What is Buprenorphine?

Buprenorphine is a semi-synthetic opioid that is derived from thebaine, which is a naturally-occurring alkaloid of the opium poppy, Papaver somniferum. It is a drug that is used in medication-assisted treatment and it is intended to treat pain and opioid addiction.

Buprenorphine is recognized as having a lower potential for abuse than methadone, which is also used to treat opioid addiction, and it has been shown to be effective. Two buprenorphine products were approved for clinical use in 2002 by the FDA: Suboxone and Subutex. Both drugs are formulated as tablets that are designed to be rapidly dissolved under the tongue, but there are some differences between the two.

• Subutex (which contains the active ingredient buprenorphine) was formulated first but users were more likely to abuse it because they were able to abuse it to get high. As a result, Suboxone was developed.
• Suboxone is a combination product that contains buprenorphine and naloxone (an opioid antagonist). If the user tries to inject it to get high, they will experience a rapid and sudden onset of intense opioid withdrawal symptoms, which can be extremely uncomfortable. This is designed to deter any misuse of the drug.

Other forms of buprenorphine include products like Buprenex, an injection that is used to treat moderate to severe pain, Belbuca, a dissolvable buccal film and pain reliever, and Bunavail, a buccal film that contains buprenorphine and naloxone. In November of 2017, the FDA also approved another injectable form of buprenorphine called Sublocade, which is administered once monthly for the treatment of opioid use disorder.

Is Buprenorphine Addictive?

Yes, buprenorphine can be highly addictive. Buprenorphine produces effects that are similar to morphine although it is 20 to 30 times more potent as a pain reliever. It is a long-acting opioid and a depressant that can cause severe respiratory depression (slow or shallow breathing) if it is taken with other depressant drugs like alcohol or benzodiazepines.

Like other opioids, buprenorphine can produce significant feelings of euphoria if it is misused. All buprenorphine products are classified as Schedule III drugs by the DEA. However, when it is taken in the appropriate dosage, buprenorphine can effectively reduce symptoms of opioid withdrawal, suppress opioid cravings, and help people stay sober.

Slang for Buprenorphine

The following terms are street names or slang for buprenorphine:

• Buse
• Oranges
• Sobos
• Stops
• Strips
• Sub
• Subs

How Common Is Buprenorphine Abuse and Addiction?

According to the DEA, 9.1 million buprenorphine prescriptions were dispensed in the U.S. in 2012. By 2017, that number had risen to about 14.6 million buprenorphine prescriptions and 9.3 million buprenorphine prescriptions were dispensed by the third quarter of 2018.

Although not all people who receive prescriptions for buprenorphine abuse it, certain forms of the drug are capable of producing significant feelings of euphoria and pleasure, which drives people to misuse it. Intravenous misuse of buprenorphine is most likely to cause addiction very quickly.

In countries like France, Scotland, Ireland, and others where buprenorphine has become a popular drug of abuse, the majority of people who misuse it are young drug abusers, non-addicted opioid abusers, heroin addicts, and patients who are being treated with buprenorphine. It is often abused via injection or users take it with a benzodiazepine like Ativan, , or , which can have life-threatening side effects.

In America, an estimated 21,83 emergency department visits were associated with the misuse of buprenorphine in 2011, which was about five times the number of ED visits in 2006. Additionally, U.S. poison centers recorded 3,732 buprenorphine case mentions, 2,160 single substance exposure cases, and five deaths involving buprenorphine.

What Are the Side Effects of Buprenorphine Abuse?

The abuse potential of buprenorphine alone is more common than drugs that are a combination of buprenorphine and naloxone. When buprenorphine is abused on its own, it can cause side effects like:

• Euphoria
• Sedation
• Respiratory depression

In some instances, a person may abuse Suboxone to self-manage opioid withdrawal symptoms in between the illegal use of opioids like heroin. That way, they don’t have to experience withdrawal, but they can still get high if they wait long enough before taking more heroin. If someone is misusing Suboxone, he or she may display the following signs:

• Difficulty thinking clearly
• Slurred speech
• Impaired motor functions
• Excessive itching
• Lack of appetite
• Insomnia
• Muscle aches
• Drowsiness
• Dilated pupils
• Diarrhea
• Nausea/vomiting
• Increased blood pressure

What Are Common Signs of Buprenorphine Overdose?

