We Provide Care Because We Do Care
Buprenorphine PointsHarm reduction therapy is not a cure, but by turning off the craving for opiates, buprenorphine mitigates against a compulsive, destructive behavioral pattern that makes addiction such a terrible disease. My colleagues and I have witnessed the majority of our patients “get their life back” and pursue education, employment and family life goals that are gratifying to witness. Make no mistake that for many individuals, buprenorphine is life-saving.
Treatment with buprenorphine is not just substituting one opiate drug for another. This is an important issue that must be understood clinically. There are three distinct properties that make buprenorphine uniquely beneficial and efficacious in the treatment of opiate dependency.
First, buprenorphine is a partial agonist at the mu-opioid receptor sites. Morphine, methadone, hydrocodone, and oxycodone are full agonists and are much more likely to cause respiratory depression and overdose deaths. Overdose deaths with buprenorphine are rare with monotherapy, and commonly involve benzodiazepines or other polydrug abuse settings. The partial agonist effect of buprenorphine means that at a dose that effectively relieves craving a ceiling effect prevents the euphoria associated with drug abuse. The user cannot abuse the drug to get “high”. Twenty pills offer no more reward than two or three pills. Increasing dose is ineffective because the effect peaks. Abuse potential is minimized by the properties of this unique partial agonist.
Second, buprenorphine has a high affinity, low dissociation constant. It latches on tighter to the mu-opioid receptor sites and displaces/blocks other opioids. This results in a situation where, if a patient in a moment of weakness slips and uses morphine, methadone, hydrocodone, oxycodone or any other opiate, the patient experiences little, if any, effect. He or she has wasted his or her time and money. Buprenorphine protects the individual from relapse in this potential situation because a high affinity, low dissociation molecule will not be displaced and will not let another opiate attach. Just knowing that other opiates will have no effect is another deterrent to relapse.
Third, the property of a long half-life (48 to 72 hours) provides a long duration of action that smoothes out the effect and prevents highs or lows. Not only does a patient feel normal (for the first time in years), he or she may on occasion actually forget to take the scheduled dose, just as a person on scheduled diabetes or hypertension medicines might forget.
The question of how long a patient “should” be on buprenorphine for addiction management is hard to say and may vary from one person to another. Addiction and Diabetes have similarities as chronic diseases. Both diseases have a genetic influence; it is not exclusively the person's fault that they got the disease, but it is still his or her responsibility to control it. Both diseases have available medications that greatly improve control, but no medications that are “curative”. Both diseases have a pattern of relapse and control that is influenced by behavioral factors. With diabetes, a similar question is "how long should a patient be on metformin for diabetes management?" The answer is, when years of diet and exercise have removed the need, and control is achieved without medication assisted therapy. With addiction, the question is "how long should a patient be on buprenorphine for addiction management?" The answer is, when years of treatment and addiction recovery efforts have removed the need for it, and control is achieved without medication assisted therapy. There is not a time limit on a lifesaving drug, whether it be buprenorphine or metformin. Buprenorphine is a bridge that takes away the craving and allows someone the ability and sobriety to do the hard work of recovery.