Buprenorphine is a partial opioid-receptor agonist used in high dosages to treat the opioid-dependence disorder. This semi-synthetic opioid derivative of thebaine/paramorphine (an opiate alkaloid) is popularly used in Medication-assisted Treatment (MAT) or opiate-drug detoxification process, which helps reduce or completely cease chronic addiction to heroin, morphine and other opiates. Short or long-term opioid replacement therapy using buprenorphine is more effective when practiced through a ‘whole-patient approach’ with behavioral interventional therapies and psychological support, given through one-to-one guidance counseling.
Buprenorphine, also a partial opioid agonist, is just as effective as methadone, having a similar mechanism of action. These drugs negate the potential of any life-threatening respiratory depression or stress known to occur in heroin abuse. Buprenorphine also has fewer side-effects when compared to alpha-2 agonists, since withdrawal symptoms resolve quickly in shorter duration than methadone or clonidine. Buprenorphine’s long-acting opioid effects increase on regular administration until they level off at a certain dosage; thereafter, drug-effects would not escalate even if the dosage is increased. This is called the ‘ceiling effect’, which helps reduce the chances of drug misuse or dependency and helps control other side effects of the drug.
One of the major advantages of buprenorphine is that it does not require a highly sophisticated clinic setting for treatment, like in the case of Methadone. Buprenorphine is the first medication, which can be dispensed directly to the patient through a physician’s prescription. This ease of treatment methodology has increased access to the drug, which can be prescribed in any setting, be it a doctor’s office, private health clinic, community hospital or public health department. Though therapeutic efficiency of buprenorphine is identical to methadone, it is not the commonly preferred treatment of choice for patients with high level of physical dependence on opiates. Common side effects of buprenorphine use are fever, fatigue, muscle cramps, insomnia, nausea, vomiting, stress, and irritability.
Phases of Buprenorphine treatment
- Induction is the primary administration of buprenorphine to an opioid-dependent addict. One important condition to start this drug treatment is abstinence from opiate-consumption for at least 12 – 24 hours before buprenorphine ingestion. If the patient is not in the early stages of withdrawal and still has opioids circulating in their bloodstream, severe withdrawal symptoms may set in, upsetting the treatment course.
- Stabilization phase is when the patient has ceased or greatly reduced their opioid abuse habit and do not experience cravings or side effects. Buprenorphine dosage may be reduced from daily to an alternate-day regimen, due to the long-acting nature of the drug.
- The maintenance phase is when the patient is showing steady recovery while on continuous buprenorphine treatment. The length of maintenance on the drug is customized according to every patient’s needs and could also go on indefinitely. Medically-supervised withdrawal or tapering the dosage helps in making the transition to a drug-free state smoother. To prevent chances of relapse back to the old addiction, the patient is recommended to continue rehabilitation through psychiatric guidance and counseling.
Buprenorphine Misuse Potential
Mild opioid effects of buprenorphine’s intake are usually misused by many, especially by those who have no opioid dependency. To forestall diversion from treatment course and prevent the likelihood of drug-misuse, Naloxone is added along with buprenorphine as it blocks opioid withdrawal symptoms.