Buprenorphine is a long-acting opioid that is used in the treatment of opioid addiction. This drug acts on the same receptors in the brain as heroin and morphine. Buprenorphine sates an addict’s physical need for the opioid without giving them the same high that an illicit opioid like heroin would. It also lacks the dangerous side effects that accompany most opioids.
How Buprenorphine Is Used in Addiction Treatment
Medical professionals use buprenorphine in medication-assisted treatment (MAT). MAT involves both medication and therapy in the treatment of substance use disorders, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Buprenorphine is a particularly valuable tool for MAT for opioid addiction, as it can diminish one’s physical addiction to opioids over time. Unlike methadone, which must be administered in specific clinical settings, buprenorphine can be prescribed by physicians. This greatly increases the accessibility of the drug. Safeguards were put in regarding this practice, as only specially trained physicians can legally prescribe buprenorphine.
Buprenorphine lessens the chance of opioid misuse and abuse, according to SAMHSA. It also helps to quell withdrawal symptoms that are often present when an opioid addict stops using. In general, buprenorphine is a much safer opioid than those commonly abused. This drug has what is referred to as a “ceiling effect,” which means that at a certain point, increasing the dosage of buprenorphine will not increase the effects of the drug, according to the National Drug Intelligence Center (NDIC).
Similar to other opioids, buprenorphine produces the following effects, though to a lesser degree when compared to their illicit counterparts:
- Sense of heightened wellbeing
- Respiratory depression
Unlike most opioids, buprenorphine does not impede motor function, making it safe for an individual taking it to operate a motor vehicle. Because buprenorphine binds to the same receptors as other opioids, an individual taking buprenorphine will not achieve a high if they use heroin or another opioid.
Like any opioid, buprenorphine can be misused and abused. If the drug is injected instead of taken orally, it can itself become physically addictive quickly. Buprenorphine abuse is common worldwide, according to the Journal of Substance Abuse Treatment. However, the development of Suboxone has helped with this problem.
Suboxone is a rather ingenious drug. It contains buprenorphine and naloxone. Naloxone is an opioid antagonist, meaning that it blocks opioid receptors. It is most commonly used as an injection to combat opioid overdose. Suboxone combines naloxone with buprenorphine to create a medication that is more difficult to abuse than buprenorphine on its own.
If taken properly, Suboxone will quell opioid cravings while providing very mild opioid effects. The buprenorphine provides relief from opioid withdrawal while the naloxone blocks the brain from receiving the effects commonly associated with such substances.
This medication is taken orally, but if it is abused in any way (such as diluted and then injected), the naloxone produces effects similar to those experienced in opioid withdrawal, according to the National Institute on Drug Abuse (NIDA). These effects are extremely uncomfortable and even painful, serving as a significant deterrent for misuse.
Abuse potential for buprenorphine alone appears to be significantly higher than that of the combination of buprenorphine and naloxone. Suboxone quickly saw success in the treatment of opioid-addicted young adults, according to NIDA.
Effects of Suboxone
Suboxone can produce the following side effects:
- Pain in the mouth
- Stomach discomfort
- Problems concentrating
- Altered perception
More serious potential side effects of the drug include:
- Rapid heart rate
- Severe drowsiness
Should any of these symptoms present, seek medical assistance immediately.
Some individuals begin taking Suboxone in an effort to kick their opioid habit, but they end up taking the drug for very long periods of time. Long-term use of Suboxone can result in symptoms similar to those experienced during withdrawal, such as:
- Joint discomfort
- Muscle pain
- Decreased libido
While it can quell physical cravings, Suboxone does not produce the same high effect that many opioid users long for. The presence of naloxone in the drug makes it very painful to abuse in a traditional sense, but Suboxone can still be abused. For some, the mild opioid effects of this drug are better than no effects at all. It has become a popular drug of abuse among prison inmates.
