Buprenorphine Treatment & Support Program for Opioid Addiction

Buprenorphine (brand names Suboxone, Subutex, Sublocade) is a partial opioid agonist, meaning it activates the body’s opioid receptors much like any other opioid substance, but because it is very weak, it doesn’t cause the same euphoria (high) as before. Enterhealth primarily utilizes Suboxone, a formulation which contains buprenorphine and another component called naloxone.

Naloxone helps reverse the effects of opioids so that the they can’t produce the euphoria (or high) normally associated with opioid use. This prevents patients from abusing the buprenorphine itself and deters them from relapsing because they will not be able to achieve a high from any opioid drug while the naloxone is in their system.

When used in tandem, these two medications help patients by preventing the unpleasant physical withdrawal symptoms of opioid addiction and allowing them to participate fully in therapy for the psychological aspects of their addiction. When used within a comprehensive addiction treatment program, buprenorphine treatment often makes the patient feel quite “normal” for the first time in many years. This internal emotional stability allows the patient to focus on recovery rather than relapse and makes it easier for them to understand the necessity of their rehabilitation.

Buprenorphine treatment for opioid dependence occurs in three phases: induction, maintenance, and tapering. Buprenorphine is used in each of these phases, with the dose only being slowly tapered down when the patient is deemed to be emotionally and physically stable.

Induction

The induction, or “acute,” phase starts as soon any opioid drugs have left the body – typically around 12 to 18 hours after the last time the person used the substance. Depending on variables such as drug use history, age and weight, the doctor at Enterhealth will prescribe the initial dose of buprenorphine, which may be gradually raised it until the withdrawal symptoms are satisfactorily under control.

During the induction phase, buprenorphine is used to reduce withdrawal symptoms when opioid use is being decreased or stopped. Buprenorphine is only used for induction in people who are dependent on short-acting opioids, which includes things like include heroin, codeine, morphine, and oxycodone, as these drugs leave the body relatively quickly.

Because it contains naloxone, use of Suboxone should only begin when the effects of these opioids have safely worn off and withdrawal symptoms have begun. This allows the withdrawal symptoms to come on gradually. If Suboxone is administered too early, it can induce what is called precipitated withdrawal, which occurs quickly and can be quite intense.

Maintenance

During the maintenance phase, buprenorphine is administered at a stable dosage for an extended period of time. The purpose of the maintenance phase is to reduce cravings and other symptoms of withdrawal so that patients are able to fully participate in a comprehensive addiction treatment program.

Tapering

Studies have shown that longer treatment times lead to better outcomes, which is why drugs like buprenorphine are becoming widely used for the treatment of opioid addiction. Studies show that up to 49 percent of participants are able to successfully reduce their opioid use during buprenorphine treatment.

Usually after a period of several months to a year or longer, your physician will gradually reduce your dosage, being careful to avoid the onset of withdrawal symptoms as much as possible. The longer the tapering phase, the better.

Buprenorphine is typically formulated as either a film or tablet meant to be taken sublingually (dissolved under the tongue). Use dry hands when handling buprenorphine. Place the sublingual tablet or film under your tongue and allow the medicine to dissolve slowly. Do not chew or swallow it whole.

Injecting or snorting Suboxone may lead to a life-threatening sudden onset of withdrawal (sudden, serious, withdrawal symptoms such as pain, cramps, vomiting and diarrhea) in people who are physically dependent on other opioids.

Buprenorphine should only be used as directed by your doctor, and it’s important to follow all directions on your prescription label and read all medication guides. In a clinical setting, buprenorphine is often administered under supervision to ensure that the patient takes the medication as directed and to prevent misuse.

If you miss your dose, the best thing to do is usually to wait until it’s time for your next dose. If only a short amount of time has passed since you missed your dose you may take it, but it’s important to maintain a regular schedule.

You should never take two doses at the same time, as this does not make up for the dose you missed and may cause overdose or other negative reactions.

Buprenorphine overdose can be fatal, especially in children or in people using this medicine without a prescription.

Symptoms of buprenorphine overdose are similar to those of other opioid drugs, including:

• Loss or coordination
• Drowsiness
• Slurred speech
• Difficulty concentrating
• Reduced heart rate and breathing
• Unconsciousness
• Seizures

If you or someone else is experiencing symptoms of buprenorphine overdose, contact a poison control center or emergency room as soon as possible.

Buprenorphine can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking buprenorphine. This list does not include all possible side effects.

The more common side effects of buprenorphine include:

• Dizziness
• Headaches
• Drowsiness
• Nausea
• Depression
• Decreased sex drive

Serious side effects from buprenorphine aren’t common, but they can occur. Serious side effects can include the following:

• Severe allergic reaction
• Breathing problems
• Coma
• Hormone problems (adrenal insufficiency)
• Liver damage
• Severe withdrawal symptoms

Some medicines can interact with buprenorphine and naloxone and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, herbal products, or medicine for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

Do not consume alcohol while undertaking Suboxone treatment, as this may increase the risk of breathing difficulties that can lead to coma and death.

