Buprenorphine is a prescription medication used to treat opioid and opiate addictions. This medication is used in Opiate Replacement Therapy (ORT). With opioid addiction and overdose rates on the rise, buprenorphine is becoming a popular and common medication used for addiction treatment.
This medication works as a partial opioid agonist. It means that it has the same effects as other opioids, like oxycodone and heroin. This effect helps ease and stop withdrawal symptoms.
Although this drug can help people overcome an addiction, it does come with a potential for abuse. This means that it is also addictive, and it’s possible to develop a chemical and physical dependence on it.
As strange as it may seem, buprenorphine abuse and addiction is happening in the United States. It’s absurd to think that it is possible to abuse this medication, and even more absurd that it’s possible to become dependent on it. However, it’s happening more and more with every passing year.
Buprenorphine is a drug that is sold under a number of brand names. Depending on the brand, the drug is used to treat an opioid or opiate addiction, or to treat chronic pain. This medication is a bit diverse in its properties. It is commonly sold under the following brand names:
Each brand offers a different dosage and a different use. It also comes in a different form. Some of these brands offer tablets while others are injections. The brand of buprenorphine prescribed will depend on each patient’s needs.
To better understand an addiction to buprenorphine, we should dive into the specifics of each brand. Here’s a quick review of the various buprenorphine products that can be purchased at pharmacies.
Subutex is a sublingual tablet that contains buprenorphine. This medication is approved specifically for the treatment of opioid or opiate dependence. It is not recommended for treating chronic pain. The reason behind this is that Subutex can cause overdose deaths in opioid-naive patients even in 2 mg doses.
Patients who are taking Subutex will place the tablet underneath their tongue. The tablet will slowly dissolve. Swallowing is not recommended, as this can reduce the bioavailability of the medication.
Those who suffer from moderate to severe hepatic impairment will need to take lower doses. This medication comes in two doses: 2 mg and 8 mg of buprenorphine.
Belbuca is a type of buprenorphine that is administered through the buccal drug delivery system. This basically means that it comes in the form of a film or tablet that is placed on the inner lining of the cheek. The film or tablet will dissolve and enter the body through the mucosal lining.
Belbuca is one of the first buprenorphine products approved by the FDA for pain relief. It is also used for long-term opioid treatment. Most patients will need to take this medication once every 12 hours.
For optimal efficacy, patients should rinse their mouth with water before taking this medication. To ensure that the film sticks, patients should press and hold this in place for at least 5 seconds. They should also avoid moving the film with their tongue or finger, drinking, or eating anything until it has fully dissolved.
The dosage of the film will vary. It depends on the patient's medical condition, as well as his or her response to treatment. The doses that are available include 75 mcg, 150 mcg, 300 mcg, 450 mcg, 600 mcg, 750 mcg and 900 mcg. Belbuca is able to offer a larger dose variation in comparison to other buprenorphine products, like Butrans. With that said, it requires a more frequent dosing schedule.
Many patients take doses of over 450 mcg every 12 hours if they are being treated for an opioid or opiate addiction.
Released in 1985, Buprenex is the first injectable formulation of buprenorphine. Patients will inject the medication either into a muscle or into a vein. Most injections contain about 0.3 mg of buprenorphine per mL.
When injected into a vein, the medication should be administered over a period of at least 2 minutes. In most cases, the medication will start to kick in within 15 minutes after the injection. Effects typically last for over 6 hours.
Buprenex is used to treat moderate to severe pain. It is also used for the treatment of heroin withdrawal symptoms. The benefit of this medication is that no dosage adjustments are needed even among patients who have renal or hepatic impairment.
This medication does come with some side effects. Patients have reported feeling nauseous, dizzy and headaches. Some patients also felt sedated, while others experienced hypotension, hypoventilation and mitosis. It's also not unusual for some patient to vomit or to sweat profusely after taking the drug.
Butrans is a transdermal patch that is used for pain management and for long-term opioid and opiate addiction treatment. This medication comes with a small range of doses. They include 5 mcg/hr, 7.5 mcg/hr, 10 mcg/hr, 15 mcg/hr, and 20 mcg/hr. Patients who are using Butrans for pain relief only should take a dose of 5mcg/hr.
