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Buprenorphine Detox and Treatment

Buprenorphine Detox and Treatment drug rehabilitation and alcohol rehabilitation

Close to a million individuals in US are addicted to opioids and yet less than 20% receive any treatment for their addiction. The best management for these chronic addicts is medical treatment which decreases their addiction and improves their social status in society.


For the past 4 decades, methadone has been the treatment of choice for the treatment of drug addicts . However, all methadone programs have long waiting lists; have rigid admission criteria and the majority of methadone programs are only found in large urban cities. Current data indicate that buprenorphine, which is a partial opioid receptor agonist, may also be effective for treatment of opioid addiction.

 

The Drug Addiction Treatment Act of 2000 allowed physicians to provide office-based treatment for opioid addiction. This Federal Legislation allowed physicians to prescribe Schedule III, IV, or V "narcotic" medications that were approved by the U.S. Food and Drug Administration for patients with opioid addiction. In 2002, the FDA approved buprenorphine and combination of buprenorphine/naloxone (Suboxone) to manage opioid dependence.

 

Buprenorphine (Suboxone)

Buprenorphine, is an opioid drug with partial agonist and antagonist activity. Buprenorphine was first marketed in the 1980s as an analgesic, yet today it is primarily used for the treatment of opioid addiction. It has a longer duration of action than morphine, and sublingual administration offer an analgesic effect which lasts 6 to 8 hours. Because the drug cannot be reversed by naloxone, it is not recommended for pain control.


When used for opioid dependence, buprenorphine remains effective in the body for up to 48 hours, decreases the tendency for withdrawal symptoms and counteracts the effects of concomitant opioids that may be taken by the patient.


Side Effects

Buprenorphine does have some side effects and these include nausea, vomiting, drowsiness, dizziness, headache, itch, dry mouth, meiosis, orthostatic hypotension, difficulty with ejaculation, decreased libido, urinary retention, and constipation. Rare cases of liver necrosis and hepatitis with jaundice have been reported with the use of buprenorphine. For those who receive buprenorphine, the liver function is regular monitored. The most severe and serious adverse reaction associated with buprenorphine use is respiratory depression which can be fatal. This is particularly problematic with buprenorphine because unlike morphine, there is no effective antidote.


Additionally, concurrent use of buprenorphine and CNS depressants (such as alcohol or benzodiazepines) is contraindicated as it may lead to fatal respiratory depression.


Dependence

As with other opioids, buprenorphine can produce both physical and psychological dependence. However, unlike other opioids, users of buprenorphine rarely develop a tolerance to the drug. Maintenance dosages can remain at the same moderate level and in many cases even lowered, without causing withdrawal symptoms.


Treatment of Opioid Dependence

Sublingual buprenorphine preparations are often used in the management of opioid dependence (such as heroin, oxycodone, hydrocodone, morphine). The use of buprenorphine replacement therapy in the management of opioid dependence is regulated and monitored. In the United States, a special federal waiver is required to prescribe Subutex on an outpatient basis. Each Federally approved physician is allowed to manage only 30 patients on buprenorphine for opioid addiction as outpatients.


Withdrawal Symptoms

The partial agonist/antagonist activity of buprenorphine means that it may precipitate withdrawal symptoms when an opioid-dependent patient is commenced on the drug soon after the use of another opioid drug. Patients are advised to wait between 24 and 36 hours after their last use of short-acting opioids (such as heroin or oxycodone) before beginning treatment with buprenorphine. Those who are on methadone should only be treated with buprenorphine once withdrawal symptoms are present. Beginning any earlier may result in extreme cases of opioid withdrawal.


BUPRENORPHINE vs. METHADONE

Buprenorphine and methadone are both used for short-term and long-term opioid maintenance therapy. Each agent has its relative advantages and disadvantages.


Buprenorphine sublingual tablets have a long duration of action which may allow dosing every two days, compared with the daily dosing required with methadone. In the United States, following initial management, a patient may be prescribed one month supply for self-administration on the condition that the patient receives other dependence therapy.


Buprenorphine may have a lower dependence-liability than methadone. Buprenorphine treatment typically lasts several months (though sometimes for only a few weeks or up to two or three years), as opposed to an indefinite, often life-long methadone regimen.


