While buprenorphine can help some people kick an addiction, the narcotic painkiller can prove a habit-forming problem for others.
Buprenorphine first landed in the United States in the 1980s, marketed as Buprenex. In 2002, the U.S. Food and Drug Administration (FDA) approved two buprenorphine products to help treat narcotic addiction.
Subutex consists of buprenorphine only, while Suboxone combines the opioid with naloxone. Both are sublingual, or drugs that are placed under the tongue. Manufacturers add naloxone to Suboxone because it produces withdrawal symptoms if buprenorphine is abused. If people cannot take naloxone (due to pregnancy or allergies, for example) then they may be given Subutex instead.
In 2010, the FDA approved Butrans, an extended-release transdermal film (a film placed on the skin) to help people diagnosed with severe chronic pain.
Other buprenorphine drugs include:
- Bunavail (with naloxone, available as a buccal film that is placed between the gum and cheek)
- Zubsolv (a sublingual drug that also contains naloxone)
- Sublocade, a monthly injectable for adults who have already begun transmucosal treatment (treatment administered through mucus membranes in the mouth or nasal passages)
Because it can help temper some of the discomfort a recovering opioid addict might feel, buprenorphine can be a valuable tool in helping overcome dependency. Because it is an opioid, however, buprenorphine can be addictive.
The U.S. Drug Enforcement Administration (DEA) has reported that buprenorphine trafficking and abuse have grown more common since 2003, not long after Suboxone and Subutex entered the market.
People who use buprenorphine also misuse and abuse it. “In countries where buprenorphine has been used widely for the treatment of opioid dependence, such as France, diversion has been a problem in 20% of recipients,” wrote Paul J. Whelan and Kimberly Remski in an article that discussed buprenorphine and another common medication used to treat addiction, methadone.
DEA sites state that buprenorphine has been sought out by narcotic users, opioid abusers, heroin addicts, and people being treated with buprenorphine. It gets snorted, injected, and swallowed in pill form.
The DEA cites Drug Abuse Warning Network (DAWN) statistics that state that 21,483 emergency room visits were tied to buprenorphine abuse in 2011, nearly five times 2006’s 4,440 reported ER cases.
According to the American Association of Poison Control Centers, in 2016 there were 3,732 visits that mentioned buprenorphine, 2,160 cases of exposure, and five connected deaths. Buprenorphine can be addictive — like many medications can be — after a while. Experts typically advise tapering doses when quitting buprenorphine and working with professionals. If people don’t do these things, the detox process can cause withdrawal symptoms that may be uncomfortable and even dangerous. The symptoms may include:
- Anxiety or restlessness
- Chills and goosebumps
- Stomach cramps and diarrhea
- Nausea or vomiting
- Muscle aches
Because of its role in helping people quit opioids, buprenorphine can be tricky to obtain. Not all doctors are cleared to prescribe it. Some people who use the drug require regular check-ins at treatment centers to keep their recovery on track.
Signs of Buprenorphine Use
Signs of buprenorphine use may not be immediately apparent, but many users experience some side effects. Common ones include:
- Body aches, headaches and cold- or flu-like symptoms
- Trouble sleeping or tiredness
- Nausea, vomiting
- Mood swings
Many of the above symptoms may be remedied by a change in dosage (with doctor approval first) or by slight lifestyle or dietary changes. Such changes may include ingesting more water and fiber to treat constipation, or quitting caffeine consumption earlier in the day to combat insomnia.
There are more serious side effects, too, especially with long-term use of buprenorphine. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) recommends consulting with one’s doctor if any of the following symptoms continue, because the signs can point to poor liver health:
- Dark urine
- Continuous, intense stomach pain
- Pale-colored bowel movements
- Yellowing of the whites of the eyes or the skin
Buprenorphine can be deadly when mixed with other medications and substances. Illegal drugs, alcohol, sedatives, tranquilizers or any drugs that slow breathing (many opioids do this) all increase the likelihood of an overdose or death.
Buprenorphine Addiction Treatment
Addiction treatment can take many forms.
