FAQ - Buprenorphine

Is buprenorphine treatment just trading one addiction for another?

No.  With successful buprenorphine treatment, the compulsive behavior, the loss of control of drug use, the constant cravings, and all of the other hallmarks of addiction vanish. When all signs and symptoms of the disease of addiction vanish, we call that remission, not switching addictions.The key to understanding this is knowing the difference between physical dependence and addiction.  Buprenorphine will maintain some of the preexisting physical dependence, but that is easily managed medically and eventually resolved with a slow taper off of the buprenorphine when the patient is ready. Physical dependence, unlike addiction, is not a dangerous medical condition that requires treatment. Addiction is damaging and life-threatening, while physical dependence is an inconvenience, and is normal physiology for anyone taking large doses of opioids for an extended period of time. 

Why use buprenorphine for treatment?

Buprenorphine is a partial opioid agonist, which makes effectiveness unique. For purposes of treatment for opioid addiction, buprenorphine:

  • less or no euphoria and physical dependence
  • lower potential for misuse
  • a ceiling on opioid effects
  • relatively mild withdrawal symptoms compared to other opoids

At the appropriate dose buprenorphine treatment may:

  • Suppress symptoms of opioid withdrawal
  • Decrease cravings for opioids
  • Reduce illicit opioid use
  • Block the effects of other opioids
  • Help patients stay in treatment

How does buprenorphine help with withdrawal symptoms?

Buprenorphine can block the effects of opioids and can precipitate, or bring on withdrawal symptoms if an opioid is in the bloodstream of an opioid addicted person. This is the result of the high affinity buprenorphine has to the opioid receptors. The affinity refers to the strength of attraction and likelihood of a substance to bind with the opioid receptors in the brain. Buprenorphine has a higher affinity than other opioids and as such will compete for the receptor and win. Buprenorphine will "knock off" other opioids and occupy that receptor blocking other opioids from attaching to it. If there is enough Buprenorphine to knock the opioids off the receptors but not enough to occupy and satisfy the receptors, withdrawal symptoms can occur.  If this happens, the treatment is more buprenorphine until withdrawal symptoms disappear.  

What are the side effects of buprenorphine?

The most common side effects are:

constipation

headache

dry mouth


More serious or concerning side effects may be experienced if the dose is too high (over-medicated) or too low (withdrawal symptoms).Buprenorphine induction and maintenance is closely monitored by the nursing staff and physician.

References

Center for Substance Abuse Treatment. Buprenorphine: A Guide for Nurses. DHHS Pub. No. (SMA) 09-4376. Technical Assistance Publication (TAP) Series, No. 30. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009.