This medication is easy to apply. Patients basically stick a patch on their skin. The medication will slowly diffuse through the skin, and into the bloodstream. The patches should be left on for 7 days before they are removed.
Patients who are starting off on this medication should use the same dose and strength for at least 72 hours. This is the length of time it takes for the drug to reach a steady concentration in the bloodstream.
Bunavail, Suboxone and Zubsolv are all essentially the same thing. They're transmucosal films that contain both buprenorphine and naloxone. These drugs are mainly used for treating an opioid dependence. They're used not only during the induction phase, but also for maintenance therapy.
Due to this reason, it's not unusual for some patients to be on these drugs for months, if not years. It can be difficult for some patients to wean off of these medications.
The pharmacokinetics for Bunavail, Suboxone and Zubsolv are quite similar. The main difference lies in their bioequivalence. In general, Suboxone is used during induction. This is the type of medication that would be used in the medical detox process. Bunavail and Zubsolv are often used for maintenance therapy.
As these medications contain naloxone, many addiction experts believe that it is harder to abuse these drugs. With that said, the buprenorphine as a much higher binding affinity to opioid receptors than naloxone. Buprenorphine also has a much longer half-life in comparison to naloxone.
Unfortunately, sometimes people remain on these drugs for a long time. They get addicted to them. Some individuals abuse buprenorphine for the euphoric high that it can give them. In either scenario, recovery is necessary, and it’s best to do this in a professional setting.
The abuse of buprenorphine is an issue that has only gotten worse since the drug’s release. According to SAMHSA’s Dawn Report:
In 2005, there were 3,161 ER visits because of this drug.
By 2010, the number of those visits had increased to 30,135.
This was a 255% increase. This is believed to have happened due to the increased availability of this drug.
In 2005, there were about 100,000 prescriptions written for this medication. That number increased to 800,000 only five years later. In fact, we start to see more of the devastating effects of buprenorphine in 2010.
During 2010, most of these visits were classified under the nonmedical use of medications. This accounted for 52% or 15,778 of these visits. 24% of the visits were due to people seeking substance abuse detox and treatment. 13% of cases reported to the ER complained of adverse reactions. Furthermore, in 2010, 59% of these cases involved the use of additional pharmaceutical drugs.
When we look further into these cases, we find that further statistics tell us that Buprenorphine is commonly combined with:
Polysubstance abuse involving buprenorphine happens quite often. Alcohol was involved in 11% of ER visits. 11% involved marijuana, 9% involved heroin and 8% involved the use of cocaine.
The statistics show that buprenorphine use is a double-edged sword. This is a problem that experts aren’t exactly sure how to solve. On one hand, this medication is working well for many people who need to recover from opioid addiction. On the other hand, it’s causing an increase in opioid addiction. It continues to be an ongoing issue, and most likely will for years to come.
Buprenorphine works by binding to opioid receptors in the central nervous system (CNS). It has several pharmacological activities. They include:
It's important to note that buprenorphine can act as a full agonist if it is used in patients who have not abused opioids before. Buprenorphine is the active chemical that plays a large role in treating pain and opioid dependence. Its active metabolites are not believed to play as important of a role, if any.
Much like with many chemicals, buprenorphine actually can do a lot more than bind to opioid receptors. It can also:
This drug is metabolized in the liver, and then excreted into bile. Buprenorphine can break down into many metabolites. Norbuprenorphine is one of the main ones. This metabolite is a full agonist of many opioid receptors; however, it's not potent.
Buprenorphine abuse occurs any time this drug is taken in a way that it is not prescribed. With that said, it’s possible for many people to become addicted to this drug first even when they are taking it as prescribed.
This is not a drug that most people purchase off the streets. Most commonly, people begin using it because they have a prescription from a doctor. However, in most cases, they aren’t expected to stay on it for very long. Buprenorphine is most commonly prescribed for short-term use, and it’s discontinued after a few days. After completing the buprenorphine treatments during the induction period, people are usually placed on Suboxone, which has addiction risks of its own.
