Buprenorphine for Painkiller Addiction

By Hugh C. McBride

After decades of effective use, methadone maintenance treatment for opioid addiction is the most well-known type of medically assisted addiction treatment. But methadone is not the only drug that has helped individuals overcome addictions.

For the past seven years, a drug called buprenorphine has helped thousands of patients in the United States kick their dependence upon opioids and narcotics and regain control over their lives.

About Buprenorphine

According to the National Alliance of Advocates for Buprenorphine Treatment (NAABT), the U.S. Food and Drug Administration (FDA) approved two medications containing buprenorphine for the treatment of opioid dependence in 2002:

•  Subutex (buprenorphine hydrochloride)
•  Suboxone (buprenorphine hydrochloride and naloxone hydrochloride)

The inclusion of naloxone hydrochloride in Suboxone is done to preclude users from attempting to abuse the drug via intravenous injection. If Suboxone is injected, the naloxone will cause the immediate onset of withdrawal symptoms – but, the NAABT reports, taking the drug as directed (in pill form, placed under the tongue) will not result in any such symptoms.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has posted the following information about the safety and effectiveness of the medication:

Studies have shown that buprenorphine is more effective than placebo and is equally as effective as moderate doses of methadone and LAAM in opioid maintenance therapy. Buprenorphine is unlikely to be as effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence.

Few studies have been reported on the efficacy of buprenorphine for completely withdrawing patients from opioids. In general, the results of studies of medically assisted withdrawal using opioids (e.g., methadone) have shown poor outcomes.

Buprenorphine, however, is known to cause a milder withdrawal syndrome compared to methadone and for this reason may be the better choice if opioid withdrawal therapy is elected.

Buprenorphine Treatment

The SAMHSA website reports that buprenorphine treatment is typically conducted in three phases:

• Phase #1 (Induction) – The induction phase begins when a patient has abstained from using drugs for 12 to 24 hours and is in the early stages of withdrawal. It is important for the patient to be in the early stages of withdrawal because if traces of abused substances remain in the body, the buprenorphine dose could actually lead to the onset of withdrawal symptoms.

• Phase #2 (Stabilization) – Once cravings and side effects have all subsided, the patient is ready to enter the stabilization phase of buprenorphine treatment. During this phase, the dosage levels will likely be adjusted, and the patient may be able to switch to an every-other-day dosage pattern (rather than the typical daily doses that are required during the induction phase).

• Phase #3 (Maintenance) – When the correct dosage has been determined and the patient has proved to be remaining healthy and free of cravings, the healthcare provider can develop an individualized buprenorphine maintenance plan. Some individuals remain on buprenorphine for a predetermined amount of time before being weaned from the drug, while others continue to take the drug for an indefinite period of time.

A Success Story

One of the "success stories" featured on the NAABT website was written by an anonymous 30-year-old woman who had become dependent upon Vicodin (acetaminophen and hydrocodone) after first using it for back pain and then later being prescribed the drug for post-surgery pain. (The relationship between chronic pain and addiction is not uncommon, as many individuals become dependent upon substances that they were originally given for legitimate medical conditions.)

After an initial false start (ineffective short-term use of Suboxone), this patient began taking the drug on a long-term maintenance basis and has experienced what can only be termed as success:

I'm now on a maintenance dose of 2mg of Suboxone and it's been 3 months since I've taken a Vicodin!! The first month I still had bad cravings and the second month it got a little easier but I still thought about them. The third month I had no cravings.

I feel really good. I'm back to doing all the things I use to do. I don't feel anything from the Suboxone except normal. I can look at myself in the mirror again and feel good about it. I have my life back. More important, my son has his mother back!

Getting into a Buprenorphine Treatment Program

If you or someone you love is struggling with an addiction to painkillers, buprenorphine treatment may be the answer you have been looking for.

A number of highly effective substance abuse treatment programs feature buprenorphine and other types of addiction recovery programs. As with any type of healthcare decision, the most important factor is finding a program that meets the specific needs of the individual patient.