QUESTIONS ABOUT BUPRENORPHINE DETOX

What is buprenorphine?
Buprenorphine is a semi-synthetic opioid medication that’s used to treat addiction to heroin and other opiates. Buprenorphine works the same way that other opioids do, by affecting the central nervous system in such a way as to enhance feelings of calmness and euphoria.

The difference between buprenorphine and other opioids is that it is only a partial agonist – meaning its effects are milder, are non-addictive, and reach a plateau regardless (a dosage ceiling after which larger doses have no effect). Buprenorphine also has a higher affinity than other opioids, which means it will bind to receptors in the brain and even block the effect of full agonist opioids, such as heroin.

Is buprenorphine treatment just trading one addiction for another?
No -- but this is a common misconception about treatments that involve buprenorphine and methadone. Administering buprenorphine is just one part of a multi-faceted treatment plan that includes – among other aspects – counseling and behavior therapy. A patient who participates in buprenorphine treatment will continue to be physically dependent on opioids, but he will no longer be addicted.

People sometimes mistake physical dependence for addiction, but they are very different. Physical dependence is a physiological state that can be managed, while addiction is a compulsive drive to use drugs regardless of the damage caused to personal health, vocation or relationships. Addiction is life-threatening; physical dependence is not. And over time, physical dependence can be reduced by slowly decreasing buprenorphine dosage.

How do opioids work?
Opioids act like neurotransmitters, and attach to receptors in the brain. Opioids block pain, slow breathing, and cause feelings of calm or euphoria. While the body produces some opioids naturally, it cannot produce enough to block chronic pain; thus, people who suffer from severe, chronic pain have to take medications such as oxycodone, which can be addictive.

Opioids release dopamine into the brain, not just activating its reward system, but over-stimulating it. This overstimulation is what causes the euphoric feeling many people seek when they abuse opioids. This is also what causes opioids to be so addictive.

Is buprenorphine addictive?
While it is possible for someone to become addicted to buprenorphine, it is not likely. Addiction is caused by a complex combination of environment, genetics, and other factors. The substance itself is only one facet.

The addictive potential for any drug is based on three factors: the intensity of its effects, the speed with which its effects are felt, and the duration of its effects. Heroin, for example, causes a quick reaction, is very intense, and lasts for a short amount of time. By contrast, buprenorphine has a mild effect, a slow onset, and can last from one to three days.

Does buprenorphine show up in drug tests?
Buprenorphine doesn’t show up on standard drug tests. It won’t cause a positive result on opiate tests either, because those tests look for a metabolite that isn’t found in buprenorphine.

Who can prescribe buprenorphine?
Buprenorphine can be prescribed only by doctors who have been assigned a special number by the U.S. Drug Enforcement Agency. Doctors who want to be able to prescribe buprenorphine need to take an eight-hour class on addiction treatment. Once they have their DEA number, they are limited to treating 30 buprenorphine patients at a time.