Sometimes people don’t tolerate Suboxone as well as other forms of buprenorphine. In these cases, a patient can switch to another type of this medication. When they’re taking this drug long-term, the addictive potential is there.
A common thing that happens is that people find that the medication doesn’t work as well for them after some time. Due to this reason, they may increase how much they’re taking on their own. This increases tolerance to the drug. Forming a tolerance can be an indication of an addiction.
As patients increase their dosage, they may also start to get high from the drug. This drug can produce a euphoric feeling, which causes people to use more of it. The high is very similar to an opioid high. Some people who are addicted to opioids may use buprenorphine recreationally just to get high.
Subutex is a drug that can be abused in several different ways. Sometimes people will simply take more of the pills. However, this drug is equipped with a ceiling effect when people use too much of it. It becomes impossible to get high after using a certain dosage. With higher doses, it can also cause precipitated withdrawal symptoms.
To counteract this problem, people will manipulate the drug in a few different ways. They may chew the pills instead of just swallowing them. Some people may even smoke them, or crush the tablets and snort them. It’s also possible to dissolve them in water and inject them.
The method of injecting buprenorphine increases its bioavailability 100%. It’s not surprising that so many people are turning to this administration method as a way to get high. The effects of the drug will kick in quite quickly.
The Buprenex high is a sensation of euphoria and relaxation. Users state that it makes them feel extremely happy and calm. However, they also report that after some time, they’re no longer able to feel its effects. This is when they turn to other methods of abusing it.
This type of high is best suited for people with a low tolerance for other opioid drugs. For someone who is a veteran user, they’re not likely to feel it as much. They may need to take higher doses, or combine it with another drug or alcohol.
With that said, those who have never abused any opioids before are more likely to experience euphoric sensations when taking large doses of this drug. This is because their body has yet to develop a tolerance. They may get addicted to this opioid and then move onto something stronger, like heroin or oxycodone. These drugs are fairly easy to find on the black market.
Yes, Subutex is an addictive drug and so are all other buprenorphine products. It might not take long to form an addiction once abuse begins.
Once you’re addicted, it’s so important to get help. Professional buprenorphine rehab can assist you with your recovery. This is not a drug that you should just stop taking on your own.
There is a slight difference between dependence and addiction, but they are also similar. When you are dependent upon buprenorphine, you may notice that you feel uncomfortable or weird without buprenorphine. You might need to take larger and larger doses of this medication for it to work as well as it once did. This is because you’re forming a tolerance to your dosage. This is the point where people usually increase how much they’re using.
When you’re addicted to the drug, you are unable to quit using it. You may neglect familial, school and work obligations in favor of using the drug. It has become a permanent part of your life. You’ll also experience withdrawal symptoms if you ever try to quit. An addiction is both physical and psychological, whereas dependence is more physical. When someone is addicted, he or she is also dependent. However, the opposite isn’t necessarily true.
Both of these situations are serious and need to be dealt with immediately. If you’re only dependent on buprenorphine, you need to make your doctor aware of the problem. It may be time for you to stop taking the medication. Otherwise, you could eventually become an addict and develop a secondary addiction.
It’s possible that you have been abusing this drug for quite some time. However, you don’t know if you’re an addict or not. You may want to try and look for some of the more common signs of addiction in your own life. These can include:
Have you noticed any of these symptoms? If you have, it’s quite possible that you are addicted. An addiction isn’t something that you can ignore. You may be tempted to hope that it will go away on its own, but it doesn’t work that way. Buprenorphine treatment is required if you want to recover.
If you’re still on the fence as to whether you’re addicted to buprenorphine or not, consider taking our opiate addiction quiz. Answer the questions as truthfully as possible. We’ll send you an email with our findings. If you need addiction treatment or professional help, we’ll let you know.
One of the problems with this medication is that some of the short-term effects of using this drug are desirable. These are the reasons why people continue abusing this drug. Some favorable short-term effects include:
These effects are due to how buprenorphine binds with opioid receptors in the CNS. Although there are some favorable effects to using buprenorphine, there are also some adverse effects. Once someone starts to increase his or her dosage to dangerous levels, more serious effects can start to appear. These can include:
When this drug is combined with alcohol or benzodiazepines, its effects can even become fatal. The effects of the substances are magnified when combined together.
