Lebanon, TN Addiction Treatment

Buprenorphine has unique pharmacological properties that help:

• Lower the potential for misuse
• Diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings
• Increase safety in cases of overdose
  Buprenorphine is an opioid partial agonist. This means that, like opioids, it produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as heroin and methadone.

Buprenorphine’s opioid effects increase with each dose until at moderate doses they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects. Also, because of buprenorphine’s long-acting agent, many patients may not have to take it every day.

Buprenorphine’s side effects are similar to those of opioids and can include:

• Nausea, vomiting, and constipation
• Muscle aches and cramps
• Cravings
• Inability to sleep
• Distress and irritability
• Fever

Because of buprenorphine’s opioid effects, it can be misused, particularly by people who do not have an opioid dependency. Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product. When buprenorphine/naloxone is taken as a sublingual tablet, buprenorphine’s opioid effects dominate and mitigates opioid withdrawals. If the sublingual tablets are crushed and injected, the naloxone effect dominates and can block the euphoric effect and potentially bring on opioid withdrawal symptoms.

People should use the following precautions when taking buprenorphine:

• Do not take other medications without first consulting your doctor.
• Do not use illegal drugs, drink alcohol, or take sedatives, tranquilizers, or other drugs that slow breathing. Mixing large amounts of other medications with buprenorphine can lead to overdose or death.
• Do ensure that a physician monitors any liver-related health issues that you may have.

Buprenorphine may be prescribed to women who are pregnant and have an opioid use disorder. Buprenorphine and methadone are considered the treatments of choice for OUD in pregnant and breastfeeding women.

Review SAMHSA’s Federal Guidelines for Opioid Treatment Programs – 2015 for more information about the use of buprenorphine in pregnancy. In the United States, methadone remains the current standard of care for the use of MAT with pregnant women who have opioid dependency.

The ideal candidates for opioid dependency treatment with buprenorphine:

• Have been objectively diagnosed with an opioid dependency
• Are willing to follow safety precautions for the treatment
• Have been cleared of any health conflicts with using buprenorphine
• Have reviewed other treatment options before agreeing to buprenorphine treatment

Before buprenorphine treatment begins, policies and procedures should be in place to guarantee patient privacy and the confidentiality of personally identifiable health information. Under the Confidentiality Regulation, 42 Code of Federal Regulations (CFR) 2, information relating to substance use and alcohol treatment must be handled with a higher degree of confidentiality than other medical information.

Buprenorphine treatment happens in three phases:

1. The Induction Phase is the medically monitored startup of buprenorphine treatment performed in a qualified physician’s office or certified OTP using approved buprenorphine products. The medication is administered when a person with an opioid dependency has abstained from using opioids for 12 to 24 hours and is in the early stages of opioid withdrawal. It is important to note that buprenorphine can bring on acute withdrawal for patents who are not in the early stages of withdrawal and who have other opioids in their bloodstream.
2. The Stabilization Phase begins after a patient has discontinued or greatly reduced their misuse of the problem drug, no longer has cravings, and experiences few, if any, side effects. The buprenorphine dose may need to be adjusted during this phase. Because of the long-acting agent of buprenorphine, once patients have been stabilized, they can sometimes switch to alternate-day dosing instead of dosing every day.
3. The Maintenance Phase occurs when a patient is doing well on a steady dose of buprenorphine. The length of time of the maintenance phase is tailored to each patient and could be indefinite. People can engage in further treatment—with or without MAT—to prevent a possible relapse.

Treatment of opioid dependency with buprenorphine is most effective in combination with counseling services, which can include different forms of behavioral therapy and self-help programs.

Patients can possibly switch from methadone to buprenorphine treatment, but because the two medications are so different, patients may not always be satisfied with the results. Studies indicate that buprenorphine is equally as effective as moderate doses of methadone. However, because buprenorphine is unlikely to be as effective as more optimal-dose methadone, it may not be the treatment of choice for patients with high levels of physical dependency.

A number of factors affect whether buprenorphine is a good choice for someone who is currently receiving methadone. Patients receiving buprenorphine can possibly be switched to methadone. Patients interested in learning more about switching their treatment should discuss this with their doctor. Learn more about methadone.

Buprenorphine as an opioid use disorder treatment is carefully regulated. Qualified physicians are required to acquire and maintain certifications to legally dispense or prescribe opioid dependency medications. SAMHSA’s Division of Pharmacologic Therapies (DPT) makes available required buprenorphine training for physicians, webinars, workshops, and summits, and publications and research.