer a life-threatening overdose involving buprenorphine. Signs of a buprenorphine overdose include the following:
- Pinpoint pupils
- Shallow breathing and difficulty breathing
- Irregular heart rate
- Blurred vision
- Possible loss of consciousness
Using Buprenorphine for Recovery
Buprenorphine can be a great tool to manage opioid addiction. Unlike methadone, buprenorphine can be prescribed out of a doctor’s office and picked up at your local pharmacy. It can be dispensed as part of a MAT program and through an opioid treatment program (OTP). Your treatment provider will give you detailed instructions on how and when to take it.
If you follow the directions and take buprenorphine as directed, it can manage your opioid drug cravings and help you maintain abstinence from full opioid agonists. Buprenorphine can also keep withdrawal symptoms to a minimum, which can make it easier to avoid relapse.
Many buprenorphine products are combination products, often mixed with the opioid antagonist naloxone. The naloxone component can deter abuse. If you try to crush the pills to inject the buprenorphine, the naloxone will activate, precipitating bad withdrawal symptoms.
These combination medications can be a powerful tool to maintain compliance in recovery.
Complete Addiction Treatment
Opioid addiction is a public health crisis. Around 130 people die from an opioid overdose every day in the United States. But opioid addiction is treatable.
Buprenorphine can be important in treating opioid dependence, but it is not enough by itself. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that buprenorphine, or any MAT medications, should be used as part of a more comprehensive opioid addiction treatment program.
Opioid addiction is a complex disease that impacts you physically, emotionally, behaviorally, and socially. If you only address the physical aspect of addiction with medications, relapse is highly likely. While buprenorphine can help to stabilize your system, manage withdrawal symptoms, and control cravings, you need to address the root issues that led you to abuse substances in the first place.
Opioid addiction treatment should include the following:
- Behavioral therapies
- Group and individual counseling
- Social support, such as support groups
This comprehensive treatment approach ensures you are treated on various levels. This provides the best foundation for ongoing recovery. Addiction is a chronic and complex brain disease, and a multifaceted treatment approach is ideal.
No two people are the same; therefore, no two treatment plans will be identical. Tailored treatment is key to a successful recovery, so look for a rehab that offers customized care.
You may find one type of treatment doesn’t work particularly well for you. Talk to your treatment providers. There isn’t a one-size-fits-all approach that works for everyone, and your team can tweak your overall care plan so it works best for you.