Another trend of Suboxone abuse has been using the drug between uses of illicit opioids. In these cases, a physically dependent individual will use Suboxone to quell withdrawal symptoms. If they wait long enough after taking the Suboxone, they can return to using a drug like heroin and still achieve the high they desire.
An individual abusing Suboxone could be lying to their doctor to obtain more, or they may be visiting multiple doctors in an effort to increase their supply. These are red flags when it comes to Suboxone use. Someone abusing the drug may also display difficulty thinking clearly. They may appear drunk in that they exhibit slurred speech or an impairment of their motor functions. Excessive itching can also be a sign of Suboxone abuse.
It is possible to overdose on buprenorphine. In the case of an overdose, an individual may see drastic mood alterations, becoming irritable and anxious. The appearance of being drunk is common as well. The person’s heartbeat will often slow, which can become very dangerous. Abdominal pain and vomiting are also sign of buprenorphine overdose. Seizures and coma are two of the graver effects of a buprenorphine overdose, and they can lead to death. While some people completely recover from an overdose, others have to live with long-lasting consequences of their drug abuse.
Polydrug use with buprenorphine can be extremely hazardous to one’s health. Mixing buprenorphine with benzodiazepines is considered to be excessively dangerous, as benzos can greatly enhance the effects of other substances. According to SAMHSA, between 2005 and 2011, nearly a million people required emergency medical attention due to some combination of opioids, benzos, and alcohol.
Withdrawal and Treatment
An individual will often experience withdrawal symptoms if they abruptly stop taking buprenorphine or Suboxone, though these withdrawal symptoms are not usually as severe as those associated with other opioids. However, flu-like symptoms, stomach discomfort, uncontrollable shaking, and muscle pain may be present.
Opioid addiction is extremely difficult to overcome, usually requiring intensive treatment. In most cases of opioid addiction, MAT would be used, but an addiction to buprenorphine complicates the use of replacement medication during recovery. In some instances, the person will be weaned off buprenorphine or Suboxone slowly under direct medical supervision. This supervision prevents the individual from abusing the medication during this structured withdrawal period.
Cognitive Behavioral Therapy (CBT) is one of the most popular forms of therapy in dealing with addiction. CBT requires the client to be very active in the recovery process. They must develop a close working relationship with their therapist; only then will CBT work to its fullest potential. If done correctly, the skills learned through CBT can remain with a person for the long-term, providing them with the tools they need to stay in recovery even after therapy has ceased.
CBT examines the interactions between thoughts, feelings, and behaviors and how they all figure into addiction and recovery. Many addicts have false or destructive beliefs than can cause negative emotional responses. Stress, anxiety, and other such responses can often lead to an individual relapsing. Drug use becomes a kind of coping mechanism, but more appropriate coping skills are taught in CBT. These skills can help individuals calm themselves when they feel stressed or anxious and allow them to get through the situation without using.
Breaking behavioral patterns is a big part of CBT. Addicts often fall into patterns of behavior that lead them to use, and identifying past behaviors can help to prevent them from occurring in the future. CBT also looks to reengage an individual in activities that bring happiness, as many addicts neglect their interests due to drug abuse and depression.
There are many forms of therapy outside of CBT that are also used in recovery facilities, such as family therapy and holistic treatments.
Once an individual leaves a treatment facility, continued care is incredibly important. Many individuals begin outpatient treatment once their stint of inpatient treatment is complete. Some take the transitional process a step farther and move into a sober living facility. Sober living homes are group homes that only house people in recovery from addiction. These homes are usually privately owned and located in residential settings.
While there are rules in sober living facilities, residents can normally come and go as they please, which is generally not the case at inpatient rehab centers. Individuals have to pay rent, maintain a job or be in school, buy their own groceries, and begin to assimilate back into an everyday life. Residents remain removed from the environment where they lived during the throes of their addiction. In this supportive environment, residents can begin to transition back to normal life with minimal temptations to abuse buprenorphine, opioids, or other substances.