Buprenorphine for Opioid Addiction: An Overview
Buprenorphine is often used as a form of medication-assisted treatment to help people stop using opioid drugs and recover from opioid addiction.
Buprenorphine is an FDA approved medication marketed under a variety of brand names and formulations used in the treatment of opioid use disorder (OUD) and, in some cases, for pain. This Schedule III medication has been found to help with OUD by lessening withdrawal symptoms and improving social functioning when compared to counseling alone.
What Is Buprenorphine?
Buprenorphine is a prescription medication that works as a partial opioid agonist. This means it acts in the same areas of the brain and works similarly to opioids, even producing euphoria and respiratory depression at low doses. Because buprenorphine is a partial opioid agonist, these effects are weaker than full opioid agonists like heroin or methadone, resulting in a safer medication. Buprenorphine can help to treat OUD by reducing withdrawal symptoms and cravings and is safe and effective when taken exactly as prescribed.
What Is Buprenorphine Used For?
Buprenorphine is a Schedule III prescription drug used as medication-assisted treatment for OUD. In some cases, buprenorphine may also be prescribed to treat pain. When used as prescribed, this medication can help you stop taking opioids safely and effectively by reducing cravings and lowering the risk of overdose.
Buprenorphine Brand Names
Common brand names of buprenorphine and buprenorphine-containing products include:
- Subutex: buprenorphine sublingual tablets
- Suboxone: buprenorphine/naloxone sublingual films
- Zubsolv: buprenorphine/naloxone sublingual tablets
- Bunavail: buprenorphine/naloxone buccal film
- Probuphine: buprenorphine implants
- Sublocade: buprenorphine extended-release injection
- Butrans: buprenorphine transdermal patch
- Generic buprenorphine/naloxone sublingual tablets
Buprenorphine Administration and Dosing
Buprenorphine comes in several different dosage forms and strengths. The medication can be administered as a patch, injection or dissolvable tablet or film.
Buprenorphine patches are applied transdermally but are only FDA-approved for treating pain. Butrans patches are available as doses of 7.5, 10, 15 and 20 mcg/hour, and each patch is worn for seven days.
Buprenorphine Sublingual Tablets
Buprenorphine sublingual tablets are dissolved under the tongue. No more than two tablets should be used at a time. It is important to handle these dissolvable tablets with clean, dry hands and to take them exactly as prescribed for OUD. These are available as either 2 mg or 8 mg tablets.
Buprenorphine film is intended to be dissolved under the tongue or inside of the cheek. These are available in a variety of strengths, and a typical dose for OUD treatment is buprenorphine 16 mg/naloxone 4 mg. Available dosages include:
- Buprenorphine 2 mg/naloxone 0.5 mg
- Buprenorphine 4 mg/naloxone 1 mg
- Buprenorphine 8 mg/naloxone 2 mg
- Buprenorphine 12 mg/naloxone 3 mg
Buprenorphine extended-release injection is available in 300 mg or 100 mg doses that are given once monthly. Most patients receive 300 mg doses during the first two months of OUD treatment, then decrease to 100 mg doses each month thereafter.
Buprenorphine Dose for Opioid Addiction
Buprenorphine dosing can vary depending on your tolerance for opioids. Doses are determined using either in-office or at-home induction, where you are given doses and monitored for signs of withdrawal until a safe and appropriate dose is achieved. These doses typically range from 2 mg to 8 mg and can decrease over time.
Buprenorphine Dose for Pain Management
Buprenorphine is used to treat pain in some cases. As with other opioids, tolerance can develop, so the lowest dose should be used for the shortest duration of time. Doses are highly variable between people.
Buprenorphine can be effective for pain because of the ceiling effect on respiratory depression. In other words, higher doses will not stop breathing and will only rarely cause overdose. This may also be helpful in elderly patients with pain because it carries a lower risk of accidental overdose.
Buprenorphine Max Dose
The maximum dose of buprenorphine as immediate release formulations (tablets, film, or patches) is generally considered to be 32 mg. However, the FDA-approved package insert states that doses higher than 24 mg have not been shown to have a clinical advantage in the treatment of OUD.
As a partial opioid agonist, buprenorphine is unlikely to cause an overdose. This is because it has a ceiling effect on respiratory depression, which is one of the most common causes of opioid overdose deaths. In instances where people have overdosed while using buprenorphine, they have typically taken several other substances, such as benzos, opioids and alcohol. The risk of overdose can increase when quitting buprenorphine, so you should speak with your doctor before discontinuing the medication.
How Does Buprenorphine Work?
Buprenorphine is a partial opioid agonist. This means that it binds to the same brain receptors as opioids (mu opioid receptors) and activates some while inactivating others. By doing so, buprenorphine can cause some of the same effects as opioids, including euphoria and respiratory depression. However, this partial activation also results in decreased cravings for opioids. Additionally, it makes a person much less likely to overdose on buprenorphine alone.
Buprenorphine Therapy for Opioid Addiction
Medication-assisted treatment using buprenorphine or similar medications can help people recover from opioid addiction and maintain sobriety. Most commonly, treatment using buprenorphine involves a gradual tapering process known as opioid replacement therapy.