While short-term effects will usually subside with time, there are long-term effects that those who are addicted to buprenorphine should be aware of. The long-term effects of Buprenorphine are even scarier. Long-term effects can become permanent. They can also cause other health complications. Long-term effects include:
The long-term effects of buprenorphine abuse will intensify based on the length of the addiction and the dosage taken. There are many factors that come into play. Those who have abused buprenorphine for a long period of time are more likely to experience health complications. They’re also more likely to have difficulties recovering.
It’s possible that you have a loved one who is abusing this medication, or you may suspect it. If so, it’s not always easy to tell whether that person has become addicted to the drug. Many addicts are able to easily hide their drug use.
To help an addict, you need to know the signs that you should look for. Certain actions and behaviors may clue you in on what’s really going on behind the scenes. You can tell if someone is on buprenorphine if you notice that:
If you notice any of the above signs, you have a right to be concerned. It’s possible that your loved ones are abusing buprenorphine. If you are the one taking buprenorphine and you feel that there’s a chance that you’re addicted, take our addiction quiz. It’ll give you even more insight as to whether you may have developed an addiction.
It may help to talk with your loved one if you suspect Buprenorphine abuse. However, you need to be aware that this might not move them toward getting help. Sometimes addicts will make a lot of empty promises just to buy themselves some more time. If this happens in your situation, you may want to consider another approach.
Intervention services are available for you if you need them. This is a meeting between you, other friends and family and your addicted loved one. An interventionist will guide and oversee the meeting.
Most people find that interventions are extremely helpful. Addicts are often agreeable to getting treatment immediately afterwards. It’s definitely something that you may want to consider.
If you’re addicted to this drug, it’s time to think about what recovery looks like or entails. It’s possible to get clean with the right type of professional help. Buprenorphine addiction treatment can address every aspect of your addiction. It is both a physical and psychological problem that won’t go away on its own.
Even though buprenorphine is used to treat opioid withdrawals, it does have withdrawal symptoms of its own. This is something you need to be aware of when you decide you want to stop using it. Those who quit taking buprenorphine abruptly will be most likely to experience withdrawals.
When you go through withdrawals, some of the symptoms that you can expect include:
Most people find that these and other symptoms are hard for them to deal with on their own. This is why it’s recommended for addicts to go through buprenorphine detox. Detox can help them to manage their symptoms.
The withdrawal timeline for buprenorphine will vary from one patient to another. With that said, this timeline is very similar to many other opioid and opiate withdrawal timelines. Understanding what the timeline looks like can help some patients maintain motivation during the recovery process. The timeline for buprenorphine is roughly outlined below:
The withdrawal timeline will vary. It depends on a patient's length of buprenorphine abuse, the dose he or she took, as well as his or her biological makeup.
When you stop the use of any drug, there are risks involved. This is because you’ve been using this substance for quite some time. Withdrawal occurs because you’re throwing your body into shock. It’s not used to not having the drug, and it can take some time to adjust. This is why withdrawal occurs.
Sometimes people experience complications when they stop using opioid drugs like buprenorphine. You could be someone who is at risk for seizures or other problems. Detoxification can help to reduce your risk of complications. Overall, it makes the entire experience much more comfortable.
So, how does one detox from buprenorphine?
There are several factors that come into play. For one, most rehab centers will place patients on a taper schedule. This means that patients will slowly take a lower and lower dose of buprenorphine until they are able to completely wean off the medication.
Patients may also be prescribed various types of medication depending on the type of symptoms that they are experiencing. It’ll also depend on the intensity and severity of the symptoms. If patients can withstand the symptoms, they may not be prescribed any medications at all.
Patients will need to speak with their doctors to determine which medications may work for them.
So, how long does it take to completely taper off buprenorphine? Is it better to have a long taper schedule or a short one? A popular study has looked into these questions by comparing two taper schedules to one another.
