Buprenorphine and Suboxone Treatment
Buprenorphine was approved for clinical use in October 2002 by the U.S. Food and Drug Administration (FDA). Used in addiction treatment, buprenorphine is an opioid medication that acts on heroin and morphine receptor targets without producing the same intense “high” or dangerous side effects. At low doses, buprenorphine produces sufficient agonist effects to help opioid-addicted individuals discontinue abuse of opioids without experiencing withdrawal symptoms. The agonist effects of buprenorphine increase linearly with increasing doses of the drug until a plateau called the “ceiling effect” is reached, which results in increased dosages having no additional effect. Therefore, buprenorphine carries a lower risk of abuse, addiction and side effects compared to full opioid agonists like methadone.1,2,3
The following buprenorphine products are FDA-approved:
- Bunavail (buprenorphine and naloxone) buccal film
- Suboxone (buprenorphine and naloxone) film
- Zubsolv (buprenorphine and naloxone) sublingual tablets
- Probuphine (buprenorphine) under-the-skin implant1
The Drug Addiction Treatment Act of 2000 enables qualified U.S. physicians to administer buprenorphine to individuals for opioid dependency outside of inpatient drug treatment programs. These settings include physician offices, community hospitals, health departments and correctional facilities. In addition, buprenorphine can be prescribed for take-home use. This provides an important treatment option for many people with opioid addiction.1,2
Typical treatment involves clients initially taking the drug alone and then in a co-formulation with naloxone in a drug called Suboxone (an opioid antagonist). Like buprenorphine, Suboxone is typically used to facilitate detox, withdrawal and the early stages of opioid abuse recovery. It can also be used as a maintenance medication to reduce the risk of relapse of more dangerous substances. As an opioid receptor antagonist, naloxone counteracts opioid overdose and helps prevent more potent opioids from fully delivering euphoric effects.4
Buprenorphine/Suboxone Addiction and Abuse
Because of buprenorphine’s opioid effects, it can be misused, especially by people without opioid dependency. Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse. As such, Suboxone abuse is not as widespread as the misuse of buprenorphine. Data indicates teens, non-addicted opioid abusers, heroin addicts and clients receiving buprenorphine treatment abuse it, frequently taking it as a primary drug of abuse instead of heroin. This abuse is more common in countries outside the U.S. Routes of administration include sublingual, intranasal and injection. Reports have shown many addicts in these countries abuse buprenorphine by injection in combination with a benzodiazepine.5 The risk of overdose is increased when either of these drugs is combined with alcohol or benzodiazepines, which produces an intense high. This dangerous combination can cause extreme, widespread suppression of physiological processes, slowed breathing and heart rate, coma and death.4
Stats and Facts
- Of 2.5 million people in the U.S. who could benefit from medication-assisted treatment, only 1 million are receiving it. A 2015 survey showed two-thirds of responding physicians who were authorized to prescribe buprenorphine reported a demand exceeding the legal limit of 100 clients.6
- The estimated number of dispensed buprenorphine/naloxone prescriptions nearly tripled from 2008 (3,178,571) to 2015 (9,122,150).7
- A retrospective study involving two large U.S. health systems showed average total healthcare costs for opioid-dependent individuals receiving buprenorphine treatment and counseling were less than half the costs for those receiving little or no treatment.8
- When clients and physicians were surveyed by SAMHSA about the effectiveness of buprenorphine, they reported an average 80% reduction in illicit opioid use, along with significant increases in employment and other measures of recovery.9
- Since 2006, U.S. emergency department visits due to non-medical use of buprenorphine have tripled from 4,440 to 14,266.10
For opioid addictions, buprenorphine treatment is an effective method for decreasing the incidence of relapse. The Prescription Opioid Addiction Treatment Study (POATS) showed less than 10% of prescription opioid-dependent clients who were initially treated with buprenorphine were opioid dependent after 42 months. There is a drawback to buprenorphine, which appears to occur in conjunction with heroin use. Study participants with a history of heroin use were more likely to be opioid-dependent at 42 months. In addition, about 8% used heroin for the first time and 10% reported first-time injection of heroin within the 42-month period in which follow-up assessments were conducted.3
A large-scale study involving more than 600 treatment-seeking outpatients addicted to prescription opioids analyzed the efficacy of Suboxone treatment in combination with brief standard medical management. Half of the participants also received varying intensities of addiction counseling provided by trained substance abuse or mental health professionals. An estimated 49% of participants reduced prescription painkiller abuse during extended Suboxone treatment of at least 12 weeks, although the success rate dropped to 8.6% once Suboxone was discontinued.11
- Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine Updated May 31, 2016. Accessed February 8, 2017.
- What exactly is Buprenorphine? The National Alliance of Advocates for Buprenorphine Treatment website. https://www.naabt.org/faq_answers.cfm?ID=2 Accessed February 8, 2017.
- Buprenorphine: Long-term Efficacy for Opioid Dependence. Medscape website. http://www.medscape.com/viewarticle/863801 Published May 25, 2016. Accessed February 8, 2017.
- Suboxone Abuse. Drug Abuse website. http://drugabuse.com/library/suboxone-abuse/ Accessed February 8, 2017.
- U.S. Drug Enforcement Administration website. https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf Published July 2013. Accessed February 8, 2017.
- TFAH comments on proposed HHS rule regarding medication assisted treatment. Healthy Americans website. http://healthyamericans.org/health-issues/wp-content/uploads/2016/05/TFAH-Comments-MAT.pdf Published May 31, 2016. Accessed February 8, 2017.
- Budnitz DS, Lovegrove MC, Sapiano MR, et al. Notes from the Field: Pediatric Emergency Department Visits for Buprenorphine/Naloxone Ingestion – United States, 2008-2015. MMWR Morb Mortal Wkly Rep. 2016 Oct 21;65(41):1148-1149. doi: 10.15585/mmwr.mm6541a5.
- Gunderson EW, Sumner M. Efficacy of Buprenorphine/Naloxone Rapidly Dissolving Sublingual Tablets (BNX-RDT) After Switching From BNX Sublingual Film. J Addict Med. 2016;10(2):122-128. doi:10.1097/ADM.0000000000000201.
- Buprenorphine Waiver Management. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/medication-assisted-treatment/buprenorphine-waiver-management Updated August 17, 2016. Accessed February 8, 2017.
- Schuman-Olivier Z, Connery H, Griffin ML, et al. Clinician Beliefs and Attitudes about Buprenorphine/Naloxone Diversion. Am J Addict. 2013;22(6):574-580. doi:10.1111/j.1521-0391.2013.12024.x.
- Painkiller Abuse Treated by Sustained Buprenorphine/Naloxone. National Institute on Drug Abuse. https://www.drugabuse.gov/news-events/news-releases/2011/11/painkiller-abuse-treated-by-sustained-buprenorphinenaloxone Published November 8, 2011. Accessed February 8, 2017.