Buprenorphine


Approved for clinical use in October 2002 by the Food and Drug Administration (FDA), buprenorphine represents the latest advance in medication-assisted treatment (MAT). Medications such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid dependency. When taken as prescribed, buprenorphine is safe and effective.


Suboxone, Zubslov, and the now available buprenorphine/naloxone combination contains both buprenorphine and the opiate antagonist naloxone. Naloxone has been added to guard against intravenous abuse of buprenorphine by individuals physically dependent on other opiates. If misused by injection, the naloxone (along with the buprenorphine itself) will help cause immediate withdrawal in physically dependent people, however when taken as directed, the naloxone is not well absorbed and is considered clinically insignificant.


Buprenorphine is an opioid used to treat opioid addiction. It can be used under the tongue or administered under the skin as an injection (Sublocade). For opioid addiction it is only started when withdrawal symptoms have begun to avoid sudden withdrawal symptoms. For long term treatment of addiction a combination formulation of buprenorphine/naloxone is recommended to prevent misuse by injection.


Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access. Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified U.S. physicians can offer buprenorphine for opioid dependency in various settings, including in an office, community hospital, health department, or correctional facility.


On July 22, 2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA) in to law. CARA is a sweeping bill that came together over the course of several years with input from hundreds of addiction advocates. Its provisions address the full continuum of care from primary prevention to recovery support, including significant changes to expand access to addiction treatment services and overdose reversal medications. It also includes criminal justice and law enforcement-related provisions.


As with all medications used in medication assisted treatment (MAT), buprenorphine is prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs; this is a absolute requirement for participation in the MAT program at Pathways Addiction Recovery, with no exceptions given. Use of buprenorphine alone, without counseling and participation in social support systems is not considered an appropriate form of treatment.


Side effects may include respiratory depression (decreased breathing), sleepiness, adrenal insufficiency, QT prolongation, low blood pressure, allergic reactions, and opioid addiction. Among those with a history of seizures, there is a risk of further seizures. Opioid withdrawal following stopping buprenorphine is generally less severe than with other opioids. It is unclear if use during pregnancy is safe and use while breastfeeding is not recommended. Buprenorphine affects different types of opioid receptors in different ways. Depending on the type of receptor it may be an agonist, partial agonist, or antagonist.


Buprenorphine is not right for everyone. There are significant risks from undergoing buprenorphine treatment, including risk of opioid overdose and sudden opioid withdrawal. Buprenorphine should not be used in conjunction with certain other medications. Contact us today to find out if buprenorphine may be right for you. For more information on buprenorphine and how it works in the brain, a comprehensive educational brochure can be downloaded HERE.



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