Buprenorphine

Buprenorphine is a newer treatment option and was approved by the FDA in 2002.1 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.3 Other benefits include:4

  • 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:5

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.

The buprenorphine implant, sold as Probuphine, was approved by the FDA in 2016 for people who are already taking other forms of buprenorphine. The implant is placed into a patient’s arm and provides a low level dosage of buprenorphine that lasts for six months. While many research studies about Probuphine are still underway, it may be beneficial because:6

  • it is convenient, as patients have no need to take daily medication
  • there is an increased adherence to treatment with no possibility that medication will be lost, stolen, or forgotten

Brand Name

Probuphine®

Administered

Implant

How It Works

The buprenorphine implant (placed under the skin) is used for maintenance treatment of opioid dependence in patients who have achieved stability on oral forms of buprenorphine treatment. Probuphine should be used as part of a complete treatment program including counseling and behavioral therapy.

Potential Serious Side Effects

Serious complications may happen from insertion and removal of Probuphine, including nerve or blood vessel injury in your arm, movement of implant (the implant can move into blood vessels or the lung causing serious complications or death), implant sticks out of the skin (called a protrusion), or implant comes out by itself (called an expulsion).

Call your healthcare provider right away if Probuphine sticks out of the skin or comes out by itself, you experience bleeding or symptoms of infection at the site after insertion or removal, including excessive or worsening itching, pain, irritation, redness, or swelling, you have numbness or weakness in your arm after the insertion or removal procedure, or you have weakness or numbness in your arm, or shortness of breath.

Common Side Effects

Dizziness, headache, drowsiness, nausea, constipation, sedation

Availability

By prescription from licensed and trained doctors only. Visit their website for Probuphine implant information.

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 abuse.7 When those patients stopped taking buprenorphine with naloxone, the rate dropped to 8.6%.8 The NIDA study also showed that patients who received intense counseling while taking buprenorphine with naloxone showed no additional benefit to recovery success rates.9

Clinical Benefits

A systemic review of research conducted about the effects of buprenorphine found that it’s more effective at reducing opioid use than a placebo.10

Brand name

Suboxone, Zubsolv, and Bunavail

Administered

Oral film strip, sublingual tablet (placed under the tongue) or implant though the cheek

How It Works

Buprenorphine attaches to the receptors in the brain without the pleasurable effects of opioids, tricking the brain into feeling satisfied. Naloxone is an opioid blocker, and reverses the effects of opioids.

1. US Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm191521.htm “Subutex and Suboxone Approved to Treat Opiate Dependence”
2. Miller, Peter. M “Principles of Addiction” Comprehensive Addictive Behaviors and Disorders, Volume 1. Academic Press. San Diego, CA. 2013
3. Gowling L, Ali R, White J. Burprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev. 2004;(4):CD002025.
4. SAMHSA. “Buprenorphrine” Retrieved from: http://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
5. https://www.naabt.org/collateral/How_Bupe_Works.pdf
6. US Food and Drug Administration. 2016. “FDA Approves First Buprenorphrine Implant for Treatment of Opioid Dependance”
7-9. National Institute of Health. https://www.nih.gov/news-events/news-releases/painkiller-abuse-treated-sustained-buprenorphine/naloxone “Painkiller Abuse Treated by Sustained Buprenorphine/Naloxone”
10. Johnson RE, Eissenberg T, Stitzer ML, Strain EC, Liebson IA, Bigelow GE. A placebo controlled clinical trial of buprenorphine as a treatment for opioid dependence.Drug Alcohol Depend. 1995;40:17–25
All Drug and Side Effect Information Provided By:
http://www.rxlist.com/script/main/hp.asp
http://www.webmd.com/drugs/index-drugs.aspx?show=drugs
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