Buprenorphine
Learn more about buprenorphine, the partial opioid agonist widely used in addiction treatment programmes worldwide.
Overview
Common Nicknames
Suboxone (combined with naloxone), Sublocade, bupe
Drug Class
Opioid
Drug Form
Tablets, films, and pathes
Route of Administration
Sublingual and transdermal
What is the science of Buprenorphine?
Buprenorphine is a prescription-only medicine used mainly to treat opioid addiction. It was initially used as a pain-killer but now it is much more widely used to treat people who have become addicted to heroin or other opioid drugs. Buprenorphine is an opioid drug. It mimics the body’s natural pain-killing chemicals, endorphins. Therefore it can relieve pain, cause drowsiness, can cause mild euphoria, slow breathing, slow the bowels causing constipation, and other side effects of opioids. However, it is a partial-agonist, that is it only partly causes and effects at the receptor, and therefore produces much less of these effects than full-agonists such as heroin, methadone, and morphine. People report being much less tired and sedated taking buprenorphine rather than heroin or methadone. As it is a partial-agonist if someone is taking it regularly it can block the effects of full-agonist opioid drugs such as heroin. This makes it very useful in the treatment of addiction to heroin.
What are the risks?
If someone overdoses on a opioid drug they can die instantly. This is usually by respiratory depression (slowing the drive and effectiveness of breathing). Anyone not used to opioid drugs would be much more at risk of this. However, as buprenorphine is a partial agonist, that is it only has a partial effect at the opioid receptor, it is much less likely at heroin and methadone to cause respiratory depression and therefore death by overdose.
The risks of death by overdose increase when many substances are taken together for example alcohol and benzodiazepines which also have effects on breathing (respiration). There is evidence that buprenorphine taken with benzodiazepines increases the effects on depressing breathing.
The risks of depressed breathing caused by buprenorphine may be increased in people with conditions such as muscle weakness (e.g. myasthenia gravis), sleep apnoea, or lung disease/breathing disorders).
Buprenorphine decreases control and impairs judgment, making the risk of accidents much higher. This means activities like driving under the influence of buprenorphine is potentially very dangerous.
How might the drug make you feel?
Buprenorphine can relieve pain, cause drowsiness, can cause mild euphoria, slow breathing, slow the bowels causing constipation, and other side effects of opioids. However, it is a partial-agonist, and therefore produces much less of these effects than full-agonists, such as heroin, methadone, and morphine.
Is Buprenorphine addictive, and what are the long-term effects?
One-off or occasional use of buprenorphine is very unlikely to result in the development of dependence. However, taking buprenorphine regularly over a sustained period can cause serious physical and psychological addiction. People who become dependent on buprenorphine may become tolerant to the drug’s effects and experience withdrawal symptoms without it. Users may crave the drug and feel unable to cope without it. The longer the drugs are taken, the higher and more regular the dose and the stronger the buprenorphine, the higher the risk of dependence. However, users generally report that it is much easier to come off buprenorphine than heroin or even methadone.
Long-term risks of buprenorphine are low if it is used as prescribed. Crushing and injecting illicit buprenorphine puts a person at risk of clots such at DVT (deep vein thrombosis) and PE (Pul-monary Embolus). PE can be life threatening and very dangerous. People can get PE’s from DVT’s in the legs. Other consequences of injecting are also possible such as infections.
Harm Reduction and Drug-Drug Interactions
If taken according to prescription, buprenorphine is very safe.
Mixing with benzodiazepines and alcohol is potentially very dangerous. If other opioid drugs are used, although the effects are blocked by buprenorphine, eventually you can overwhelm the buprenorphine and accidentally overdose.
Medical Uses
Buprenorphine is mostly used as a substitute medication for people addicted to opioids such as heroin. It is also a prescribed pain-killer.
Myths and Misconceptions
Buprenorphine is just substituting one addiction for another.
Buprenorphine is a medication that stabilizes brain chemistry and eliminates withdrawal, allowing people to function normally, much like insulin for diabetes. Physical dependence on a prescribed medication is not the same as addiction, which involves compulsive use despite harm.