What is Buprenorphine?

Most people are unfamiliar with buprenorphine medications and how they are used in the treatment of opiate addiction. Buprenorphine medications include Suboxone, Zubsolv, Bunavail, Subutex and other buprenorphine products.

The following questions and answers are provided to educate and familiarize you with buprenorphine and buprenorphine/naloxone and their use in opiate treatment.

• What is opioid dependence?
• What is buprenorphine?
• What is a partial opioid agonist?
• How effective is buprenorphine treatment?
• How does buprenorphine work?
• Is buprenorphine addictive?
• How long does treatment take?
• What will buprenorphine treatment be like?

What is opioid dependence?
Opioids, such as some prescription pain medications or heroin, attach to the opioid receptors in the brain, which stimulate the release of dopamine and produce pleasurable feelings. When the opioid eventually detaches from the receptors, people experience withdrawal and cravings and have a strong need to repeat the experience. The need to satisfy cravings or avoid withdrawal can be so intense that people who want to stop taking opioids find this difficult to do. Or, they may find themselves doing things they would not ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.

Drug use often begins as a choice, but frequent use can cause the brain cells to change the way they work. The brain is re-set to think that the drug is necessary for survival. Researchers have discovered that many drugs, including opioids, cause long-term changes in the brain. These changes can cause people to have cravings years after they stop taking drugs. Research has shown that addiction is a chronic, relapsing brain disease, however treatment can help achieve recovery.

What is buprenorphine?

Buprenorphine one of the newest medication available to block painful withdrawal symptoms and cravings in order to feel normal again. In 2000, under the Drug Addiction Treatment Act 2000 (DATA 2000), Buprenorphine and Buprenorphine/naloxone were the first opioid medications approved for treatment in a private office setting. Buprenorphine is the active ingredient in the medication, which includes the brands Suboxone and Zubsolv. Buprenorphine is a partial opioid agonist, that when taken daily, blocks other opioids from attaching to receptors in the brain. The second ingredient is naloxone, which has no effect when the medication is taken as prescribed; however, if the medication is injected then the naloxone is activated and can cause immediate withdrawal. This treatment can help you stop misusing opioids and when combined with counseling, can help you rebuild your life.

What is a partial opioid agonist?

A partial agonist is an opioid that produces less effect than a full agonist when it binds to opioid receptors in the brain. The way different opioids work can be explained using a lock and key example. Receptors are like a lock to a door. Only the right key will fit the lock, and only opioid-like drugs fit opioid receptors. With a full opioid agonist such as oxycodone, hydrocodone, morphine, or heroin, the key fits the lock, opens the door wide, and produces full opioid effects (the feeling of euphoria, or being high, as well as the side effects.) With a partial opioid agonist such as buprenorphine, the key fits the lock but doesn't open the door all the way, so it produces less than full opioid agonist effects and, at the appropriate dose, blocks other opioids from opening the door fully.

How effective is buprenorphine treatment?

It has been well documented that buprenorphine helps control symptoms and cravings, so that a person can focus on resolving issues and gaining relapse prevention skills in counseling. Patients report they feel “normal” again, like they did before they ever abused opiates. Per SAMHSA, “Buprenorphine’s partial agonist effects give it several clinically desirable pharmacological properties such as lower abuse potential, a lower level of physical dependence (less withdrawal discomfort), and a ceiling effect at higher doses."

How does buprenorphine work?

Buprenorphine, is a partial opiate agonist with a series of actions that make it possible to block painful withdrawal symptoms and cravings. A partial agonist produces limited effects and does not allow other opioids to enter. The medication we prescribe also contains naloxone, which is an opioid antagonist. An opioid antagonist fits into the receptor but blocks all opioids. The naloxone is there to deter people from dissolving the medication and injecting it. When the medication is placed under the tongue as prescribed, very little naloxone is absorbed into the bloodstream. When the medication is used incorrectly, by injecting, its naloxone component can cause withdrawal symptoms to rapidly occur.

Is buprenorphine addictive?

Physical dependence and tolerance are part of addiction, but they are not the whole story. Addiction is characterized by compulsive use of the drug, despite adverse consequences. Active addiction often involves engaging in high-risk, unhealthy behaviors that are harmful to one’s self and others. As with methadone, patients who receive buprenorphine treatment may be dependent on the medication, but they are not addicted to the medication.

How long does treatment take?

You and your treatment team decide what will be an appropriate length of treatment to ensure the best outcome for you. Although short-term treatment may be an effective option for some people, it may not allow others enough time to address the psychological and behavioral components of their disease. Since physical dependence is only part of opioid dependence, the chances of relapsing can be higher with short-term treatment because patients have less time to learn the skills necessary to maintain an opioid-free lifestyle. Suppressing cravings with buprenorphine (for as long as you need) combined with counseling and or support, can often increase the level of treatment success.

What will buprenorphine treatment be like?

Please call our office to speak with a professional that specializes in opioid addiction to book an appointment with one of our physicians. At the first visit, the doctor will ask questions about use in order to provide the best treatment. Medication is given within a short time in order to relieve withdrawal symptoms. After an observation period, additional medication may be necessary. Additional medication will be prescribed as needed and clinic attendance will be determined at that time.