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Buprenorphine sublingual tablets for opioid dependence?

The high costs of pain pill addiction

Not every opiate addict can afford the gold-standard treatment for pain pill addiction. Most addicted professionals and celebrities (and addicts lucky enough to get on Dr. Phil’s show) go to inpatient treatment centers where they undergo medically managed detoxification. This is followed by no less than one month of inpatient residential treatment, and when they leave the treatment facility, they continue treatment with outpatient counseling.

But what about opiate addicts who don’t have insurance to pay for effective inpatient treatment, or who have insurance, but can’t support their families if they go away to treatment for a month or so? What are their options?

Many opiate addicts cycle in and out of detox units, staying only five to seven days, because that’s all they can afford. This limited treatment produces relapse rates of at least ninety percent. Methadone maintenance programs, despite forty-five years of evidence that it works, still have such a stigma attached to the therapy that, unfortunately, many opiate addicts refuse to consider this option.

Buprenorphine is an innovative option.

Buprenorphine just a substitute?

Critics say that using buprenorphine is merely exchanging one drug for another, and they’re right, but there’s a reason for using it. The pharmacological principle behind buprenorphine is the same as with methadone: both are long-acting opiate medications, which when dosed properly, prevent opioid withdrawal for more than twenty-four hours (a much better option than cold turkey OxyContin withdrawal), and don’t cause a euphoric high. Instead of endless cycle of intoxication and withdrawal, addicts on a stable dose of buprenorphine feel normal. If they relapse while on buprenorphine, they won’t feel it, since it blocks the high.

Buprenorphine vs. methadone

Buprenorphine is only a partial opiate, and less potent than methadone. With a full opiate like methadone, the more you take, the more opiate effect you feel.  But with buprenorphine, maximum effect occurs at doses around 24 to 32 milligrams. After that, there’s no additional opiate effect. Therefore, it’s a safer drug than methadone, but not strong enough for some addicts with high opiate tolerances.

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Because it’s a partial opiate, it was hoped that this drug would be easier than methadone to taper off, but that’s not everyone’s experience. Some patients are able to taper down to 2 to 4 milligrams, but feel intolerable withdrawal when they try to taper further. Others taper easily, but have difficulty avoiding relapses.

Buprenorphine sublingual tablets: what are they?

Buprenorphine may be better known by its manufacturer’s brand names, Suboxone and Subutex. Suboxone contains both buprenorphine and an anti-opiate called naloxone. Subutex contains only buprenorphine.

The naloxone in Suboxone is the generic name of Narcan, which is used by emergency medical personnel to reverse potentially fatal opiate overdoses. When the Suboxone tablet is used properly by dissolving under the tongue, no naloxone gets into the addict’s system. But if the addict dissolves the tablet in water and injects it, the Narcan is active, putting the addict into withdrawal. Therefore, Suboxone is felt to be a safer product, because it’s less likely to be abused by opiate addicts. Can Suboxone get you high?

Using buprenorphine correctly

The high cost of buprenorphine treatment and the relative scarcity of doctors authorized to prescribe it are the biggest obstacles to treatment with this drug. In most areas, office-based treatment with buprenorphine is more than twice the cost of treatment at a methadone clinic.

The medication isn’t meant to be used alone. Just like with methadone, medication is only one part of treatment. The best outcomes are seen with counseling and involvement with recovery groups.

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6 Responses to “Buprenorphine sublingual tablets for opioid dependence?
Abuse
12:59 pm November 10th, 2010

We just discussed this last night in group. Everytime someone relapses, which is all to frequently, we have to go over what happened and devise tactics to defeat it next time. Sometimes that means re-visiting the basics and sometimes it gets a lot more complicated. Anyway, thanks for sharing.

Heinz Aeschbach, MD
9:32 am January 6th, 2011

Inpatient detoxification and residential treatment (“rehab”) is not the “gold standard”: heroin and pain pill addicts do best with structured opioid maintenance treatment, not medical withdrawal or monthly Suboxone prescriptions. Many patients withdraw, then relapse; overdoses are frequent, accidental, suicidal or parasuicidal. Many ‘rehab’ survivors function poorly and become hopeless.
There is hardly another treatment in psychiatry that decreases a pathological behavior and thought patterns more successfully than methadone maintenance decreases abuse-addiction behaviors, particularly if combined with cognitive therapy groups and other psychiatric treatment.
People still misunderstand the treatment – it may be compared with nicotine patches for smoking. Physiological dependence and psychological addiction are not the same: many medications lead to withdrawal on discontinuation without taper, while stopping many addictions behaviors does not lead to withdrawal symptoms. On a proper methadone dosage, which may be below 40mg or above 100mg, the person feels healthy and functions normally, with much decreased craving, always feeling like “I do not need the drug, or at least not yet”. If there are lapsing thoughts during maintenance treatment, the patient rarely relapses. After one to a few years of treatment, many patients taper off safely and do well.
Heinz Aeschbach, MD,
Addiction and Psychotherapy Services

Prashant Salve
6:44 pm June 30th, 2011

Hi Dr. Jana,

Your article is very informative.
And you have very rightly poited out the limitations of this treatment. Rusan has a complete range for Deaddiction Medicines along with Pain Management Therapy. Taking this cause further Rusan Pharma Ltd. manufactures market Deaddiction Medicines like Addnok (Buprenorphine) 0.4 Mg, 2 Mg & 8 Mg Sublingual Tablets; Addnok-N (With Naloxone) worldwide.

matt
3:55 pm September 29th, 2011

Hi, my name is Matt. I was a pill addict for seven years. I tried every option doctors gave me. Everything from methadone to suboxon. And the truth about these drugs is they may relive your withdrawals, but in the long run your just getting addicted to another drug..and they are just as hard to quit.. I’ve Ben clean for over a year now. Take two weeks off work and suffer it out. Life is to short to keep killing yourself.

crosslegged
6:07 am November 12th, 2011

Thanks for sharing your experience, Matt. It’s a real great thing to read that you are totally free of opioids, and you are an example to others who are in maintenance programs that you can get totally clean. How long were you on buprenorphine?

dev
9:17 am October 17th, 2014

I am from Punjab and used opium regularly from last 5yrs,,,,,but may,2014..i started addnok-n and used 4 tabs daily 2+2…..then i trried to down the daily dose and used 2 tabs daily 1–1…..after 3 months i going more down dose…..and used 0.2 mg tabs used 2 daily…..1morning–1 evening….then when i tried to use 1 tabs daily…..i got a problems……first heart pain…..second dizziness,,sneezing,,tired,,sleepness…..i got treatment for heart pain..and then ok..but second problem is still……..from last 13 days i left addnok-n 0.2 mg and nothing using……..i have a lot problem body pain legs,,arms pain,,,,,sleepness,,nausua……but i promise with myself……no more drugs…..just like opium or addnok-n……i think buperenophine is legally drug…..authorised drugs…..

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About Dr. Jana Burson, MD

Jana Burson M.D. is board-certified in Internal medicine, and certified by the American Board of Addiction Medicine. After practicing primary care for many years, she became interested in the treatment of addiction. For the last six years, her practice has focused exclusively on Addiction Medicine. She has written a book about prescription pain pill addiction: "Pain Pill Addiction: Prescription for Hope." Also see Dr. Burson's blog here.

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