What Is Buprenorphine? Uses, Treatment for OUD, Managing Withdrawal & Side Effects
Is Buprenorphine An Opioid?
Yes. Buprenorphine is a synthetic opioid that treats pain and opioid use syndrome. It was developed in the late 1960s. It is a synthetic analog of thebaine, which is an alkaloid compound derived from the poppy flower. It is a schedule III drug, which means that it has some potential for moderate or low physical dependence or high psychological dependence. 
What is buprenorphine? Buprenorphine is a medication approved by the Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD). Buprenorphine is an opioid partial agonist. It produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as methadone and heroin. 
What Is Buprenorphine Used For?
What is buprenorphine and is it safe? When taken as prescribed, buprenorphine is safe and effective. Buprenorphine has unique pharmacological properties that help:
The Drug Addiction Treatment Act of 2016 now allows physicians to provide office-based treatment for opioid addiction (DEA, 2018). This Federal legislation permits physicians to prescribe schedule III, IV, or V “narcotic” medications approved by the US Food and Drug Administration (FDA) for patients with opioid addiction. In 2002, the FDA approved buprenorphine and a combination of buprenorphine/naloxone to manage opioid dependence. 
- For managing opioid-dependent patients who have a contraindication to methadone
- There are no available methadone treatment facilities or healthcare providers, or there is a long waitlist of more than three months to join a methadone clinic.
- For opioid-dependent patients with intolerance to or have failed methadone treatment.
- Other individuals who may benefit from buprenorphine are those with a short history of opioid dependence and/or have lower needs for opioid agonists.
Buprenorphine For Opioid Use Disorder
Patients diagnosed with an opioid use disorder should talk to their health care practitioner before starting treatment with buprenorphine to fully understand the medication and other available treatment options.
- To begin treatment, an OUD patient must abstain from using opioids for at least 12 to 24 hours and be in the early stages of opioid withdrawal. Patents with opioids in their bloodstream or who are not in the early stages of withdrawal, may experience acute withdrawal.
- After a patient has discontinued or greatly reduced their opioid use, no longer has cravings, and is experiencing few, if any, side effects, if needed, the dose of buprenorphine may be adjusted. Due to the long-acting agent of buprenorphine, once patients are stabilized, it may be possible to switch from every day to alternate-day dosing.
- What is buprenorphine and how long it is usually prescribed? The length of time a patient receives buprenorphine is tailored to meet the needs of each patient, and in some cases, treatment can be indefinite. To prevent possible relapse, individuals can engage in on-going treatment—with or without medication-assisted treatment.
Buprenorphine Opioid Withdrawal
Buprenorphine is FDA-approved for acute pain, chronic pain, and opioid dependence. It is an agent used in agonist substitution treatment, which is a process for treating addiction by using a substance (such as buprenorphine or methadone) to substitute for a stronger full agonist opioid (such as heroin). The prescriber then tapers down the substitute, and the patient withdraws from the opiate addiction with minimal discomfort.
Buprenorphine substitute treatment allows the patient to focus on therapy instead of uncomfortable withdrawals. It is an effective option to treat opioid dependence, reduce cravings, and improve the quality of life for patients undergoing drug addiction treatment. It allows the patient to circumvent many of the uncomfortable symptoms of opioid withdrawal, creating a treatment plan that patients are more likely to adhere to, thereby decreasing morbidity and mortality.
Off-label, use includes withdrawal for heroin-dependent, hospitalized patients. This use is only by injection.
Potential For Buprenorphine Abuse
Even though buprenorphine is only a partial opioid agonist and has mild addictive potential, some people still misuse the drug. Buprenorphine tablets are misused by crushing them and either snorting the powder or dissolving the power and using it as an intravenous solution. Also, in the US, where buprenorphine is also available in a sublingual formula, concerns have been raised about diversion and abuse; thus, the sublingual formulation is combined with naloxone to prevent IV abuse. Further, most patients undergo supervised daily dosing for the first two months of treatment to help lower the risk of diversion. Pharmacists also pay close attention to the patient’s compliance to ensure that double doctoring and lost or stolen ‘carries’ do not occur frequently.
There is always the potential of overdose from the diverted buprenorphine in opioid-naive individuals when combined with benzodiazepines, alcoholism, or other centrally acting agents. If a patient overdoses on buprenorphine, they may experience confusion, dizziness, pinpoint pupils, hallucinations, hypotension, respiratory depression, seizures, or coma. Respiratory depression is a possibility when using other central nervous depressants, especially benzodiazepines. For example, using buprenorphine and diazepam together increased the risk of respiratory and cardiovascular collapse.
When a patient overdoses on buprenorphine, they must be given a naloxone bolus dose of 2 mg to 3 mg followed by a continuous infusion of 4 mg per hour; this will cause a full reversal of the overdose within 40 to 60 minutes. A bolus dose is needed to overcome the high affinity that buprenorphine has to the mu-opioid receptor.
Buprenorphine Side Effects
Common side effects of buprenorphine include:
- Constipation, headache, nausea, and vomiting
- Drowsiness and fatigue
- Dry mouth
- Tooth decay
- Muscle aches and cramps
- Inability to sleep
- Blurred vision or dilated pupils
- Disturbance in attention
Serious side effects of buprenorphine include:
- Respiratory distress
- Adrenal insufficiency
- Itching, pain, swelling, and nerve damage (implant)
- Pain at injection site (injection)
- Neonatal abstinence syndrome (in newborns)
These are not all the side effects of buprenorphine. For more information, patients should talk to their health care practitioner or pharmacist. Patients should tell their health care practitioner about any side effects that are bothersome or do not go away.
Because of buprenorphine’s opioid effects, it can be misused, particularly by people who do not have an opioid dependency. Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product.
All healthcare workers who prescribe must have an active DEA registration number and a waiver to prescribe buprenorphine. The parenteral formula is not FDA-approved for the management of opioid dependence, and hence Intravenous use is not permitted, except under extraordinary circumstances and with permission; otherwise, such use can be illegal, and the prescriber can lose his or her DEA number and ability to write any future prescriptions for controlled substances.
Benefits Of Buprenorphine Compared To Methadone
What is buprenorphine and is it better than methadone treatment? The use of buprenorphine has been demonstrated to be more effective than detoxification in improving outcomes in patients with opioid dependence. When compared to methadone, buprenorphine has the following advantages:
- It is safer even at high doses
- Optional therapeutic doses are achieved relatively quickly
- There is less risk of abuse and diversion
- The drug is easier to taper
- There is less stigma associated with buprenorphine than methadone.
- Patients can get the medication from any healthcare provider and do not have to go to specialized methadone clinics
Buprenorphine, because of its partial opioid receptor agonist activity, is said to cause less euphoria compared to full agonists like methadone or morphine and thus is less likely to be abused or diverted. The buprenorphine treatment typically lasts 3 to 6 months (or sometimes 1 to 2 years); conversely, methadone treatment is often lifelong.
The success of buprenorphine/naloxone is dependent on patient education. Thus, the patient should be educated about the drug’s addiction potential and avoidance of other CNS sedatives at each visit.
Family members, or the caregiver, should receive education about the signs and symptoms of buprenorphine toxicity. Patients and/or caregivers should also receive instruction regarding actions to take in the event of depressed respiration.
To ensure that there is continuity in care, healthcare workers need to communicate all aspects of the treatment with each other at the weekly meeting to ensure that there are no omissions or overlap in the dosing of buprenorphine. This approach is vital following patient discharge from jail or a healthcare institution. The outcomes depend on compliance with therapy. However, because many patients with substance misuse disorder have other significant comorbidities or a case of dual diagnosis, the overall effectiveness is poor, marked by remissions and relapses. As with any drug, but perhaps even more so with buprenorphine, the regimen needs to be part of an interprofessional team approach to ensure optimal patient outcomes with minimal harm. 
We Level Up opioid addiction treatment center is here to help individuals successfully complete the opioid detox process and to address psychological, physical, and spiritual issues connected to drug abuse. Qualified doctors, nurses, therapists, and addiction cases managers will be with you throughout the recovery process to ensure you have the support you need.
What is buprenorphine and is it the best option for you? If you or a loved one is dealing with dependence or addiction to opioids, contact We Level Up treatment support to find the best treatment option and opioid detox for you.