Buprenorphine Treatment


How Does Buprenorphine Work?

Buprenorphine is legally classified as a “narcotic” and acts as such acts through its effects at opioid receptors in the central nervous system. There are various types of opioid receptors but the best studied are the mu- (μ-) opioid receptors; pharmaceuticals that activate these receptors are called “agonists” and those that block receptors “antagonists”. Buprenorphine is often referred to as a “partial agonist” because some of its effects reach a “ceiling” or “plateau”, notably sedation and respiratory depression; for this reason, fatal overdose due solely to buprenorphine is very uncommon.

What are Buprenorphine's FDA Indications

In the U.S. buprenorphine has FDA indications for the treatment of chronic pain in a low-dose patch (Butrans®) as for the treatment of opioid dependence (addiction) in high dose sublingual (i.e. under the tongue) preparations in brand (e.g. Suboxone) and generic formulations. When used to treat addiction, buprenorphine is able to suppress opioid (narcotic) cravings to about the same degree as methadone. Before committing to any treatment, patients should get the information they need to discuss the treatment options with their clinicians.

Buprenorphine for Chronic Pain

Many people who have become addicted to prescription opioids are able to resume their "normal" lives without the ups and downs of cravings and withdrawal with when buprenorphine is prescribed in doses appropriate for treating addiction. Many reporting that this drug is a life-saving "miracle". While there are a few studies reporting the effectiveness of buprenorphine for the treatment addiction complicated by chronic pain, these studies lack detail regarding pain conditions and to what extent the primary problems affecting function were addiction- or pain-related. When buprenorphine is found to be a primary, effective chronic pain treatment, in all likelihood the pain conditions were not so complex as require a multidisciplinary pain team approach; in such cases, addiction is more likely to have been the primary problem.

Concerns about Buprenorphine Treatment

When used in standard doses for addiction, buprenorphine is consider a high opioid dose treatment, exceeding current chronic pain opioid guidelines. One concern about buprenorphine is the difficulty many individuals encounter when trying to discontinue the drug. The question as to how long someone should be treated with buprenorphine remains unanswered because there are no high-quality published studies available. Some people report that they are unable to tolerate stopping buprenorphine completely after long-term use, and may choose to stay on a low dose (e.g. 2 mg). An analogy may be made to psychiatric medications used to treat anxiety and depression; in the U.S, we consume more psychoactive medications than in other countries. Medications are effective and less costly than psychotherapy, at least in the short term; however, when medication is stopped, symptoms are apt to return and long term medication effects on the central nervous system are largely unknown.
Because buprenorphine is viewed as a "substitution" treatment, some drug counselors contend that buprenorphine is “trading addictions" and, sadly, to individuals being shunned in 12-Step support groups because they are not abstinent from drug use. There is no question that buprenorphine helps many individuals begin the process of recovery, and that group support is often helpful as well.