MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).
The U.S. Food and Drug Administration (FDA) has approved three treatment medications for addiction: buprenorphine, naltrexone, and methadone. (Naloxone [Narcan] is a rescue medication for overdose, not a treatment for addiction.)
All three medications control cravings for opioids and block the effects of other opioids. Each medication affects patients somewhat differently, based on whether they act as what doctors call opioid agonists or opioid antagonists.
But here’s what they have in common: addiction medications are effective and affordable, and have been shown to cut premature death rates in half.
Let’s take a look at the first of the three medications we’ll review: buprenorphine.
Related blog: MAT Facts: What is Medication-Assisted Treatment?
How does buprenorphine work?
Buprenorphine is the generic name for such medications as Suboxone, Subutex, Zubsolv, Bunavail, Probuphine, and Sublocade. Suboxone is probably the most commonly prescribed form of buprenorphine, but all forms of this medication treat withdrawal, control cravings, and block the effects of opioids
How does buprenorphine do all of this?
Buprenorphine acts as a partial opioid agonist, which means that it activates the opioid receptors in the brain, creating a small opioid effect that suppresses withdrawal symptoms and cravings.
The opioid effects of buprenorphine are far less than full opioid agonists, such as heroin or oxycodone. This minimal effect reduces the risks of abuse, addiction, or side effects.
According to The National Alliance of Advocates for Buprenorphine Treatment, appropriate 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
While buprenorphine is itself an opioid, it is different than other opioids in that it may allow for:
Less euphoria and physical dependence
Lower potential for misuse
A ceiling on opioid effects
A much lower risk for overdose
Relatively mild withdrawal profile
The buprenorphine treatment process
Patients who have been approved for buprenorphine treatment by a qualified physician must undergo a short period of opioid withdrawal if they’re still using opioids like pain medicines or heroin. Usually that means abstaining from opioid use for 12 to 24 hours. Without experiencing early withdrawal, buprenorphine can trigger more extreme withdrawal symptoms if opioids are still in a person’s system. Patients without opioids in their system, like immediately after detox, can start buprenorphine without being in withdrawal.
MAT providers may adjust the prescription dose of buprenorphine over the first week or so of treatment. Once on a stable dose, buprenorphine is taken once daily as it effects last for more than one day.. A high-quality MAT provider will meet with the patient regularly to guide her through all aspects of her recovery, including any necessary behavioral support and outside services.
As patients are stabilized and continue through their recovery, they enter a maintenance phase of MAT, which is tailored to the needs of the individual. The dosage may be tapered, but the length of time for this phase could be indefinite; it all depends upon what each person needs to avoid relapse.
Side effects and safety
SAMHSA notes buprenorphine may have some side effects, some of which are similar to those of other opioids:
- Constipation, nausea, and vomiting
- Difficulty sleeping, especially if taken later in the day
- Muscle aches and cramps
Patients should be prepared to follow safety precautions, including these Dos and Don’ts:
Do not take other medications without first consulting your doctor.
Do not use illegal drugs, drink alcohol, or take sedatives, tranquilizers, or other drugs that slow breathing. Drinking lots of alcohol or mixing large amounts of other medications with buprenorphine can lead to overdose or death.
Do ensure that a physician monitors any liver-related health issues that you may have.
A life-saving medication, extremely regulated
When it was approved by the FDA in 2002, buprenorphine represented a big leap forward in increasing patient access to MAT. Before buprenorphine was allowed for clinical use, the sole MAT option for patients was methadone, a treatment that can only be performed in highly structured clinics.
Suboxone, Zubslov, and Bunavail contain both buprenorphine and the opiate antagonist naloxone, which blocks other opioids.
The addition of naloxone to buprenorphine decreases the ability for it to be misused and therefore diverted. When these products are taken as sublingual tablets, there is no effect from the naloxone. If injected, however, the naloxone is potent and will trigger opioid withdrawal.
Buprenorphine can be taken as a daily sublingual drug, a monthly injectable, or a six-month implantable drug. The sublingual version of buprenorphine is the only medication assisted treatment for opioid use disorder that can be routinely prescribed by a clinician and filled at the pharmacy. Other treatments like injectable naltrexone are usually filled at a specialty pharmacy, and methadone is not legally available by prescription for addiction. Physicians, nurse practioners, and physician’s assistants who have received the proper qualifications can offer buprenorphine for opioid dependency in offices, community hospitals, health departments, or correctional facilities.
That said, buprenorphine is the only medication which requires its own DEA certification to prescribe, the only addiction medication which requires the prescriber to demonstrate special training, and the only medication with limits on the numbers of patients a prescriber can treat.
As the opioid epidemic has ballooned into the biggest health crisis in decades, experts on the frontlines - like CleanSlate - have questioned the extreme limitations surrounding buprenorphine qualifications for physicians. As an organization committed to saving lives, we are doing everything we can to expand access to MAT and make critical medications such as buprenorphine more readily available.
CleanSlate treats patients suffering from opioid or alcohol addiction with medications and a continuum of care to support each individual's journey to recovery. If you or someone you love needs help, contact us at 833-505-HOPE, or visit our website at www.cleanslatecenters.com to find the center nearest you.
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