Buprenorphine itself appears to have less-severe withdrawal effects than methadone, and thus it is easier to discontinue use. Buprenorphine, as a partial μ-opioid receptor agonist, has been claimed to have a less euphoric effect compared to the full agonist methadone, and was therefore predicted to be less likely to be diverted to the black market.


DETOX AND REHABILITATION

The practice of using buprenorphine in an inpatient rehabilitation setting is increasing rapidly. These rehabilitation programs consist of "detox" and "treatment" phases. The detoxification phase consists of medically-supervised withdrawal from the drug of dependency, sometimes aided by the use of medications such as buprenorphine and valium.


Buprenorphine is sometimes used only during the detox protocol with the purpose of reducing the patient's use of mood-altering substances. It considerably reduces opioid withdrawal symptoms that are normally experienced by opioid-dependent patients on cessation of those opioids, including diarrhea, vomiting, fever, chills, cold sweats, muscle and bone aches, muscle cramps and spasms, restless legs, agitation, gooseflesh, insomnia, nausea, watery eyes, runny nose and post-nasal drip, nightmares, etc. The buprenorphine detox protocol usually lasts about 7-10 days, provided that the patient does not need to be detoxed from any additional substances such as barbiturates, benzodiazepines, or alcohol.


Dosing

During detoxification Buprenorphine is administered on a daily basis. Generally, the patient receives a single dose each day to ensure a consistent active level of the medication remains in the patient's central nervous system. Typically, the initial daily dose totals around 8-16mg. The dosage is slowly tapered each day and the medication is usually stopped 36-48 hours prior to the end of the detox program, with the patient's vitals monitored up until discharge from the detox program.


Summary

Buprenorphine is an alternative and not a replacement agent for methadone in patients with opioid dependence for opioid agonist therapy in patients with opioid dependence. Buprenorphine is viable in the primary care setting, which enhances treatment accessibility, and may be a better initial choice for patients at greater risk of respiratory depression, such as elderly patients and those taking benzodiazepines. Choice of first-line treatment will depend on patient preference, expectations, past treatment experiences and side effect profile as well as availability, dispensing regulations, cost and government reimbursement schedules. However, regardless of choice of methadone or buprenorphine, patients with opioid dependence do best in a comprehensive program involving opioid agonist treatment, counseling and support.



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Sobriety Help and Education

Topic Discussion

  1. Addict

    Interesting information - I am doing research on the pros and cons of buprenorphine vs. methadone for opioid replacement therapy....if there's anyone who has had personal experience (whether themselves or someone they know), what I really want to know is this: Say a person has been on methadone for 2-3 years, and wants to change to buprenorphine due mostly because of the fact that insurance won't pay for methadone because of the way it is dispensed. Unless one has medicaid, methadone has to be paid for out of pocket, and while that's a small price to pay for a drug that both saves and changes lives, the reality is that the cost really starts to add up. If buprenorphine works just as well, why not switch to that from methadone, and have it paid for by insurance? Anyone with experience about that? Would love to hear from you if you do!! Thanks..

    • Addict

      I know someone who can help Neda...

  2. Addict

    Buprenorphine works well. The insurance will cover it. Down side is that you will be logged into a data-base and prevented from getting prescribed opiates as a result. You will have to adhere to a demanding pro-active out patient treatment plan to be considered for Buprenorphine meaning a single dose given for the first week or two until a script will be issued, urine test etc. It worked for me coming off oxy 80's 2 years use. I bought it cash in Tijuana and self administered for 8 days. Then walked away clean.

    • Addict

      This may be true if you live in KY. DAMN KASPAR PROGRAM!!!

  3. Addict

    Bob

    I have been on buprenorphine for about three years. I really want to get off of that. even help me a lot and almost my depression gone away It is hard to get off of it. mostly in state i can not find it with out prescription
    Please help me

    Thank you all

  4. Addict

    I have a friend who is in her first trimester of pregnancy. She is/has been buying Subutex off the street for over 2 years now. She is not taking them by mouth. She is snorting them through her nose. She has decided to continue using Subutex during her pregnancy. I understand that it is very dangerous for the baby to quit this drug cold turkey, but i am afraid of the effect this will have on her baby once it's born - especially since she does not plan on informing her doctor. My main question is what will the effects have on her baby once it's born? And is there a medication that the doctor would give the newborn if he knew the mother's addiction to the drug? - Her defense for continuing to use is that "they prescribe subutex to pregnant woman" but she is not informing her doctor.

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