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Buprenorphine Dependence

Isn’t Buprenorphine Supposed To Treat Drug Problems?

Yes!…and it is very effective in doing so, especially when combined with counseling and behavioral therapies.

Buprenorphine – brand name Subutex or Suboxone – is a part of medication-assisted treatment for people who are addicted to strong drugs like heroin, oxycodone, or hydrocodone. Since it is a medication that treats these problems … many do not understand that while it ‘blocks’ the effects of opioids…it also leaves a high possibility for physical dependency for anyone using it, as prescribed (or illegally).

Q: Why does buprenorphine lead to the development of physical dependency?
A: Because buprenorphine is an opioid partial agonist.

In this article, we review the chemical changes in the brain and body that lead to dependency, the signs of dependence, and ways to treat it. At the end, we invite you to send us your questions and try to answer all legitimate inquiries personally and promptly.

Buprenorphine vs. Opioids

You may be wondering: If people can still develop dependence on buprenorphine, how is it different than the opioid drugs that it’s used to treat?

Buprenorphine is a synthetic partial opiate agonist drug that does produce effects of euphoria, analgesia, and sedation…similarly to the way opioid drugs do. But, although it stimulates the same brain receptors as full opiate agonists, buprenorphine produces a lesser degree of sedation and respiratory depression, and causes no significant impairment of cognitive or motor skills. In addition, tolerance and physical dependence to buprenorphine develop more slowly than to other more potent opioids.

A person who takes buprenorphine as prescribed feels normal, and will not get high off of the drug. It makes the brain think it is receiving your opioid drug of choice…keeping withdrawal symptoms at bay. This way, you are given a chance to work on your recovery without experiencing cravings or a compulsive need to use.

Symptoms of Dependence

The two main indicators of physical dependence to any psychoactive drug are tolerance and withdrawal. Here is how these main symptoms manifest when you’re physically dependent on buprenorphine.:

1. Tolerance. Under normal conditions, our bodies are able to produce enough endogenous opioids (e.g. endorphins) to prevent withdrawal. But as tolerance increases, you start to require more buprenorphine and use it more often in order to feel the wanted effects…lower doses just don’t have any effect on you anymore.

2. Withdrawal. Individuals who are physically dependent on buprenorphine experience withdrawal when doses are abruptly reduced or discontinued. Withdrawal from buprenorphine, although somewhat less severe than withdrawal from full agonists, can also be severe and prolonged. Symptoms of withdrawal may include:

  • Anxiety
  • Depression
  • Drowsiness
  • Indigestion
  • Insomnia
  • Irritability
  • Nausea
  • Muscle and body aches
  • Vomiting

NOTE HERE: Although withdrawal from buprenorphine may be more tolerable than that of full agonists, relapse rates after tapering are very high. This is why continued management of your physical and psychological condition in recovery is crucial for maintaining long-term sobriety.

Other Signs of Dependence

The World Health Organization has issued the following guidelines that define dependence on drugs, notably to opiates like buprenorphine. So, along with tolerance and withdrawal, a person dependent on buprenorphine will likely display some of the following signs:

  1. Being defensive when inquired about buprenorphine use.
  2. Buying buprenorphine off illegal sources (off the street, internet pharmacies, off other people who are prescribed).
  3. Cravings for buprenorphine use.
  4. Going doctor shopping (visiting multiple doctors to obtain multiple prescriptions).
  5. Neglecting responsibilities at school, work or at home due to buprenorphine use.
  6. Running out of your buprenorphine prescription before it’s time for a refill.
  7. Spending a significant amount of time obtaining and using buprenorphine, or recovering from its effects.
  8. Using buprenorphine secretively.

If you can recognize 2 or more of these scenarios, you might need to speak with your doctor about possible assessment of your need for buprenorphine dependence treatment.


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Does Buprenorphine Dependence = Addiction?

Dependence on drugs like buprenorphine is different from addiction.

A person dependent on buprenorphine finds their body to have adapted to presence of the drug and needs it regularly to maintain its chemical balance. Problems occur whenever use is inhibited or reduced because the body relies on a external source to prevent withdrawal. Physical dependence is predictable, and can be easily managed with medication and a slow taper off of buprenorphine.

A buprenorphine addicted person has no control over their use, and compulsively takes the drug despite harm and negative consequences to health, family and career. Recovery from an opioid use disorder aims to reverse the adverse brain changes that have occurred as a result of drug use, to the extent possible. Buprenorphine addiction treatment is accomplished through therapy and replacing the addictive behaviors with healthy alternative behaviors.

How to End the Dependence?

Treatment for buprenorphine dependence is somewhat similar to the protocols used for opiate abuse. When you seek treatment, you may need to be admitted to a drug addiction treatment center. Here is what the process of addressing dependence looks like:

STEP 1. Evaluation.

At the start of treatment, you will need to go through an initial phase of assessment. Doctors will evaluate the severity of your buprenorphine use patterns, run tests to evaluate your overall health,  and craft an individualized treatment plan that fits your specific needs and goals based on these assessments.

STEP 2. Detoxification.

If necessary, you will undergo buprenorphine detox to remove the drug from your system, while supportive care is provided to help you cope with withdrawal symptoms. In most cases, your doctor will slowly taper you off of buprenorphine. This may cause you to feel withdrawal symptoms, which will be managed using medications such as:

  • Analgesics (acetaminophen and ibuprofen) to alleviate pain.
  • Maalox for stomach acidity.
  • Loperamide for diarrhea.
  • Diphenhydramine for insomnia.
  • Promethazine, clonidine and dicyclomine for anxiety.
  • Dicyclomine for abdominal cramps and GI tract problems.

STEP 3. Continued Care.

Once you’ve finished the detoxification process, following through with an inpatient treatment program, and then an outpatient program can help you develop skills to build a life that is not opioid-dependent. You may also experience cravings to relapse on buprenorphine, which is why aftercare programs are also highly recommended.

Got any questions?

If you have any questions regarding buprenorphine use, addiction, or its treatment, please CALL the number listed on the top of our page, explore the content of our website further, or leave a comment in the designated section below.

We do our best to respond personally and promptly to all legitimate inquiries. In fact, we strive to help all who need a hand to make buprenorphine abuse a thing of their past once and for all.

Reference Sources: SAMHSA: Buprenorphine
U.S. Department of Justice: Buprenorphine: Potential for Abuse
SAMHSA: The facts about buprenorphine
NCBI: Buprenorphine Withdrawal Syndrome

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One Response to “Buprenorphine Dependence
5:06 pm June 5th, 2018

Thank you for this post.