Mixing buprenorphine with other substances like benzodiazepines, alcohol, or opioids is extremely dangerous and can cause a drug overdose. Signs of buprenorphine overdose include:

• Irritability
• Anxiety
• Slow heartbeat
• Abdominal pain
• Vomiting
• Seizures
• Coma

What Are the Signs and Symptoms of Buprenorphine Addiction?

A person with a history of opioid abuse may be more likely to abuse buprenorphine. Some common signs and symptoms of buprenorphine abuse and addiction include:

• Lying to a doctor to get more buprenorphine
• Seeing multiple doctors to get more buprenorphine
• Taking buprenorphine that is not prescribed by a doctor or using it in other ways than prescribed
• Having injection paraphernalia in one’s home or bedroom
• Losing a significant amount of weight without explanation
• Being disinterested in usual hobbies
• Having financial difficulties
• Being deceitful or defensive about the use of buprenorphine products

Buprenorphine Withdrawal Symptoms and Detox

If buprenorphine is misused, it can produce withdrawal symptoms. Although it has fewer withdrawal symptoms than methadone, buprenorphine withdrawal can still be uncomfortable and may produce flu-like symptoms for up to a week or longer. Similar to heroin withdrawal, buprenorphine withdrawal symptoms are often milder and can include:

• Headaches
• Nausea
• Watery eyes
• Changes in sleeping habits
• Changes in appetite
• Mood swings
• Cold sweats
• Body aches
• Abdominal cramps
• Cravings
• Flu-like symptoms
• Depression

Although buprenorphine withdrawal isn’t life-threatening, a medical detox program can help make the process more comfortable and reduce the risk of relapse by providing round-the-clock medical and clinical care. Effective treatment in rehab may also be easier to navigate with referrals from a multidisciplinary buprenorphine detox treatment team.

Buprenorphine Withdrawal Timeline

The severity and duration of buprenorphine withdrawal will vary from person to person and mild withdrawal symptoms can sometimes last several weeks, even after a detox program is over. Here is a general timeline of what you may experience during buprenorphine withdrawal, although withdrawal is different for everyone.

Buprenorphine Withdrawal Timeline
1-3 days after the last dose:	Symptoms like diarrhea, sweating, nausea, watery eyes, dilated pupils, and restlessness are common during buprenorphine detox.
4-7 days after the last dose:	Anxiety, depression, and mood swings may set in during the first week of buprenorphine detox, as well as abdominal cramps, body aches, and difficulty sleeping.
7-14 days after the last dose:	Although the most severe withdrawal symptoms have usually faded by this time, some symptoms may persist long after the start of buprenorphine detox, such as cravings, body pain, abdominal cramps, irritability, and depression.
3 weeks after the last dose:	Cravings, depression, and mood swings may persist weeks after the last dose, but buprenorphine detox clients generally feel better and experience fewer cravings three to four weeks after the final dose.

Treatment for Buprenorphine Addiction

Buprenorphine addiction is a disease that will require ongoing treatment to overcome. Additionally, if someone is abusing Suboxone, he or she may eventually start using other opioids again, so it’s important to get help right away.

After medical detox, the next step in the buprenorphine treatment process is often rehab. The National Institute on Drug Abuse states that long-term addiction treatment of at least 90 days has the best potential for positive treatment outcomes. For this reason, many people complete several episodes of buprenorphine treatment to ease the transition into a life of recovery after being addicted.

During buprenorphine rehab, clients work closely with addiction treatment experts and their peers in recovery to further understand the disease of addiction and the recovery process, establish life skills that are necessary for a life of sobriety, and develop strategies to cope with the stressors of everyday life that would otherwise encourage drug use. Clients also work with therapists on an individual basis to address underlying causes of drug abuse, such as trauma, PTSD, anxiety, depression, low self-esteem, self-hate, and other mental health issues and co-occurring disorders.