Opioid Replacement Therapy
Opioid replacement therapy, sometimes called opioid substitution, involves using a medication like buprenorphine or methadone in place of a stronger opioid like heroin or morphine. Over time, the substitute (buprenorphine or methadone) is tapered down. This process helps make withdrawal safer while also reducing symptoms.
Buprenorphine helps patients avoid uncomfortable symptoms of withdrawal, increase their quality of life and reduce cravings. In these ways, buprenorphine is an integral component of opioid addiction treatment. Patients are also more likely to adhere to it, which helps decrease the chances of relapse and fatal overdose.
Buprenorphine vs. Methadone
Both buprenorphine and methadone are effective MAT options that have been shown to decrease all-cause mortality in patients with OUD. However, methadone prescribing carries very specific and restrictive requirements. Compared to buprenorphine, there are fewer prescribers who can write prescriptions for methadone, and methadone requires much more frequent follow-up. In addition, methadone for OUD must be picked up at a methadone clinic, which is often another barrier.
Buprenorphine is much more accessible. For stable patients, follow-up can be spaced out to monthly or quarterly appointments and can be picked up at most outpatient pharmacies.
Is Buprenorphine the Same as Suboxone?
While buprenorphine is not the same as Suboxone, it is contained in Suboxone. Both of these medications work in the same way (partial opioid agonists) to reduce cravings and safely recover from opioid addiction.
Suboxone is the brand name for a medication containing the ingredients buprenorphine and naloxone. Naloxone ensures that Suboxone is taken as prescribed. The naloxone stops Subxone from delivering its effects if it’s taken differently than prescribed, like by injection. Buprenorphine itself, however, does not contain naloxone.
Effectiveness of Buprenorphine for Opioid Addiction
Treating patients with buprenorphine long-term was found to decrease all cause mortality by about 50%. Those treated with buprenorphine were shown to have improved social functioning, more so than those who received only counseling. This may be because taking buprenorphine reduces uncomfortable symptoms of withdrawal and cravings.
Buprenorphine Side Effects
As with any medication, buprenorphine can result in unwanted side effects. Most commonly, these can include:
- Drowsiness or fatigue
- Dry mouth
- Tooth decay
- Muscle aches or cramps
- Sleep disturbances
- Blurred vision or dilated pupils
Rare but serious side effects can include:
- Respiratory distress
- Adrenal insufficiency
- Itching, pain, swelling and nerve damage (implant)
- Pain at injection site (injection)
- Neonatal abstinence syndrome (in newborns)
Buprenorphine can induce withdrawal if taken too soon after the last dose of an opioid. It is important to speak with your health care provider about the timing of your last opioid dose to minimize this risk. Symptoms of withdrawal can include:
- Muscle aches
- Increased tearing
- Runny nose
Buprenorphine has relatively few drug interactions compared to other opioid medications. Nevertheless, you should always speak with your doctor or pharmacist about any medications or supplements you take. Some common drug interactions with buprenorphine include:
- Anticholinergics (allergy medications)
- Anticonvulsants (seizure medications)
- Antiemetics (nausea medications)
- Muscle relaxants
Buprenorphine carries several warnings, including:
- It carries the risk of abuse and addiction, which can lead to overdose and death.
- Serious, life-threatening respiratory depression may occur.
- Accidental exposure, especially when it involves children, can result in death.
- Combined use with benzos or other CNS depressants can result in death.
- In January 2022, the FDA issued a warning about dental problems in people taking dissolvable buprenorphine.
Buprenorphine carries with it a risk for abuse and addiction. Like other opioids, buprenorphine can produce feelings of euphoria. However, the risk of buprenorphine abuse is substantially lower than that of other opioids because it is only a partial agonist. As a result, buprenorphine is classified as a Schedule III medication under the Controlled Substances Act.
Other FAQs About Buprenorphine
Can Buprenorphine Get You High?
While buprenorphine can produce euphoria, this “high” is much milder than what is produced by other opioids. Most often, people abuse buprenorphine by taking it between doses of short-acting opioids like heroin to prevent withdrawal symptoms.
What Is Buprenorphine’s Detection Time in Urine?
Buprenorphine can be detected in urine for up to seven days. Norbuprenorphine, the medication’s metabolite, can be detected in urine for up to 14 days.
What Is Buprenorphine Hydrochloride?
Buprenorphine hydrochloride is the salt form of buprenorphine and represents the full chemical name for buprenorphine.
What Schedule Is Buprenorphine?
Buprenorphine is classified as a Schedule III medication under the Controlled Substances Act.
Who Can Prescribe Buprenorphine?
Many different health care professionals can prescribe buprenorphine for addiction treatment. These include but are not limited to:
- Nurse practitioners
- Physician assistants
- Clinical nurse specialists
- Certified registered nurse anesthetists
- Certified nurse midwives
Find Opioid Addiction Treatment in New Jersey
Opioid addiction can be difficult to recover from on your own, but The Recovery Village Cherry Hill at Cooper is here to help. At our licensed, accredited facility located in South Jersey, we provide effective and affordable treatment services to those struggling with addiction or co-occurring disorders, including medication-assisted treatment like buprenorphine.
If you or someone you love is struggling with opioid abuse and addiction, we’re here for you. Contact us today to learn more about treatment programs that can help you begin your journey toward a healthier, opioid-free life.
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