What is Buprenorphine
Buprenorphine is a long acting, semi-synthetic opioid to treat Opioid Use Disorder (OUD).
Buprenorphine is one of three FDA approved medications commonly used to treat opioid addiction. The other two are methadone and naltrexone.
Opioid Use Disorder
Opioid Use Disorder is defined as a problematic pattern of opioid use that leads to serious impairment or distress. Opioids can include drugs like heroin, fentanyl, and pain relievers (such as morphine, oxycodone, hydrocodone, and more.) Opioids may trigger a flood of dopamine, with powerful effects on the brain. After time, the brain may be required, needing this higher level of dopamine.
Buprenorphine has the protective effect of blocking other opioids. The person who takes buprenorphine feels normal, not high. However, the brain thinks it is receiving the problem opioid, so withdrawal symptoms stay away. Buprenorphine also helps control cravings. If cravings continue to be a problem, your doctor will adjust your medication or help you find other ways to reduce them.
Currently, buprenorphine is available in tablet, sublingual film, and injectable formulations. Many formulations contain naloxone. The naloxone is added to prevent abuse—it brings on withdrawal in people who abuse buprenorphine by injecting it.
Buprenorphine should be part of a comprehensive management program that includes psychosocial support. However, treatment should not be withheld in the absence of psychosocial support. Overdose with buprenorphine in adults is less common, and most likely occurs in individuals without tolerance, or who are using other central nervous system depressants like alcohol or benzodiazepines.
Induction and Maintenance
Before you are given the first dose of any medication for opioid addiction, your doctor will ask you questions about your addiction, health, and other problems. You will get a drug test – usually a check of urine or saliva. You also will have a physical exam and tests for diseases that are common to people who have been
abusing drugs. Your liver will be checked to make sure the medication can be safely taken. If buprenorphine is safe and appropriate for you, your doctor may recommend it. You and your doctor or substance abuse treatment provider decide together on a treatment plan. The plan describes the medication routine, the counseling and other services that will be provided, and the rules that must be followed. These rules will be explained to you and you will get them in writing.
Your doctor will prescribe a low dose to start taking after withdrawal symptoms begin. The induction dose of buprenorphine may begin with 2 – 4 mg and usually stabilizes at 12 – 16 mg per day, although it can be higher for some patients. In addition, dose levels may be adjusted up as needed. Buprenorphine can make you feel drowsy at first. You should not drive or perform other high-risk tasks until you know how this medication affects you. If drowsiness continues to be a problem, your doctor may adjust dose levels. Always take doses exactly as prescribed by your doctor.
You may take buprenorphine for days, months, or years—as long as it is needed to prevent relapse. If you reach the point of stability in recovery and want to stop taking buprenorphine, you must do it slowly, over time. This is called tapering. Tapering works best with the help of your doctor or substance abuse treatment provider, after progress has been made in treatment. Opioid withdrawal can be extremely risky for the fetus, even resulting in fetal demise. Methadone and buprenorphine prevent this.
Medication is one part of treatment for opioid addiction. For many people, another important part is counseling; the opportunity to talk with a professional either one-on-one or in a group with others in treatment. Through counseling, you learn about the motivations and behaviors that led to your opioid addiction. You learn how to commit to a more healthful lifestyle. You gain support and skills while working with others to manage your recovery long term. Counseling can provide you with encouragement and with motivation to stick to treatment. It can help you learn how to make healthy decisions, handle setbacks and stress, and move forward with your life.
Buprenorphine has side effects in some people. Side effects are feelings of discomfort or sickness that come with taking medicine. Buprenorphine has a few mild side effects. Usually these go away after the medication is taken for a while. If you have side effects, you should NOT stop taking the medication. Instead, talk with your doctor or substance abuse treatment provider.
Common Side Effects
Body aches, headaches, and cold- or flu-like symptoms – Check with your doctor about over-the-counter medicines you may take.
Dizziness – Stand up slowly. Call your doctor if problems persist.
Constipation – Drink more water and juice. Eat food with fiber. Exercise more.
Sweating – Shower often. Dress in layers.
Sleep problems, including tiredness – Take the pill in the morning. Avoid naps. Go to bed at the same time every night. Exercise. Do not drink caffeine after lunchtime.
Upset stomach or vomiting – Take the pill after you have eaten. Take an antacid product as directed by your doctor.
Mood swings – Exercise more. Do fun things that do not involve the old drug lifestyle. Relax. Talk to your substance abuse treatment provider.
Serious side effects – For extreme stomach pain, vomiting, or diarrhea, contact your doctor right away.
Pregnancy and breastfeeding
Buprenorphine may be prescribed to women who are pregnant and have an OUD. Buprenorphine and methadone are considered the treatments of choice for OUD in pregnant and breastfeeding women.
Methadone and buprenorphine are the safest medicines to manage OUD during your pregnancy. Both medicines stop and prevent withdrawal and reduce opioid cravings, allowing you to focus on your recovery and caring for your baby.
Many pregnant women with OUD worry about neonatal abstinence syndrome (NAS), a group of withdrawal signs that may occur in babies exposed to opioids and other substances before birth. However, NAS is transitory and can be diagnosed and treated. It is much safer for your baby if you prevent withdrawal during pregnancy, by the use of medications such as buprenorphine and methadone.
You may need medicine other than those for OUD to treat pain during or after delivery. Other options, such as an epidural and/or a short-acting opioid, can be used to keep you comfortable.
All hospitals must report to state child welfare agencies when a mother who is using substances gives birth. This report is used to make sure that a safe care plan is in place to deal with both your and your baby’s well-being. It is not used to remove your baby from your care. Participating in OUD treatment before and after the birth of your baby shows your commitment to providing a safe, nurturing environment for your baby.
Some pregnant women with OUD consider completely withdrawing from using opioids, but seeking treatment is always the most helpful course of action. Withdrawal may make you more likely to start using drugs again and even experience overdoses. If you are not currently in treatment, talk with your healthcare professionals about treatment medicines and behavioral counseling.
Once your baby is born, breastfeeding is the best option for your baby, even with buprenorphine in your system. Your breast milk will contain small amounts which will help with or even prevent NAS. In addition, research has found that breastfeeding, cuddling, skin-to-skin contact, and rooming in prevent NAS as well.
- While taking this medication, you should NOT take other medications without consulting your doctor first.
- While taking this medication, you should NOT use illegal drugs, drink alcohol, or take sedatives, tranquilizers, or other drugs that slow breathing. Taking any of these substances in large amounts along with buprenorphine can lead to overdose or death.
- Buprenorphine kept at home must be locked in a safe place to prevent accidental use by others, especially children.
- If you are a woman and are pregnant or breast-feeding, methadone is safer than buprenorphine for mother and child. In special circumstances, doctors may recommend the naloxone-free form of buprenorphine instead of methadone. Ask your doctor for more information.
- Liver problems are rare but can occur. If you have a pre-existing liver condition, your doctor should conduct regular tests on your liver.
Addiction & Recovery
Addiction is a disease. It cannot be cured, but it can be treated with medication, counseling, and support from family and friends. The goal of medication-assisted treatment is to recover from addiction. It does NOT replace one addictive drug with another. It provides a safe, controlled level of medication to overcome the use of a problem opioid.
Many people with an opioid addiction regain normal, healthy lives. One way they do this is with medication-assisted treatment. Medication, counseling, and support: together they can help you, your loved ones, and your friends. Recovery is possible, but it takes work. After treatment is finished, everything is NOT automatically fine again. Recovery takes commitment every day, through treatment and beyond.
For further information, see