Since addiction is a family disease, family therapy is often a major part of the buprenorphine treatment process as well. Many rehab programs provide family workshops for educational and healing purposes, as well as ongoing family therapy.

Inpatient Drug Rehab vs. Outpatient Drug Rehab for Buprenorphine Addiction

There are two common types of buprenorphine rehab: inpatient rehab and outpatient rehab. If you’re searching for a drug rehab program for buprenorphine addiction, you may want to consider the differences between these two types of buprenorphine treatment so you can find the best fit for your circumstances and needs. Here is a side-by-side comparison of the two.

In residential rehab, clients: Stay at the rehab center throughout treatment Follow a structured schedule Have daily counseling sessions Participate in various types of therapies and recovery-focused group activities Have immediate access to medical and clinical care services

In outpatient rehab, clients: Attend a series of group outpatient sessions while they live at home Complete homework assignments on their own at home Maintain obligations to family, employers, or education while completing treatment Have limited access to medical and clinical care services

Although each of these types of buprenorphine rehab is equally recovery-focused, one or the other may suit the personal preferences and treatment needs of a person better than the other. Many people also complete both residential treatment and outpatient treatment to maximize the benefits of long-term buprenorphine treatment and ongoing care in recovery.

Regardless of which type of buprenorphine rehab program you choose, treatment centers often provide several different payment options, such as:

• Health insurance benefits
• Employee Assistance Programs (EAP)
• Financed healthcare loans
• Credit cards
• Crowdfunding
• HSA funds

Continued Care Options for Buprenorphine Addiction Treatment

After rehab, there are also many options for continuing care and addiction treatment. Sober living programs, aftercare programs, and personal monitoring programs are all examples of continuing care options that can help you manage the challenges of sober life and make the transition after addiction.

Sober Living Programs

Sober living programs provide safe and supportive sober housing for individuals in recovery. The type of sober living home can vary greatly depending on its location, amenities, staffing, and recovery support services offered. Although they are designed to help people stay sober, not all sober living homes are created equal, so it’s important to do your research and find the one that best suits your needs.

Some examples of common recovery support services that sober living homes provide include:

• Regular drug and alcohol testing
• Tiered recovery programming
• Educational planning
• Employment assistance
• Volunteer placement

The cost of a sober living home may vary greatly, but payment is usually collected monthly like rent.

Aftercare Programs

Aftercare is designed for people who have been in recovery for varying lengths of time but who benefit from regular group therapy with other individuals in recovery. Aftercare helps people stay on track with their recovery program, especially during transitional times in life, such as a job change, relocation, the loss of a loved one, or a period of deep depression.

Many people use aftercare as a weekly check-in and benefit greatly from receiving valuable ongoing support from counselors and peers who are also in recovery.

Personal Monitoring

Personal monitoring programs provide one-on-one sobriety support and encourage long-term engagement in a treatment program to enhance success in recovery. While enrolled in a personal monitoring program, clients work closely with a peer recovery support person to navigate the transition between stages of treatment or back home after rehab.

Regular support sessions with a support specialist give clients access to a professional who can help them work through challenges related to their recovery and identify any warning signs of relapse early before they lead to drug or alcohol use.

Overcoming buprenorphine addiction is an ongoing process with no easy solution, but you can get sober with the right support. Call Nova Recovery Center today to speak with an admissions specialist and learn more about your treatment options.

References:

1. https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf
2. https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994593/
4. https://www.naabt.org/faq_answers.cfm?ID=2
5. https://www.naabt.org/faq_answers.cfm?ID=33
6. https://www.webmd.com/drugs/2/drug-75100/subutex-sublingual/details
7. https://www.fda.gov/news-events/press-announcements/fda-approves-first-once-monthly-buprenorphine-injection-medication-assisted-treatment-option-opioid
8. https://www.centerwatch.com/drug-information/fda-approved-drugs/drug/100106/belbuca-buprenorphine-

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