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Buprenorphine (Suboxone)

What is Buprenorphine?

Buprenorphine is a prescription pharmaceutical, which attaches to the same reward centers in the brain as the abused opiate would occupy. By attaching to these sites, called Opioid receptors, buprenorphine completely eliminates withdrawal symptoms.

In 2002, the FDA approved Buprenorphine for the treatment of Opioid addiction for its favorable safety profile and the following benefits:

  • Causes no euphoria
  • Suppresses withdrawal symptoms, including cravings
  • Blocks other opiates from the brain
  • Lowers the risk of overdose and misuse of abused opiate
  • Minimal side effects
 

1.Opioid receptor is empty. As someone becomes tolerant to opioids, they become less sensitive and require more opioids to produce the same effect. Whenever there is an insufficient amount of opioid receptors activated, the patient feels discomfort. This happens in withdrawal.

 

 

2.Opioid receptor filled with a full-agonist. The strong opioid effect of heroin and painkillers can cause euphoria and stop the withdrawal for a period of time (4-24 hours). The brain begins to crave opioids, sometimes to the point of an uncontrollable compulsion (addiction), and the cycle repeats and escalates.

 
 
 
 
 
 

3.Opioid replaced and blocked by buprenorphine. Buprenorphine competes with the full agonist opioids for the receptor. Since the buprenorphine has a higher affinity (stronger binding ability) it expels existing opioids and blocks others from attaching. As a partial agonist, the buprenorphine has a limited opioid effect, enough to stop withdrawal but not enough to cause intense euphoria. 

 

 

4.Over time (24-72 hours), buprenorphine dissipates. 

 

 

 

 

 

However, it still creates a limited opioid effect (enough to prevent withdrawal) and continues to block other opioids from attaching to the opioid receptors.

Source:  The National Alliance of Advocates of Buprenorphine Treatment – www.NAABT.org

 

Prescription drugs that contain Buprenorphine

Several drugs contain the active ingredient Buprenorphine, including Suboxone, Zubsolv, Bunavail, and others are expected in the future. Suboxone is the one most frequently prescribed by physicians, has the longest track record, and provides the most availability at pharmacies.


Understanding more about Suboxone

While Suboxone (Buprenorphine) is a medically approved and useful option for opioid dependency, it is important that you educate yourself as much as possible about this pharmaceutical before making a treatment decision.

Side effects can include:

  • Headache
  • Nausea
  • Insomnia
  • Sweating
  • Withdrawal symptoms if stopped suddenly

You can read more about Suboxone at www.Suboxone.com.  Suboxone is not a cure for dependence, just as insulin is not a cure for diabetes, but is a tool to be used for treatment.


How long should treatment last?

Opioid addiction is a result of brain changes that result from chronic opioid use.  Each patient’s struggle for recovery is unique, but entails overcoming the effects of these changes. Adapting to new coping mechanisms and reversing these brain changes take time.  18 to 24 months is a reasonable expectation for a treatment timeframe.


Our office-based treatment program includes…

  • Full Medical Evaluation
  • Course of treatment prescribing Suboxone
  • Regular office visits
  • Urine testing
  • Requirement that patient attends individual or group therapy
  • Medically supervised taper and withdrawal plan (18 -24 months)
  • Post Suboxone treatment with Naltrexone

 

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Douglas Brown, MD, FAAFP
5000 New Point Road.
#3201
Williamsburg, VA 23188