Why should a person use buprenorphine for opioid addiction? Buprenorphine is a semi-synthetic opioid derived from the opium plant. It’s a partial narcotic, meaning it doesn’t activate the brain’s mu opioid receptor as completely as other full opioids do, including heroin, oxycodone and fentanyl. It’s also much longer-acting than most opioids are, except for methadone, which is also used for MAT or medication-assisted treatment. Buprenorphine is useful for some people for MAT opioid maintenance treatment therapy because it quells cravings, reduces or eliminates withdrawal symptoms, is effective with a single oral dose and doesn’t cause sedation or euphoria.
What is Buprenorphine?
Buprenorphine is the active narcotic ingredient in the trade name drug Suboxone. Suboxone also contains an opioid antagonist called naloxone. The name Suboxone is a combination of the words sublingual, meaning under the tongue and naloxone. The drug comes in small orange strips placed under the tongue until they dissolve. Buprenorphine is not active when swallowed. When taken under the tongue, it crosses the oral tissues quickly and is readily absorbed into the bloodstream.
Although naloxone, and its chemical cousin naltrexone (trade name Vivitrol), will stop a narcotic from working on the brain’s mu receptor, naloxone is not active when taken by mouth. It must be administered nasally or by injection. This is the reason why it’s included in the Suboxone formula. As long as the medication is taken by mouth as directed, the naloxone will have no effect. However, if someone tries to inject the drug intravenously, the naloxone will attach to the brain’s mu receptor. When this happens, not only does it prevent the buprenorphine from working, it will cause a full-blown withdrawal reaction in an opioid-dependent individual. (If the person isn’t addicted to opioids, naloxone will have no effect other than to reverse an overdose if such is the case).
In contrast, naltrexone is much longer-acting than naloxone and is effective by either mouth or injection. That’s why it’s used as a maintenance therapy for both opioid and alcohol abusers. If an opioid abuser gives in to a momentary temptation to use narcotics, the naltrexone will act to block any high. For reasons not clearly understood, since alcohol does not directly act on the brain’s mu receptor, naltrexone also appears to reduce the desire for alcohol. That’s why Vivitrol, a long-acting injection, is recommended as an MAT option for both recovering opioid abusers and alcoholics.
Buprenorphine for MAT
Although Suboxone is a recognized evidence-based treatment for opioid addiction, like all medications, it has its limitations. Evidence-based simply means that a treatment, whether it be psychological techniques, medication, or alternative forms of drug rehab treatment, has been proven to work in clinical trials or some other form of objective evaluation.
Responsible for the continuing sobriety for many former opioid abusers, buprenorphine has some problems. For one thing, it won’t help everyone who needs it. It appears to fail in some people who have been taking very high doses of very strong narcotics like fentanyl and its analogs. Sometimes, it just doesn’t work for some people for unknown reasons. It fails to stop withdrawal symptoms and doesn’t keep drug cravings at bay. For these people, methadone usually works.
Buprenorphine also has a another major flaw. It cannot be given until a person is well into the withdrawal process by a minimum of 24 hours since the last dose of a narcotic. By this time, the person is very, very ill from withdrawal symptoms and is experiencing high levels of anxiety. They are probably vomiting, have diarrhea, cannot sleep, feel jumpy and shaky, cannot eat, feel depressed, have severe drug cravings, restless leg syndrome and are in considerable pain as well. However, this person must endure these symptoms without any treatment until their buprenorphine doctor feels it’s safe to begin the Suboxone. Given too soon, the drug can cause a severe form of withdrawal called precipitated withdrawal or PW.
Buprenorphine can only be prescribed by special doctors, who are limited to a certain number of Suboxone patients at a time. If there is no Suboxone doctor near you or the ones that are have full patient quotas, then that’s another problem with Suboxone.
Other than that, the drug appears to work well for a high number of people who try it. The drug is addictive, and people who want to try this therapy need to understand that going in.
Call us for Help
If you’d like more information about Suboxone, call us anytime at 855-334-6120. We can refer you to Suboxone doctors near you. We’re here to help.