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Buprenorphine

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Opioid addiction can be very difficult to overcome, especially due to severe withdrawal symptoms and cravings that can occur during the recovery process. Buprenorphine is a prescription medication that is used to treat opioid withdrawal symptoms, manage cravings, help prevent relapse, and maintain sobriety from opioid addiction. In 2020, 9.5 million Americans aged 12 or over reported misusing some type of opioid, mainly prescription drugs.1 There were 2.7 million Americans diagnosed with an opioid use disorder in 2020.1

Opioid use can result in a range of harmful consequences, including increased utilization of healthcare services, damage to the health of individuals, lost productivity at work, legal issues, and financial problems. Opioid misuse has been driving significant increases in fatal overdoses for decades.2

This page will help you learn more about what buprenorphine is and how it works, what an opioid use disorder (OUD) is and how it’s treated, the benefits of buprenorphine, buprenorphine side effects, and signs of an opioid overdose.


What is Buprenorphine?

Buprenorphine is a long-acting prescription medication classified as an opioid partial agonist.3, 4 This means that the medication binds very strongly to opioid mu receptors in the brain, occupying these sites and partially activating these receptors. Buprenorphine behaves chemically similar to opioids while producing less of a high than other opioids such as morphine and less potent opioid withdrawal side effects.3, 5 This medication has been FDA-approved for the treatment of opioid withdrawal and as a maintenance treatment medication for opioid addiction.6, 7 Buprenorphine formulations can include:3

  • Tablets that are taken daily, which can be buprenorphine alone or a combination of buprenorphine/naloxone (Suboxone, Subutex, Zubsolv).
  • Buccal or sublingual films that combine buprenorphine/naloxone, which is taken daily (Bunavil, Suboxone).
  • Long-acting implants (Probuphine) that last for 6 months.
  • Extended-release subcutaneous injections (Sublocade) administered monthly.

Naloxone, an opioid antagonist can be combined with buprenorphine to reduce the abuse potential of buprenorphine. When taking this combination in intravenous (IV) form, naloxone works to prevent the high of buprenorphine and may even precipitate opioid withdrawal and therefore buprenorphine alone has a higher addiction potential compared to the naloxone/buprenorphine combination.

Buprenorphine acts on the brain to reduce symptoms of withdrawal while reducing cravings during detox, allowing the brain chemistry to rebalance.3, 8 These medications can be used during inpatient treatment or outpatient treatment.7

Opioid Use Disorder (OUD)

OUD is a chronic, progressive disease that affects how the brain works.8, 9 OUD can be managed most effectively with a whole-person approach, incorporating both medication and psychotherapy techniques that address how addiction has impacted a person, including physically, mentally, emotionally, socially, and legally.6, 9 Symptoms of an OUD include:5, 7, 10

  • Withdrawal side effects with discontinued or reduced use. These can include chills, sweating, nausea, vomiting, diarrhea, muscle and bone aches, feeling pain more intensely, runny nose, yawning, anxiety, depression, insomnia, and irritability.
  • Strong cravings.
  • Inability to manage responsibilities at home, school, or work because of opioid use.
  • Inability to stop using opioids even after they have caused or worsened a physical or mental health problem, or relationships with others.
  • Losing control over how much or how often you use.
  • Needing larger amounts to get the desired effect (tolerance).
  • Quitting activities you enjoy because they interfere with opioid use.
  • Spending a lot of time in activities associated with opioid use, including getting them, using them, or recovering from use.
  • Using in situations that can be dangerous, such as while driving.
  • Wanting to or trying to quit using opioids without success.

Opioid withdrawal can be extremely uncomfortable, and this can make it difficult to stop using. While detoxing “cold turkey” can lead to overwhelming cravings and reduced likelihood of long-term sobriety, taking buprenorphine can reduce or eliminate withdrawal symptoms and raise the chances of success in long-term recovery.3, 9

Since addiction affects each person differently, people may respond better to one medication and type of treatment than another.11 It is a good idea to speak with a doctor or addiction treatment specialist before taking any action, since they can provide information to help you make an informed decision that will be most helpful to you. In addition, they can guide you toward behavioral therapy which can increase the overall effectiveness of your treatment plan.9