The study looked at 11 outpatient treatment programs in 10 U.S. cities. It also compared two taper conditions: a 7-day taper and a 28-day taper. The study collected data during weekly clinic visits, and at 1-month and 3-month post-taper follow-up visits.
The study looked at whether the participants were able to provide opioid-free urine samples at the end of the taper and at the follow-up visits.
The findings were quite shocking. The study found that 44% of the participants in the 7-day taper group were able to provide opioid-free urine specimens. On the other hand, only 30% of participants in the 28-day taper group were able to do the same. This shows that it’s actually better to have a short taper schedule. They’re simply more effective.
But, what about the long-term effects? Were participants able to maintain long-term sobriety?
During the follow-up visits, there were basically no differences between the two groups. At the 1-month follow-up, 18% of the participants in the 7-day taper group provided opioid-free urine. In comparison, 12% of the 28-day taper group were able to achieve the same results. The percentage remained the same at the 3-month follow-up visits. Those who were able to abstain from opioids at 1-month were able to continue their sobriety.
This study shows that there’s no advantage to lengthening the taper schedule. In fact, doing so may be detrimental to a patient’s recovery progress.
Many patients are confused as to how a taper schedule looks like. Generally speaking, the dose is reduced every couple of days. The length of the taper schedule will depend on the needs of the patient, as well as the type of programs that the rehab centers offer.
Based on the study above, let’s take a look at how a 7-day and 28-day taper schedule would look like for buprenorphine doses of 8 mg, 16 mg and 24 mg.
|7-day taper schedule||28-day taper schedule|
|Initial Dose||8 mg||16 mg||24 mg||8 mg||16 mg||24 mg|
|9 - 11||-||-||-||6||10||16|
|12 - 14||-||-||-||6||8||12|
|15 - 16||-||-||-||4||8||10|
|17 - 19||-||-||-||4||4||6|
|20 - 22||-||-||-||2||4||4|
|23 - 25||-||-||-||2||2||2|
|26 - 28||-||-||-||2||2||2|
It’s quite common for people to attempt an at-home opioid detox before going to professional treatment. There are a lot of suggested methods for at-home detoxes online. Most home remedies for opioid withdrawal are not effective, and many may not be safe.
Since many things can go wrong with a buprenorphine detox, it’s generally best to do so at an inpatient treatment center. This way, recovering buprenorphine abusers can get all of the help and support that they need.
At the very least, those who want to detox at home should talk to a doctor. These addiction experts may be able to assist recovering addicts by recommending methods that are proven to be effective. If not, they can refer them to resources that can offer them the help that they want.
Some detox programs will provide patients with an outpatient treatment option. Patients are able to detox at home by following the taper schedule provided.
It’s possible to detox off buprenorphine using an inpatient or an outpatient program. Both possess unique properties and characteristics that make them stand out from the crowd.
With an inpatient program, patients will live at the rehab facility. That means that they’ll have to pack at least two week’s worth of clothes, some toiletries and other items. They receive the detox at the facility. There’s a huge benefit to this. For one, the addiction experts will be able to monitor the patient’s vitals. They can make adjustments to the taper schedule immediately if the patient feels uncomfortable.
Outpatient detox programs are different in the sense that patients don’t have to live at the rehab facility. Since patients don’t live there, they won’t receive around-the-clock supervision and care. However, they’ll usually still be given the same type of taper schedule. Patients are expected to follow the schedule on their own. As a result, outpatient detox programs are only ideal for patients who have a strong will to get sober.
Detoxing from Buprenorphine is never easy. It takes a lot of willpower, discipline and effort. The taper schedule and process can take some time. With that said, there are several tips that can help make the detox and taper process much more comfortable. These tips include:
There are many additional things that patients can do to enhance their recovery. Different things will be more effective on some patients than others. It's important to try out as many different ideas as possible. Addiction experts at rehab centers can also provide some recommendations.
Surprisingly, it's possible to overdose on buprenorphine. This happens when a person takes an excessive amount of the drug. This large dose is enough to fully incapacitate or overwhelm the person's system.
Buprenorphine overdose symptoms are similar to overdose symptoms for other opioids. Some of the most common overdose symptoms include:
A person who overdosed on buprenorphine will often appear sluggish and fatigued. They may act as if they're drunk in some cases.