Counseling — either one-on-one or group — can be effective. Therapy can help uncover the hows and whys that led to addiction. It can also be helpful in situations where drug users are also dealing with additional health issues such as depression or anxiety.
Clients learn coping strategies and meet people with the same troubles and goals in group therapies and during inpatient stays. Some groups and programs work only with clients, while others invite family and friends to involve them in the process. Internet-based groups are a good way for more isolated treatment seekers to regularly check in for regular assistance.
The National Institute on Drug Abuse (NIDA) reports that a combination of programs and therapies — such as medication-assisted treatment (MAT) — that are molded to the individual’s needs may offer the most promising recovery results.
Treatment settings include:
- Therapeutic communities: Structured, often lasting several months, where both residents and staff work together to modify behaviors and shape positive outcomes.
- Shorter-term residential treatment: Focusing on detoxification and intensive counseling.
- Recovery housing: Shorter stays, typically following other types of residential or inpatient treatment. Such housing encourages people to learn life skills, secure employment, and connect with support groups in their communities.
Recovery, it should be noted, does not happen overnight. Long-term plans are often the best courses to ensure that relapses don’t occur.
According to the National Institute on Drug Abuse (NIDA), the most effective substance abuse treatments include detoxification, counseling, medication, evaluation, and long-term follow-ups to prevent relapse.
Paying for Buprenorphine Drug Rehab
Getting better is a scary first step. Perhaps just as intimidating is the specter of a huge rehab bill.
Health insurance plans vary, as do costs and coverage. If the costs of treatment seem daunting, consider the larger cost of not getting well.
Injecting crushed and liquified pills puts one at risk of HIV or hepatitis C. Prolonged drug abuse can damage the liver. Job security, friendships, and relationships can implode.
The good news is that the federal government has ruled that mental and behavioral health services are essential benefits. Insurance plans must cover mental and behavioral health inpatient services and substance abuse treatment.
Specifics of each plan — premiums, deductibles, networks — can vary, depending on where you live and the plan you have. The Health Insurance Marketplace is a good resource for learning more.
The National Institute for Mental Health reports that addictions to drugs and alcohol are classified as a mental illness, specifically as substance use disorder. Insurance plans should cover pre-existing mental health conditions and should not place spending limits on treatment.
Considering that in 2014 the National Institute for Mental Health reported that 20.2 million adults in the United States had a substance use disorder and 7.9 million had both a substance use disorder and a separate mental illness, it’s hardly unchartered territory for anyone in need of help.
Marketplace plans cannot deny coverage or charge more for pre-existing conditions, including substance use disorders. Parity protections ensure that mental health and substance abuse services cannot be limited, just as medical services cannot be limited as well.
Privately, just like the Health Insurance Marketplace, coverage will vary depending on the type of plan. Deductibles, co-pays,and in- and out-of-network options will all impact the cost and availability of treatment.
According to the National Alliance on Mental Illness, mental health conditions and substance abuse disorders must receive the same level of coverage as other chronic conditions, such as diabetes or heart disease. There are some parity exceptions, however, including plans that have exemptions due to costs or grandfathered plans (before March 23, 2010).
Organizations such as the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) offer more information via their national helpline (1-800-662-HELP or 1-800-662-4357). SAMHSA does not offer counseling, but it is staffed with trained specialists who can help determine whether people are insured or not. Buprenorphine can be a valuable tool to fight addiction and research and assistance can help make this tool available.
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- samhsa.gov – Buprenorphine
- fda.gov – FDA Approves First Once-Monthly Buprenorphine Injection, a Medication-Assisted Treatment Option for Opioid Use Disorder
- deadiversion.usdoj.gov – Buprenorphine
- ncbi.nlm.nih.gov – Buprenorphine vs. Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds.
- store.samhsa.gov – The Facts About Buprenorphine for Treatment of Opioid Addiction
- drugabuse.gov – DrugFacts: Treatment Approaches for Drug Addiction.
- healthcare.gov – Mental Health & Substance Abuse Coverage
- nami.org – What Is Mental Health Parity?