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Buprenorphine

Buprenorphine is a newer treatment option and was approved by the FDA in 2002. It works by attaching to the brain’s neurotransmitters to help lower potential for misuse by diminishing effects of dependency (such as withdrawal symptoms and cravings), and producing a lower level euphoric effect that essentially “tricks” the brain into being satisfied.2 A research review conducted about the effectiveness of buprenorphine found that it is more effective at reducing signs and symptoms of opioid dependence, as well as sustaining treatment, than a placebo. Other benefits include:

  • a low risk of overdose or dependency
  • convenience and increased privacy, since a prescription is written and can be filled for use at home
  • long-lasting effects, so treatment may not be required daily
  • a feeling of normalcy instead of a “high,” so the person in recovery can resume daily activities

Buprenorphine treatment happens in three phases:

1. The Induction Phase

The Induction Phase is the medically monitored startup of buprenorphine treatment, performed in a qualified physician’s office 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 patients who are not in the early stages of withdrawal and who have other opioids in their bloodstream.

2. The Stabilization Phase

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 different formulations (e.g., the buprenorphine implant) or less frequent dosing. This decision should be made in conjunction with a healthcare professional as each patient’s needs may be very different.

3. The Maintenance Phase

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.

Buprenorphine is commonly combined with naloxone.

Together they block the opioid receptors in the brain. This helps produce the same feelings as opioids, which can help with withdrawal and cravings. Research conducted by the National Institute on Drug Abuse (NIDA) showed that 49% of recovery patients using buprenorphine with naloxone for at least 12 weeks successfully reduced their prescription painkiller misuse. When those patients stopped taking buprenorphine with naloxone, the rate dropped to 8.6%. The NIDA study also showed that patients who received intense counseling while taking buprenorphine with naloxone showed no additional benefit to recovery success rates.

Brand names for buprenorphine medications

Suboxone, Zubsolv, Bunavail; also available as an implant, called Probuphine, and an injectable, called Sublocade