Usually, by the end of day three on buprenorphine, a patient’s withdrawal symptoms and opioid cravings have almost completely subsided, and they are ready to proceed fully in their treatment program.

In addition to these side effects, the abrupt discontinuation of buprenorphine could also lead to the onset of withdrawal. If a person has been taking buprenorphine for a long period of time and they no longer receive it, they may be at risk of developing withdrawal symptoms similar to those associated with other opioid drugs.

The severity of symptoms experienced depends on the degree of physical dependence, which itself depends on the dose and duration of use. Common withdrawal symptoms may include:

• Opioid cravings
• Anxiety
• Insomnia
• Mood swings
• Abdominal cramps.
• Nausea, vomiting, and diarrhea
• Excessive sweating

Buprenorphine has an especially long elimination half-life compared to other opioids. Elimination half-life refers to the amount of time it takes for half of a single dose of a drug to leave the body. For buprenorphine, this period lasts for 37 hours, meaning that it can take over 8 days before it’s no longer be detectable in a person’s body.

This period of time is not the same for everyone. There are a number of factors that influence how quickly buprenorphine will be flushed out of the system. These include:

• Body fat content
• Weight and height
• Age
• Metabolism speed
• Size of the last dose taken
• Amount of time the abuse has gone on
• Liver health

Doctors will generally start lowering your dose of dose of buprenorphine once you start feeling normal and balanced. Generally, you can stay on buprenorphine treatment for lengthy periods of time without suffering from too many negative side effects.

However, you should start tapering off your dosage if you fit the following criteria:

• You are over 30
• Your confidence is higher
• Employment has become stable and consistent
• An emotional support system has been put into place for you
• Cravings have become almost absent

As addiction treatment is so individualized, there’s no generally accepted timeline for tapering off suboxone treatment. Some people may only need it a few months, while others may require it for a year or more.

Yes, buprenorphine is a controlled substance. It’s classified as a Schedule III prescription drug. This means that it has an accepted medical use, but it may cause physical or psychological dependence and may be abused if taken improperly or without a prescription.

In addition, the federal government has put into place special rules for how schedule III drugs can be prescribed by a doctor and dispensed by a pharmacist. Doctors can only prescribe this drug for opioid dependence after receiving special training and certification through the U.S. federal government.

Methadone

Methadone has been used to treat opioid addiction since the 1960s, and like buprenorphine, it’s a synthetic opiate agonist. This means that it stimulates the areas of the brain affected by opiate addiction. It is generally taken once every 24 to 36 hours and helps eliminate physical withdrawal symptoms while also helping to stop cravings for unsafe opiates, such as heroin and morphine.

One of the major pros of methadone is its well-studied nature. It has been used for more than 30 years and has been studied and tested multiple times during that duration. This means scientists understand the way it affects the body more thoroughly than they do buprenorphine. As a result, it’s easier for them to find a healthy and safe dose quickly and without much experimentation.

However, one of the major problems with methadone is that it’s possible to continue using other opioids while taking it. Unfortunately, this makes it harder for people with severe addictions to recover successfully.

People struggling with opioid addiction have noted that the two-pronged approach of suboxone is a great way to detoxify the body. The buprenorphine ensures that they don’t feel the kind of physical and emotional distress that makes withdrawal and recovery so difficult, and the naloxone makes it more difficult or impossible to use other opioids at the same time, making relapse less likely.

Buprenorphine also works on a quicker time scale than methadone, and it can be administered in both an inpatient and outpatient setting. Those prescribed are usually able to take their prescription home with them, and continue a normal schedule with work, school, and regular activities as they continue on buprenorphine until they’re able to manage their life in recovery without it.

Methadone, on the other hand, is still usually used in a clinical setting, with patients needing to visit a clinic daily to get their dose. This can interfere with many responsibilities in life and can make returning to regular activity, such as work, much more difficult.

Naltrexone

Another evidence-based medication for opioid use disorder is naltrexone, another opioid antagonist. Vivitrol is particularly favored due to its once-a-month injection formulation. This medication is delivered once every 4 weeks instead of every day, which might help address concerns about needing to take a daily medication, as well as the potential problems that could arise if someone is also taking other drugs like alcohol, benzodiazepines, and others.

The downside to Vivitrol is that it only acts to prevent relapse, it doesn’t alleviate the symptoms of withdrawal. This means that the patient needs to have stopped using opioid medications for between 7-10 days before they can be treated with Vivitrol, and it makes participation in therapy and other elements of recovery more difficult.