Buprenorphine as a Medication-Assisted Treatment in Virginia

Withdrawal is a challenge for anyone, both mentally and physically. It puts the body and mind through a lot, and it can be a significant deterrent to recovery for those struggling with opioid addiction. In trying to avoid an unpleasant detox from opioids, many users will continue their current behavior.

The Virginia Center for Addiction Medicine believes in using Medication-Assisted Treatment programs to make it easier than ever for individuals to find and hold onto their sobriety.

Through a long-term regimen of buprenorphine doses along with counseling or behavioral therapy, patients can make progress and remain in recovery even after treatment finishes. With additional help from group therapy, mental health observations, and physician-led medication tapering, those users dependent upon opioids can find new freedom.

What Is Buprenorphine?

Buprenorphine is a treatment option for those addicted to opioids. It is a semi-synthetic opioid that derives from thebaine, which is an alkaloid produced naturally within the poppy plant. Its original function was as an analgesic, or pain reliever. However, since the 1970s, researchers and addiction treatment practitioners have discussed buprenorphine as a potential tool to manage opioid dependence. [10]

The substance is a partial agonist, meaning it blocks the effects of other narcotics or opioids. By blocking the receptors that receive signaling when an addict has an urge, buprenorphine can mimic the effects that opioids typically have on the body. Because it is a partial agonist, it has several properties that serve as beneficial to opioid medication-assisted treatment. These benefits include its ability to lower abuse potential, create a ceiling effect at high doses, reduce withdrawal discomfort, decrease the physical dependence level, and protect from an overdose. [1]

Buprenorphine was a significant turning point in the United States’ treatment of the opioid epidemic as it became the first way physicians can manage opioid addiction within an office setting. [10]



Why Is Buprenorphine Prescribed?

The FDA approved two formulations of buprenorphine sublingual tablets to treat opioid addiction back in 2002. The organization also recommended using the drug in combination with other treatments such as behavioral therapies/counseling to take a whole-patient approach to opioid dependence. [9]

Since then, Buprenorphine has shown to be more effective in helping patients complete an opioid medication-assisted program. The National Drug Abuse Clinical Trials Network performed studies that resulted in 77% of patients finishing a 13-day taper program with negative urine tests for opioids as compared to participants assigned clonidine. [3] According to the World Health Organization, buprenorphine is one of the drugs categorized as “essential medicines” due to its epidemiological impact on worldwide opioid dependence. [4]

The drug has shown, especially when combined with naloxone, to be highly effective in preventing withdrawal symptoms and helping individuals complete drug treatment programs. [9]


What's the Difference Between Suboxone and Buprenorphine?

The main difference between these two similar opioid treatment medications is one ingredient: naloxone.

Buprenorphine, also known as the now-discontinued brand name Subutex, and Suboxone both contain the ingredient buprenorphine. Suboxone, however, also includes naloxone.

Subutex was the first development and then Suboxone after it. Many patients who were taking buprenorphine via Subutex abused the drug. They sought to intravenously inject the drug to experience the same euphoric high that they were used to getting from painkillers or street drugs. To combat these issues, scientists created Suboxone.

By adding Naloxone, an opioid antagonist, the new formula was able to block the common effects of opioids at the receptor sites. By blocking the desirable effects, it prevented the use of the medication intravenously to get high. If someone injects Suboxone, they will experience an instant and intense withdrawal, since it blocks their opioid receptors.

Little evidence exists to show whether Suboxone or buprenorphine is better than its competitor in treating opiate addiction. The best choice for an individual will depend on their unique circumstances. [11]


How Does Buprenorphine Work?

First, the patient must abstain from using any opioids for at least 8 hours before they can receive buprenorphine administration. When the patient begins to display mild withdrawal symptoms, the first treatment can begin.

A patient will receive an appropriate maintenance dose to start. Doctors often start with a lower dose and will adjust the dosage over several days as needed. [3] Thanks to buprenorphine’s unique pharmacological properties, it can help to lower the potential for misuse. It can diminish the physically dependent effects, and increase safety in the case of overdose. Since it is a partial agonist, it produces similar effects to an opioid. The mimicked effects mean the medication can produce feelings of respiratory depression and euphoria at low-to-moderate doses.

