What Is Buprenorphine? – Buprenorphine is a synthetic opioid that works as a partial opioid agonist and is an active ingredient in both Suboxone and Subutex. Although it has some mild analgesic properties, it is most often used in the U.S. as a treatment for opioid addiction, as people do not experience drug cravings or opioid withdrawal symptoms when using it. They also cannot get high on other opioids, because the corresponding receptors are blocked.
Buprenorphine, as an opioid replacement therapy, is similar in many ways to methadone, but there are also some significant differences between the two medications that have led to buprenorphine’s popularity.
The following are the two most significant differences between buprenorphine and methadone:
- Physicians can prescribe buprenorphine in take-home doses.
- Buprenorphine withdrawal symptoms are less severe than withdrawal symptoms from methadone.
Of note, Buprenorphine doesn’t work well for everyone, and some people find using a methadone maintenance treatment program produces more benefits. However, most people have found buprenorphine is an effective and tolerable treatment for opioid addiction.
How Does it Work?
People who have become dependant on opioids develop additional opioid receptors in the brain. Naturally-occurring levels of opioids in the brain can’t activate these unessential receptors, and when they remain vacant, withdrawal symptoms occur. Once people become addicted to opioids, they need a steady intake of opioids just to keep withdrawal symptoms at bay.
However, Buprenorphine can bind to the brain’s opioid receptors without causing the desired “high” and side effects of other opioids. When taken in sufficient doses, buprenorphine can attach itself to enough of these receptors to completely eliminate the effects of withdrawal.
Of importance, Buprenorphine is not an opiate/opioid like heroin, which is a full agonist, meaning it can activate each opioid receptor completely. Buprenorphine is a partial agonist, meaning that although it can attach to every opioid receptor, it can only activate each one just enough to eliminate withdrawal symptoms and cravings, and not enough to result in a euphoric high.
Moreover, a person taking Buprenorphine for an opioid addiction will not experience withdrawal symptoms and cravings to use opioids – and because buprenorphine so effectively satisfies opioid receptors, attempting to take another opioid or opiate such as heroin will have no effect.
Is It Safe?
Buprenorphine is generally considered to be safer than methadone. As a partial opioid agonist, buprenorphine can only partly activate the brain’s opioid receptors. People using a very high dose of methadone or other full agonist opiates, such as heroin, are at a much greater risk for respiratory depression and death. But because buprenorphine can’t completely activate the receptors, it can’t cause a significant effect on the central nervous system.
While methadone has a relatively narrow safe dosage window, it is much more difficult to overdose on buprenorphine than methadone.
What Are Some Of The Side Effects?
Most people tolerate it very well, although the medication may have some side effects. Possible side effects include the following:
- Headaches
- Nausea
- Constipation
- Sexual dysfunction
- Sweating
- Abdominal pain
Why Can I Take It at Home?
Buprenorphine is commonly prescribed as the drugs Suboxone or Subutex in the U.S. Subutex contains only buprenorphine, while Suboxone contains two active ingredients: buprenorphine and naloxone. Naloxone works as an extra precaution: it prevents people from injecting the medication to get high and prevents overdose.
Therefore, Suboxone can be prescribed in take-home doses because the risk of abuse and drug diversion are much lower than methadone.
Who Shouldn’t Use Buprenorphine?
People with a very high tolerance for opioids may find that the medication, as only a partial agonist, does not offer sufficient relief from withdrawal symptoms. Fortunately, methadone will work for anyone, regardless of their history of opioid use.
Other reasons that buprenorphine might not be right for some include the following:
- Co-occurring abuse of alcohol or benzodiazepines (polydrug use disorder)
- An inability to comply with take-home opioid medication prescriptions, low motivation
- Severe mental health conditions
- Pregnancy
- Certain physical illnesses
How Long Does Treatment Last?
The treatment duration varies depending on the needs and wants of the patient. Treatment can be as brief as just a few days or can be prolonged indefinitely.
Buprenorphine is most often used in one of two ways:
- As a part of a brief detox protocol to reduce the severity of withdrawal symptoms from full agonist opioids
- In a long-term opiate replacement maintenance program
Note: People who take it for longer periods generally experience better outcomes.
Treatment for Opioid Addiction
Buprenorphine, Subutex, and Suboxone should only be used as part of a comprehensive treatment program administered by addiction professionals. These programs also include inpatient and outpatient treatment, both of which consist of behavioral therapy, counseling, and group support.
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