Benefits of Buprenorphine

There is a wide range of benefits associated with buprenorphine to help treat opioid use disorder. One of the major benefits of buprenorphine is that you can obtain a prescription at an approved provider’s office and fill it at your local pharmacy, making this medication more accessible.3, 6

While too much of an opioid can slow or stop your breathing, buprenorphine works differently, making it less likely than methadone or other opioids to cause respiratory depression, therefore decreasing the risk of fatal overdose.3, 6, 7 In addition, formulations have been created (adding naloxone) to reduce the misuse of buprenorphine, so it can’t be used to get high, but only to suppress withdrawal symptoms and reduce opioid cravings.6, 12

A comprehensive treatment plan will effectively address not only your addiction through therapy and medication, but also your physical and mental health and your ability to function without drugs through individualized care.12 Aftercare is a type of follow-up plan once you complete treatment, and may include continued use of medication and support, along with strategies to help if you are struggling.


Side Effects of Buprenorphine

Buprenorphine has been shown to significantly benefit people in treatment for OUD, but there are potential side effects. Speaking with your prescribing provider can help you decide if buprenorphine is a good fit for you. It also must be taken once withdrawal symptoms have already begun since it can initiate opioid withdrawal symptoms if taken too early during the detoxification phase.3 Some of the common side effects may go away after a short time, and can include:

  • Constipation.3, 5
  • Difficulty with coordination and thinking clearly.3, 6
  • Dizziness.6
  • Dry mouth.6
  • Headache.5, 6
  • Heavy sweating.3, 5
  • Injection site reactions, such as pain, itching, or redness.5
  • Insomnia.3, 5
  • Nausea or vomiting.3, 5
  • Oral issues, such as redness, numbness, or pain.3
  • Sedation.3, 6

More serious side effects can include:

  • Allergic reactions, including rash, hives, or itchiness.5
  • Low blood pressure when you stand up.5
  • Overdose.5, 6
  • Physical dependence on this medication, leading to buprenorphine withdrawal if you stop taking it suddenly.3, 4

If you have any questions or concerns about potential side effects, you should speak to your doctor or pharmacist.

Buprenorphine Overdose

It is possible to overdose on buprenorphine, especially if you inject it, and/or combine it with other depressant substances, such as alcohol, benzodiazepines, opioids, or sedatives.6, 13 If you or someone else overdoses on buprenorphine, it is vital to call 911 immediately, and to speak with your health care provider as soon as possible.5 A buprenorphine overdose can be fatal, so medical care is essential. Signs of an opioid overdose include:5, 14

  • Low blood pressure.
  • Breathing that is slow, labored, shallow, or has stopped.
  • Feeling dizzy or lightheaded.
  • Making choking or gurgling noises.
  • Not being responsive to stimuli.
  • Sleepiness or unconsciousness.
  • Skin that is blue, cold, or pale.
  • Tiny (pinpoint) pupils.

Using Naloxone for an Opioid Overdose

If you have access to naloxone (Evzio injection or Narcan nasal spray), you can administer it as soon as possible in the event of a possible opioid overdose.5 This medication will temporarily reverse the effects of an opioid overdose, and can be lifesaving.5 If the person hasn’t taken buprenorphine or any opioids, this medication will have no effect.15 You should still call 911 after administering naloxone, even if the person seems fine, since the effects can wear off before the buprenorphine or opioids.5, 15 Naloxone can be obtained through a pharmacy in most states, and you do not need a prescription.15


Where Can I Find Opioid Addiction Treatment?

If you are struggling with opioid addiction, treatment can help you refrain from substance use and gain control of your life. Different treatments, including inpatient or outpatient care, detox, counseling, and medications can help people recover from OUD.4

You can find a drug and alcohol rehab center using the drugabuse.com directory. You can also verify your insurance now so that you can get started on the path to recovery today.

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Kristen Fuller, MD, enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine and contributes to medicine board education. Her passion lies in educating the public on the stigma associated with mental health. Dr. Fuller is also an outdoor activist, an avid photographer, and is the founder of an outdoor women's blog titled, GoldenStateofMinds. In her free time, she enjoys hiking, backpacking, skiing, camping, and paddle boarding with her dogs in Mammoth Lakes, California, where she calls home.
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