The effects will increase as the dose increases until the patient levels off and stabilizes. When the amount required levels off, even with a higher dose, it is not possible to maximize the effects any further. The “ceiling effect” creates a much lower risk of dependency, side effects, and misuse. [2]


The buprenorphine process within the body looks like this:

When an individual with opioid dependence hasn’t had their last dose (at least 8 hours before first treatment), the opioid receptors in the brain no longer have an opioid to fill the void, and they will experience the uncomfortable desire for more. When a full-agonist opioid fills this void (if the individual reverts to their former opioid-using behaviors), the withdrawal pain vanishes, and euphoric effects of the opioid will set in instead.

When the empty opioid receptor bonds with partial-agonist buprenorphine, however, the imperfect fit within the receptor will provide limited euphoria. The effects soothe the narcotic urge without causing the desirable full impact that opioids would. The idea here is to wean off from one addiction - not swap it out with a dependency on buprenorphine!

Buprenorphine has a stronger bond to the receptors than other opioids, so it blocks anything other than itself from attaching. It continues to hold its place in the receptor and block opioids until the dose dissipates. [8]

A bonus is that because buprenorphine is a long-acting agonist agent, a user can go about their day and rebuild their life while complying with a medication-assisted treatment program. [5]


Benefits of Buprenorphine as Medication-Assisted Treatment

Medication-Assisted Treatment can remove some of the fear of withdrawal and detox. It works as an alternative to intense detox with controlled, steady partial-agonist doses.

When you choose a MAT program that utilizes buprenorphine, you may also receive these additional benefits:

  • Prescription from a physician for at-home use rather than only within a structured clinic according to the Drug Addiction Treatment Act of 2000 [5]
  • Suppressed symptoms of opioid withdrawal
  • Decreased opioid cravings
  • Blocked effects of other opioids
  • Reduced illicit drug use
  • Improved chances of staying in and finishing treatment. [7]
  • Treatment of the underlying cause of addiction rather than detox symptoms
  • Increased social functioning during treatment and retention afterward thanks to counseling in conjunction with medication [12]

What Are the Side Effects of Buprenorphine as a Medication Assisted Treatment?

Of course, no treatment option is perfect, which is why it’s critical to share the real, possible side effects of choosing buprenorphine as a medication-assisted treatment option.

While taking the buprenorphine medication, patients may experience:

    Vomiting, constipation, stomachache Muscle cramping or aching - especially pain in the back Insomnia; trouble sleeping Coughing and hoarseness in the throat Trouble urinating or painful urination Irritability and increased distress Fever and sweating Chills, hot or cold Runny nose, stuffy nose, sneezing Decrease in appetite Anxiety, depression Flushing or redness of the skin Itchy, rashy skin Facial tenderness Headache Dry mouth [6]

If you begin to experience the side effects listed above, or any other side effects, you should advise with your doctor as soon as possible.


FAQs

Using buprenorphine with a medication-assisted treatment program can bring up a lot of questions. It’s essential to discuss these matters with your doctor before starting MAT at The Virginia Center for Addiction Medicine.
Q: Is taking buprenorphine the same as trading one drug addiction for another?
A: While buprenorphine does have addictive properties, the chances of becoming addicted while taking it within the prescribed guidelines are low with minimal risk of abuse or addiction. However, there is still a chance that you could become addicted to the medication if you take it improperly or outside of the physician’s guidelines. For this reason, it’s crucial to listen to the instructions from your doctor at the Virginia Center for Addiction Medicine carefully.

Q: Is using buprenorphine in MAT right for me?
A: The drug might be right for you if you are struggling to beat an addiction to opioids and are interested in a whole-patient recovery program. If this sounds like you, it’s a good idea to set up a consultation.

Q: How long does MAT with buprenorphine last?
A: The length of time that you will remain on buprenorphine will depend on your unique case and needs - if you are motivated to transition off of MAT sooner, your physician will work with you to accomplish that, if you are in no rush to come off of MAT, your physician will work with you to accommodate that as well. As you work with your physician, they will be able to give you a better idea of the length of treatment to expect.


Contact Us

If you need any more information about the process of using buprenorphine as a medication-assisted treatment or would like to speak to an expert on the matter, get in contact with the Virginia Center for Addiction Medicine today - 804.332.5950.

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