Buprenorphine was approved by the Food and Drug Administration (FDA) in October 2002 for the treatment of addiction to heroin and pain relievers such as morphine. It is a recent advancement in the field of medication-assisted treatment (MAT). Used in conjunction with behavioral therapies and counseling, it is effective and safe when taken as prescribed. 

Buprenorphine was the first drug approved for treating opioid addiction in a physician’s office, which helped widen treatment access significantly. The same was not the case with methadone. A qualified physician practicing in the U.S. can give buprenorphine in multiple settings, such as, health department, correctional facility, in an office, or a community hospital. Buprenorphine treatment can also be dispensed by opioid treatment programs (OTPs) certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). 

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Advantages of buprenorphine treatment

People for whom treatment at methadone clinic is not feasible can opt for buprenorphine treatment, which has several advantages. Buprenorphine has distinctive pharmacological properties as it decreases the susceptibility to misuse the drug. It also drastically reduces the physical dependency on opioids which is manifested in the form of cravings and withdrawal symptoms. Additionally, in the case of an overdose, it increases the safety of an individual. 

Some of the FDAapproved buprenorphine products are: 

  • Suboxone (buprenorphine and naloxone) film 
  • Bunavail (buprenorphine and naloxone) buccal film 
  • Zubsolv (buprenorphine and naloxone) sublingual tablets 
  • Buprenorphine-containing transmucosal products for opioid dependency 

Buprenorphine is a partial opioid agonist which means it produces the same effects as those produced by opioids like respiratory depression or euphoria, however, these effects are subtle compared to the ones produced by methadone and heroin. With each dose of buprenorphine, the opioid-like effects increase until one reaches a moderate dose when the effects stabilize even with further increase of the dose. This is known as the ceiling effect and it greatly helps in lowering the potential for dependency, misuse, and side effects. Moreover, since buprenorphine is a long-acting agent, it is possible that a lot of patients may not have to take it on an everyday basis. 

Side effects, abuse potential and precautions

Buprenorphine can induce side effects similar to those of opioids like carvings, cramps, muscle aches, nausea, constipation, vomiting, insomnia, fever, irritability, and distress. 

It has an abuse potential because of its opioid-like effects, especially in people not dependenon opioids. For this reason, a drug known as naloxone is added to buprenorphine to reduce its potential for misuse. When taken though the sublingual route, the opioid effects of buprenorphine predominate and the opioid’s withdrawal effects are blocked by naloxone, however, when the sublingual tablets are crushed and then injected, the effect of naloxone predominates and can cause similar effects as an opioid withdrawal. 

Some precautions that must be followed while taking buprenorphine are: 

  • It should never be taken with other medications without consulting a doctor. 
  • One must refrain from using sedatives, tranquilizers, alcohol, or illegal drugs that slow breathing while one is on buprenorphine. Taking buprenorphine with excessive amounts of other drugs can cause an overdose or even death. 
  • The prescribing physician should also monitor for a liver-related health hazard before putting an individual on buprenorphine. 

Suitability of buprenorphine treatment

There is a dearth of data regarding the use of buprenorphine in pregnancy for women who are dependent on opioids. However, no significant complications have been reported from its use during pregnancy from a few available case reports. According to the FDA classification, it sits on the Pregnancy Category C medications list which means that the possibility of adverse effects hasn’t been dismissed entirely. Currently, methadone is prescribed to pregnant women struggling with opioid dependency in the U.S. 

An individual can be prescribed buprenorphine in the following conditions: 

  • When thehave been accurately screened with a dependency on opioids 
  • When they are willing to comply with the safety precautions mandatory for buprenorphine treatment 
  • When they have been given a green signal of not having any health hazard with the use of buprenorphine 
  • When other treatment options have been thoroughly reviewed and discarded 

Phases of treatment with buprenorphine

It is important to note that all the procedures and policies must be ready before the commencement of treatment with buprenorphine to safeguard the confidentiality and privacy of a patient and their health record. The treatment with buprenorphine takes place in three stages. These are: 

  • The induction phaseThis is the initial step which is performed under the medical supervision of a qualified physician or certified opioid treatment program (OTP), making use of approved buprenorphine products. Once a person has been off opioids for about 12 to 14 hours and has entered the early stages of withdrawal, buprenorphine is administered. Patients who are not yet in the initial stages of withdrawal or have the presence of other opioids in their bloodstream can develop acute withdrawal symptoms with the administration of buprenorphine. 
  • The stabilization phaseOnce a patient has stopped using or substantially reduced the use of the substance they are addicted to, is living without cravings, and has only a few side effects, the stabilization phase begins. During this stage, the medical supervisor may adjust the buprenorphine dosage according to the individual’s response. Buprenorphine is a long-acting drug, therefore, once a patient has stabilized, their dose may be reduced to once in alternate day instead of every single day. 
  • The maintenance phase: The maintenance phase begins when a patient is thriving while on a steady buprenorphine regimen. For each patient, the length of this phase can be individualized, and it could even be indefinite. As soon as a patient stabilizesthey can enroll into a medically overseen withdrawal procedure which could help ease the transition from the physically dependent stage. To prevent the possibility of a relapse, the patient could further get involved into a rehabilitation program, with or without MAT. 

Treatment with buprenorphine could have favorable outcomes if it is offered as a part of a comprehensive program that includes different types of behavioral therapies, counseling services, and self-help programs. 

Switching to buprenorphine from methadone

Buprenorphine and methadone are two very different medications, therefore, it may not always be easy for patients to transition from methadone to buprenorphine, as both produce different results. Research has demonstrated that moderate doses of methadone may be as effective as buprenorphine, however, it is unlikely that buprenorphine will be effective equivalent to an optimal dose of methadone, therefore for patients with excessive physical dependency on opioids, it might not be a treatment of choice. However, it is easier for patients to switch to methadone from buprenorphine. 

Training to provide buprenorphine

The treatment of an opioid disorder with buprenorphine is regulated carefully. It is imperative that the qualified physicians obtain and maintain certifications which allow them to prescribe or dispense opioid dependency medications legally. 

Invictus Health Group partners with various addiction treatment centers who are licensed to provide buprenorphine treatment. We believe that more than the treatment process, easy access to addiction treatment encourages people to seek help for their addictions. If you or somebody you know is addicted to drugs, alcohol or any other substance and is looking for addiction treatment options, get in touch with Invictus Health Group. Call our 24/7 addiction treatment helpline 866 548-0190 or chat online with a representative to work out what suits you the best and take that first step towards sobriety. 

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