In extreme cases, buprenorphine overdoses can have fatal consequences. In general, fatal overdose cases often involve mixing buprenorphine with other substances. By mixing buprenorphine with other substances, the effects of both substances can magnify.
It's also important to note that it's more difficult to treat an overdose that involves other substances as well. This is because both substances can have a very different impact on the body and brain.
So, what should you do if you notice that someone has overdosed on buprenorphine?
The important thing is to call 9-1-1 quickly. Don't wait around for the overdose victim to feel better. By then, it may be too late. Anyone who is seeking help will need to get it as soon as possible. Otherwise, the buprenorphine may overwhelm their system to the point of no return.
Give the 9-1-1 operator as much information about the overdose as possible. This includes the dosage that was taken, and whether the overdose victim mixed the buprenorphine with any other substances. The type of buprenorphine that was taken can also be helpful to the situation.
Wait until help arrives. Try to keep the overdose victim as comfortable as possible. Don't try to get him or her to sleep, eat or drink anything. Instead, try to keep him or her warm. Talk to the overdose victim in order to try to help them stay away.
If the victim does lose consciousness at any point of time, place him or her in the recovery position, like in the video below:
By putting the victim in a recovery position, you can prevent him or her from choking on his or her own vomit. The vomit can block the airway. This can prevent the overdose victim from breathing, and can cause him or her to suffocate.
It's also important to monitor the victim's vitals. In particular, make sure that he or she is breathing. Perform CPR if necessary. It may save the victim's life.
Another thing that bystanders can do is administer naloxone. This is an important opioid-reversing medication that can help temporarily block the effects of any and all opioids. It's important to note that some buprenorphine products, like Suboxone, already contain naloxone.
With that said, this doesn't mean that the naloxone won't work. Naloxone usually comes in two forms: a nasal spray or an intramuscular injection. Both methods are equally as effective, and will usually have an effect on the body within 2 to 5 minutes. The effects usually last for up to 90 minutes.
It's important to learn how to administer naloxone. Take a look at this website to get more instructions. Don't hesitate when administering this drug. It's important to administer it as soon as possible. If you wait, it's possible that the opioid has already overwhelmed the body. In these instances, naloxone won't work at all.
If no effects are seen within 5 to 10 minutes, administer a second dose. Make sure to let the emergency responders know about that you have administered this drug.
Anyone who knows someone who frequently abuses buprenorphine products should know where to get naloxone. There are many places where a person can get their hands on some naloxone. They include:
Narcan, which is the brand name for naloxone, usually costs $150 for two nasal-spray doses. With that said, the overall cost will depend on many factors. It can depend on whether a person has private insurance or is on Medicaid. It can also depend on the type of naloxone that is purchased.
The cost of naloxone has been rising over the years. This is problematic considering how important this medication can be. Consider the following. In 2014, a two-dose Evzio package was priced at $690. By 2014, the same package cost $4,500. That's more than a 500% increase in just a little over 2 years!
The rising cost of naloxone is making it more and more unaffordable for many people. Fortunately, many insurance companies are now covering the cost of this medication. This is mostly thanks to the Affordable Care Act.
Contrary to what many people may believe, it is possible to recover when from an addiction to buprenorphine. Many people who are addicted will often feel as if the situation is hopeless. This could probably be because this is their bout with addiction. If not, they might feel hopeless because they jumped from one addiction straight into another.
The important thing is that you shouldn’t despair. With the right help, anyone can successfully stop taking any buprenorphine products. They can get a better manage on their pain, and they can learn how to wean off opioids and opiates.
At Northpoint Washington, we want you to know we’re here for you. We understand how frustrating your addiction may be to you. If you’re having difficulties dealing with an addiction, we can assist you with your recovery. We aim to help all of our patients achieve lifelong sobriety. Life is better when you’re sober!
Our individualized treatment plans take into account various factors. We understand that each patient will be affected by buprenorphine in a different way. To help us help you, call us for a free addiction assessment. Our addiction experts will analyze each case to determine what is the best route to recovery.
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