Buprenorphine, which was first approved in 2002, is currently available in two forms: alone (Subutex®), and in combination with the opioid receptor antagonist naloxone (Suboxone®). Both formulations of buprenorphine are effective for the treatment of opioid use disorders, though recent studies have shown high recidivism rates among patients tapered off of buprenorphine compared to patients maintained on the drug for a longer period of time.
Because maintenance medications such as buprenorphine are themselves opioids and are able to produce euphoria in people who are not dependent on opioids, many people have assumed that this form of treatment just substitutes a new addiction for an old one. This belief has unfortunately hindered the adoption of these effective treatments. In the past, even some inpatient treatment programs that were otherwise evidence based did not allow patients to use these medications, in favor of an “abstinence only” philosophy.
A Swedish study compared patients maintained on buprenorphine daily to a control group that received buprenorphine for 6 days followed by a placebo. All patients received psychosocial supports. In this study, the treatment failure rate for placebo was 100 percent vs. 25 percent for buprenorphine—within 3 months the Medication Assisted Treatment (MAT) group resulted in cessation of treatment. Therefore, the combination of Buprenorphine (Suboxone®) and therapy had a significant decrease in the use of opioids.
Buprenorphine Addiction Therapy
There are 3 phases of Buprenorphine treatment therapy:
- Induction Phase – 12 to 24 hours after last opioid use, where Buprenorphine is medically administered.
- Stabilization Phase – patient no longer craves opioid, usage has stopped or decreased significantly, and no longer experiencing side effects.
- Maintenance Phase – the detox phase where patient usage of opioid has stopped and Buprenorphine dosage is steady or ended completely.
In all phases, patient medication is combined with behavioral counseling for a “whole patient approach,” known as Medication Assisted Treatment (MAT).
Side Effects of Buprenorphine
Like other opioids, buprenorphine can have withdrawal side effects including, inability to sleep, cramps & muscle aching. diarrhea, nausea, & vomiting, cravings, fever and irritability. While there is some risk associated with misuse of buprenorphine, the risk of harms, such as fatal overdose, are significantly lower than those of full agonist opioids (oxycodone, hydrocodone, heroin).