Buprenorphine Abuse, Addiction, And Treatment Options
Medically reviewed byIsaac Alexis, M.D., AAMA, AMP-BC
April 30, 2019
While still considered a first choice when treating an opioid addiction, buprenorphine has been recognized as a potential substance of abuse. Attempts have been made to offer buprenorphine as a safe alternative to opioids, like heroin, morphine, and fentanyl, however there is considerable risk associated with buprenorphine when abused.
What Is Buprenorphine?
Buprenorphine is one of the medications that are approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD). It is designed to help suppress painful opioid withdrawal symptoms and encourage long term abstinence from opioids.
Buprenorphine acts as both a partial opioid agonist and an opioid antagonist, which makes it a unique option to treat opioid dependence and addiction. Buprenorphine is classified by the Drug Enforcement Administration (DEA) as a schedule III drug, which acknowledges there is a low to moderate risk for physical dependence or high risk for psychological dependence.
Buprenorphine is available as an extended-release injection, or as part of a combination of naloxone and buprenorphine medication.
How Does Buprenorphine Work?
The partial opioid agonist qualities of buprenorphine mean that it latches on to the opioid receptors in the brain and partially activates them, but not as intensely as a full opioid agonist (like heroin, morphine, or oxycodone). This partial binding creates a ‘ceiling-effect’ that makes it very difficult to overdose and decreases risk factors associated with respiratory depression.
The partial agonist effect of buprenorphine also allows a person to stop abusing other opioids without intense cravings or withdrawal symptoms typically associated with opioid dependence and addiction.
Buprenorphine antagonist effects at the opioid receptor blocks other opioids from having an effect. This means that while buprenorphine is active at the receptor, other opioids cannot attach to the receptors, preventing the euphoria typically associated with opioid abuse.
This is why buprenorphine is generally not classified as a replacement therapy or an opioid blocker. It is a unique combination medication that has qualities of both and has been successful in treating opioid use disorder.
Buprenorphine is used as part of what is referred to as a medication-assisted treatment (MAT) for OUD, in addition to a substance abuse treatment program. After the initial detoxification process for opioid addiction, many individuals are able to lower the dose of buprenorphine, and some can taper off completely.
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Medications That Contain Buprenorphine
Buprenorphine was first approved as a MAT in 2002, and are available in the following brand name medications:
- Suboxone sublingual film (buprenorphine and naloxone)
- Sublocade subcutaneous monthly injection (buprenorphine extended-release)
- Bunavail buccal film (buprenorphine and naloxone)
- Cassipa sublingual film (buprenorphine and naloxone)
- Subutex sublingual film or tablet (buprenorphine and naloxone)
- Zubsolv sublingual tablets (buprenorphine and naloxone)
The most common or most popular medication that contains buprenorphine is Suboxone. As with most of these medications, Suboxone contains both buprenorphine and naloxone. The naloxone acts as a deterrent for buprenorphine misuse, because if a person attempts to dissolve the film and inject it or crush the pill and snort it, they will immediately experience withdrawal symptoms from the release of the naloxone.
Sublocade is a buprenorphine-only monthly injection. In order to receive these injections, a person must first be on a combination buprenorphine/naloxone medication and be transitioned to Sublocade. Sublocade removes the need to take a daily medication, requiring a monthly dose.
Is Buprenorphine Addictive?
People taking buprenorphine are at risk for developing dependence on the medication, which means they need the buprenorphine to feel ‘normal’. Over time, the person will also develop tolerance, and need more buprenorphine to feel the same effects as previous, lower doses.
Individuals who are prescribed buprenorphine are usually already addicted to opioids, and it is not unheard of for the person to begin exhibiting the same addictive behaviors with buprenorphine as they did with opioids.
Some behaviors that a person is struggling with buprenorphine addiction to watching for include:
- unable to control or stop taking buprenorphine
- buprenorphine cravings
- forging prescriptions
- continuing to abuse buprenorphine, regardless of consequence
- spending significant amounts of time using or finding buprenorphine
- doctor shopping to get multiple prescriptions for buprenorphine
- illegally obtaining buprenorphine
If a person is taking buprenorphine and exhibiting these symptoms, it may be time for them to discuss their misuse with their prescribing doctor, or consider another form of treatment.
While uncommon, it is possible to overdose as a result of buprenorphine abuse or addiction. The signs and symptoms of buprenorphine overdose are similar to those of other opioids. Warning signs include fainting, pinpoint pupils, respiratory distress, weakness, hypotension, clammy skin, blue lips, and coma. It is important to seek medical assistance if any of these symptoms occur while taking buprenorphine.
The risk of overdose also increases when the person abuses other drugs in addition to buprenorphine, and can be life-threatening.
Buprenorphine Addiction Treatment
Substance abuse treatment locations that are approved to treat OUD can also treat buprenorphine addiction. These facilities are regulated and held to standards to ensure that evidence and outcome based intervention methods are used in their substance abuse program, beginning with detoxification.
Detoxing from buprenorphine is an important first step when treating a buprenorphine addiction. This can take place at a medically supervised detoxification unit as part of an inpatient substance abuse program. Using an alternative opioid use disorder treatment medication, the person can get off buprenorphine, and use of the other MATs to address this addiction.
Once detox has been completed, the person can then focus on building a support system and exploring the dynamics of their addiction in a safe, healthy environment. Developing appropriate coping skills and creating a solid aftercare plan can help a person maintain sobriety. If you or your loved one is struggling with a buprenorphine addiction, you are not alone. Contact us and we can help you find a substance abuse treatment program to help you through this complicated time.Article Sources
National Center for Biotechnology Information - Buprenorphine
Substance Abuse and Mental Health Services Administration - MAT Legislation, Regulations, and Guidelines
Centers for Disease Control and Prevention - Assessing and Addressing Opioid Use Disorder (OUD)
Food and Drug Administration - Information about Medication-Assisted Treatment (MAT)