Saturday, December 1, 2007

Buprenorphine Addiction

Buprenorphine Addiction Treatment Wonder Medication

By Olasimbo Olanusi, MD, FASAM

Opioid dependence is a result of negative neuron-adaptive changes induced in the brain, which leads to drug-taking behavior.
  • An estimated 3.1 million Americans 12 years and older have used heroin at some time in their lives.
  • A new generation of heroin abusers is emerging in America; these are teenagers who snort heroin for its "high" effects rather than inject it.
  • An estimated 4.4 million people abuse prescription opiate medication.
Buprenorphine is a derivative of thebaine alkaloid extracted from opium poppy (papaver somniferum). The medication was approved in 2000 by the Drug Addiction Treament Act {DATA} as another alternative to methadone in treating heroin and opiate addiction. It includes, but is not limited to, Vicodin, Percocet, Oxycontin, morphine, Demerol and codeine.

Q: Do people have to go to a special clinic, like methadone, to obtain buprenorphine?
A: Buprenorphine is the first medication for opioid addiction treatment that can be dispensed by physicians in an office based setting.

Q: Will buprenorphine replace methadone as a treatment option for opioid addiction?
A: Methadone clinics will continue to play a vital role in treating opioid addiction. However methadone therapy is only able to treat one fifth of the estimated one million Americans who are dependent on opiates. Office-based treatment with buprenorphine will help fill this treatment gap by making more treatment options available to the remaining opiate-addicted individuals not being treated. The medication will also expand treatment opportunities for those opioid dependent people who have avoided methadone clinics because of the stigma associated with them.

Q: In what type of drug formulation is buprenorphine made available?
A: Buprenorphine is available in tablet form which is present in two preparations.
  • Subutex: This contains only buprenorphine prescribed for patient in early stage of treatment
  • Suboxone: This is a combination of buprenorphine and naloxone which are given to patients later on in their treatment once they are on stable dose of buprenorphine.
Q: What is the route of administration of buprenorphine?
A: Buprenorphine medications are placed under the tongue and absorbed through the veins lying under the tongue.

Q: Why can't I swallow buprenorphine like other medications?
A: It is poorly absorbed into the body when swallowed.

Q: What is the mechanism of action of buprenorphine?
A: Buprenorphine addresses the neurobiological basis of dependence by acting as a partial opioid receptor agonist. It blocks heroin and other prescription opiate effects, reducing the craving for these medications and prevents their unpleasant withdrawal effects.

Q: How safe is buprenorphine medication?
A: As a partial agonist, its profile of effects including respiratory depression, physical dependence, euphoria and constipation are less risky than other opioid full agonists, which include but not limited to morphine, heroin, codeine, and fentanyl.

Q: Is it possible to abuse buprenorphine medication?
A: When buprenorphine is used as prescribed, by placing it under the tongue, it produces less stimulation and physical dependence than full agonist medications like methadone. The "high" effect of buprenorphine peaks at a lower level in comparison with methadone and other full agonist medications, no matter how much of buprenorphine is used, thereby reducing its abuse potential.
There were reports of misuse of buprenorphine when injected into the body in Europe. To circumvent the illicit diversion of the medication it is combined with naloxone, an opioid antagonist. As long as the medication is used as prescribed by placing it under the tongue only buprenorphine will be absorbed. However, crushing the tablet and injecting it into the body causes the absorption of naloxone into the body, which will trigger a precipitated withdrawal effect and the person becomes very sick.

Q: How do I find physicians who are trained to prescribe buprenorphine?
A: The lists of the physicians are on line at the physician locator on the website at

Q: What do I expect during my office visit to the physician for buprenorphine treatment?
A: The treatment of buprenorphine is divided into the different stages listed below.
  1. Intake: This involves a comprehensive substance dependence assessment, mental status and physical examination. You also receive medication education about buprenorphine. The intake is to evaluate if one is appropriate for buprenorphine treatment.
  2. Induction: You are expected to have ceased taking your current street drug or prescribed opiate medication and arrive in the physician's office experiencing withdrawal symptoms. Arrangements will be made for you to receive your first dose of buprenorphine in your doctor's office. You will then be monitored for a couple of hours by your physician. An additional dose of medication may be given to you to reduce withdrawal symptoms. You may have to visit your physician more frequently to monitor your tolerance reactions and adjust the dose of your buprenorphine until you no longer experience withdrawal symptoms and cravings.
  3. Stabilization: This is the period that your buprenorphine dose is established and you no longer experience cravings or withdrawal symptoms.
  4. Maintenance: Treatment compliance and progress will be monitored continuously during this phase which may last from weeks to years depending on the need of the patient.
  5. Detoxification: Depending on your progress, a joint decision may be made between you and your physician to taper you off your buprenorphine over a period of time.
Q: What are people's experiences with buprenorphine treatment?
A: "Bup" as fondly called by people who have regained their life back from opioid addiction, is described as the best thing that ever happened to them.

Q: What is the most common myth surrounding opioid addiction?
A: That it only happens in inner city areas. The truth is opioid addiction cuts across all socioeconomic class and geographical boundaries. The disease of addiction is no respecter of persons.

Q: What happens if I take illicit opioid or prescribed opiate first and then use buprenorphine afterwards?
A: There may be occurrence of precipitated withdrawal which may cause the person to become sick.

Q: What are the common side effects of buprenorphine?
A: The common side effects include nausea, headache, constipation, body ache and pain. These profiles of side effects usually subside during the first few weeks of starting the treatment.

Q: What are the benefits of buprenorphine treatment?
A: The medication serves as another alternative for managing opioid addiction with easier access to the treatment providers.
  • Continuity of their health care needs from familiar physicians
  • Decreased criminal tendencies
  • Ability to have better control of one's time and live a normal lifestyle.
  • Reduced drug use and increased chances of successful transition to a drug free lifestyle.
  • Reduced drug related risks and fatalities that commonly includes HIV, hepatitis C, hepatitis B, drug induced homicidal and suicidal situations.
  • Reduced stigma issues often associated with the treatment of opioid addiction.
Q: What are the barriers to buprenorphine treatment?
A: Bias about using medications to treat opioid addiction
  • Lack of medication coverage by major insurance companies
  • Low awareness of the medication
  • Some physicians stay away from treating addictive disorders because they believe this group of patients could be unruly and disruptive.
Q: Do I need counseling for substance abuse while on buprenorphine?
A: Buprenorphine with counseling or attending peer support groups like AA/ NA increases the success rate of overcoming drug addiction. Buprenorphine is a safe medication that reduces cravings and potential for opioid addiction. Let us all embrace this medication as another effective recovery tool to help us eradicate the disease of opioid addiction within our society.


No comments: