Abstract image illustrating a medication assisted treatment article on buprenorphine/naloxone for opiate use disorder.

Buprenophine and it’s role in MAT

Suboxone and it's therapeutic considerations in MAT

Mohammed Rezai DO

Mohammed Rezai DO

Medical Director

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Medication-assisted treatment (MAT) is one of the most effective interventions for substance use disorders (SUDs), including opioid use disorder and alcohol use disorder. This type of intervention has not only been proven to reduce the frequency and intensity of substance-related cravings, but it also improves treatment compliance and allows someone to maintain gainful employment by managing their symptoms.

There are a range of medications that may be recommended as part of an MAT program. Each type of medication serves a different purpose. In particular, some are intended to reduce an individual’s cravings for alcohol, while others work to minimize the effects of opioids in the body. All types are intended to prevent someone from using the substance of concern in an attempt to achieve or maintain sobriety.

Why is buprenorphine prescribed?

One of these medications is buprenorphine, which is a narcotic specifically designed to treat opioid use disorders such as addiction to heroin and methadone. This type of narcotic also falls under the category of partial opioid agonists. This means that it blocks the opioid receptors in the brain, which are responsible for regulating mood, pain levels, and someone’s likelihood for addictive behaviors. For this reason, some doctors may recommend buprenorphine for people with chronic or severe pain. When given in hospital settings, rapid-release (or fast-acting) tablets begin working on pain within an hour. Buprenorphine can also come in the form of a patch to be worn on the painful part of the body. These patches can sometimes take up to a day or day and a half to begin working, but they usually last longer than oral forms do.

Buprenorphine is more commonly known by its brand names: Belbuca, Buprenex, Butrans, and Probuphine. Buprenorphine is a controlled substance, meaning its use is strictly regulated by the government because high doses can suppress the respiratory system and cause sudden death.

What are the effects of buprenorphine?

While this is recommended to individuals as part of an MAT program that prevents substance use, buprenorphine has the same active ingredients as some other opioids. This medication is given in very small doses that are just enough to satiate the opioid receptors in the brain but not nearly enough to produce feelings of euphoria or others associated with a “high.”

Recommended doses can relieve mental tension, cause a slight drop in breathing rate, and make someone feel overall calmer. This not only serves to prevent someone from craving other opioids, but it also works to ease some of the mental health concerns that may trigger a craving, such as anxiety.

Very large doses can produce a high, but they also place someone at risk for death since large amounts of buprenorphine significantly slow the nervous system and can cause someone to stop breathing.

When someone takes the recommended dose of buprenorphine, this medication is a safe, long-term alternative to opioids. It is intended to last for up to 24 hours, so it is usually taken once per day to produce the desired effect.

Can buprenorphine be combined with other medications?

It is highly recommended that buprenorphine not be taken with alcohol, since both of these substances suppress the nervous system and can cause a significant drop in breathing. Another MAT medication called Suboxone is a combination of buprenorphine and a similar medication called naloxone. This is a sublingual medication that comes as a film (similar to a Listerine strip), which is placed below the tongue and dissolves before entering the bloodstream through tissue in the mouth. When taking any sublingual medication, the film should remain in this position until it has the chance to dissolve. This usually takes between 15 and 30 seconds. This is the form that buprenorphine is most commonly taken in.

What forms can buprenorphine be taken in?

When buprenorphine is consumed in isolation, it is usually as a sublingual tablet. This is also dissolvable and placed underneath the tongue. It appears visually similar to tablets that are swallowed whole, but sublingual tablets offer a concentrated dose that directly enters the bloodstream.

Both types of sublingual doses offer a much higher percentage of absorption in the body, meaning they are more effective than tablets or other oral medications swallowed whole. For this reason, buprenorphine typically comes in a lower dosage than other medications. This is because a greater majority of sublingual medications are immediately used in the body as compared to oral medications, which have large portions processed and then eliminated by the digestive system.

Buprenorphine may also be taken as a subcutaneous injection, meaning it will be injected into the upper arm using a needle. These are designed to be extended-release and the body slowly uses up a dose similar to what each tablet contains throughout the course of each day. Injections may be given weekly or monthly depending on the doctor’s recommendation and the individual’s preference or demonstrated need. Extended-release is suited for individuals who struggle with medication compliance due to memory issues, transportation, or other unavoidable circumstances.

What are the side effects of buprenorphine?

As with any medication, buprenorphine can cause some adverse side effects. Many are tolerable and may be acceptable for individuals to manage or cope with, while others are more severe or even life-threatening and may require them to switch medications. If any of the following side effects are causing discomfort, you should report them to a doctor and discuss what other options are available:

  • Digestive discomfort such as nausea, constipation, and vomiting
  • Dizziness
  • Fatigue
  • Muscle aches
  • Difficulty sleeping
  • Trouble focusing
  • Fever
  • Heart palpitations, or an increased heart rate
  • Dry mouth
  • Sweating
  • Fever
  • Vision changes
  • Tremors, or shaking hands

More serious side effects to monitor include:

  • Difficulty breathing
  • Withdrawal, or emotional and physical discomfort in the absence of the medication
  • Impaired adrenal system, which causes poor metabolism, impaired sleep, and other hormonally-based functions
  • Severe pain in the arm, which may result if given via subcutaneous injection

If other medications are taken alongside buprenorphine without first consulting a doctor, this can lead to some of the above side effects and potentially even more life-threatening ones. This medication works on the nervous system, so it can have unsavory interactions with other medications that have a similar effect. This includes anti-anxiety medication, antidepressants prescription painkillers, blood pressure medication, antihistamines, and heart medication.

Is there anyone who shouldn’t take buprenorphine?

Buprenorphine may not be a good fit for people with breathing problems, since this medication can slow the breathing rate and cause even more respiratory issues. Individuals with gastrointestinal problems may also have difficulty with buprenorphine, since narcotics and opioids can cause constipation and slowed digestion. People with heart problems should also use buprenorphine with caution because the medication can slow the heart rate and cause complications to any existing conditions.

When used in combination with counseling and other behavior therapies, this medication can be extremely helpful in reducing cravings for opioids. As a result, someone taking buprenorphine can experience an increased quality of life and improved ability to function. This can help improve their overall treatment compliance while allowing them to engage in meaningful activities such as productive leisure and employment. There are a lot of factors to take into consideration before beginning buprenorphine as part of an MAT program. Buprenorphine should only be used as recommended by a doctor, but this can help someone start the road to recovery from opioid use disorder.

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Brittany Ferri PhD

Brittany Ferri PhD

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