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Opioid Addiction–Buprenorphine (“Suboxone”) by Dr. Lipi Roy

WHAT IS BUPRENORPHINE?

Buprenorphine (a.k.a. “bupe,” “Suboxone™,” “Subutex™”) is a medication used to help people reduce or quit their use of heroin or other opioids such as prescription painkillers (oxycodone, percoset, morphine). Bupe was approved by the FDA in 2002. When taken as prescribed, buprenorphine is safe and effective. Buprenorphine saves lives.

Watch as I discuss the mechanism and benefits of buprenorphine (“Suboxone”) to Reentry and Continuity Services & Department of Correction staff at Rikers Island:

HOW DOES BUPRENORPHINE WORK?Image result for buprenorphine partial agonist

Bupe binds the same receptor as other opioids such as heroin or oxycodone. But bupe has a higher affinity (i.e. it has a stronger “magnetic pull”) for the opioid receptor, thus can  ‘knock off’ and replace any other opioid. In addition, unlike heroin which is a full agonist, bupe is a PARTIAL agonist, which means it is associated with:

  • A “ceiling effect” (i.e. opioid effects will increase with each dose until it levels off)
  • Less euphoria and physical dependence
  • Mild withdrawal symptoms
  • Less potential for misuse

WHAT ARE THE BENEFITS OF BUPRENORPHINE?

At the correct doses, bupe can make people feel better, carry on with their lives (work, school, family, church, sports, etc.). Bupe allows for RECOVERY. These are the specific clinical benefits:

  1. Decreases opioid withdrawal symptoms
  2. Decreases cravings for opioidsBupe-receptor
  3. Decreases illicit opioid use
  4. Blocks the effect of other opioids
  5. Helps people stay in treatment

WHAT ARE THE SIDE EFFECTS OF BUPRENORPHINE?

Similar to the side effects of other opioids, and can include:

·        Nausea

·        Vomiting

·        Constipation

·        Cravings

·        Insomnia

·        Irritability

·        Headache

·        Dizziness

·        Numbness/tingling


CAN BUPRENORPHINE BE MISUSED?

Because of bupe’s opioid effects (mild euphoria), it can be misused/diverted, particularly by people who have not developed opioid dependence or addiction. This is why naloxone (an opioid antagonist) is added to bupe to reduce diversion and misuse. When taken as sublingual tablets/film, bupe’s opioid effects dominate; naloxone blocks opioid withdrawal symptoms. But if the tablets are crushed and injected, naloxone dominates and can precipitate withdrawal.

REFERENCES

American Society of Addiction Medicine (ASAM)
Centers for Disease Control and Prevention (CDC)
National Institute on Drug Abuse (NIDA)
National Alliance of Advocates for Buprenorphine Treatment (NAABT)
Substance Abuse and Mental Health Services Administration (SAMHSA)

 

 

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