Buprenorphine is a partial opioid agonist most commonly used in medication-assisted treatment to help individuals stop using heroin or other narcotics. However, recent studies have also found that both stand-alone buprenorphine and buprenorphine-naloxone combination products may also provide relief for opioid-dependent patients experiencing chronic pain. Although buprenorphine has less potential for misuse than full agonist opioids, it has also been associated with abuse, dependence, and addiction.
How Buprenorphene Works
Buprenorphine works by relieving withdrawal symptoms when an opioid-dependent person stops using. Buprenorphine has a unique mechanism of action that makes it beneficial for treating opioid dependence and addiction as well as chronic pain.
Buprenorphine has a high affinity to specific opioid receptors responsible for pain alleviation. It binds to these receptors for a more extended period than other drugs, which results in a prolonged effect.
However, despite this attraction, it acts only as a partial agonist, meaning that it prevents opioid withdrawal symptoms, but its effects are not as potent as other opioids. Perhaps most crucially, buprenorphine does not act on opioid receptors that cause intense feelings of reward and well-being. Moreover, the drug does not produce a “high,” meaning that it has a substantially lower potential for abuse and addiction than other opioids.
As mentioned, buprenorphine is often combined with naloxone in the form of a drug known as Suboxone. Naloxone is a short-acting opioid antagonist. When combined with buprenorphine, naloxone offsets the dangerous effects of other opioids, including respiratory depression, without hindering pain relief.
Although not nearly as uncomfortable as other opioids, both buprenorphine and Suboxone can have unwanted side effects, such as the following:
- Abdominal and back pain
- Blurry vision
- Sleep disturbances
- Mouth numbness
More severe side effects, including breathing difficulties or swelling of the mouth or tongue, require immediate medical attention. Critically, mixing buprenorphine with other drugs, such as benzodiazepines, can prove lethal.
Buprenorphine for Pain: Research
In a 2017 review, investigators examined the efficacy of buprenorphine for chronic pain management. They examined more than two dozen randomized controlled trials involving five buprenorphine formulations.
Overall, investigators found that 14 studies suggested buprenorphine in any formulation was beneficial for treating chronic pain. More specifically, 10 of 15 studies found that transdermal buprenorphine in the form of skin patches was effective, and two of three studies revealed that buccal film (film placed between cheeks and gum) was also helpful.
However, only one study showed that either sublingual (under the tongue) or intravenous buprenorphine was useful for treating chronic pain. Notably, no severe adverse effects were reported in any studies, intimating that buprenorphine use is relatively safe.
In 2014, scientists published a review investigating the effectiveness of sublingual buprenorphine to treat chronic pain and found that this administration method was, indeed, efficacious.
Researchers posited there were some potential benefits of buprenorphine, such as the following:
- Increased effectiveness in treating nerve pain
- Ease of use among older persons and those with renal impairment
- Less immunosuppression compared to fentanyl and morphine
- Ceiling effect for respiratory depression when used without other depressants
- Less tolerance development
- Antihyperalgesic effects
Treatment for Hyperalgesia
Due to buprenorphine’s binding abilities, it’s believed that it may help those who experience hyperalgesia. Opioid-induced hyperalgesia is defined as sensitization induced by exposure to opioids. The condition is characterized by a contradictory response in which a person using opioids for pain relief becomes more sensitive to painful stimuli.
Prescribing Buprenorphine for Pain
In the United States, buprenorphine is sometimes used to treat chronic pain, and Suboxone is also prescribed off-label for this purpose. Additionally, the transdermal buprenorphine patch is available to some for the treatment of severe long-term pain.
Suboxone Abuse and Addiction
Suboxone, when used by prescription and under the supervision of a health provider or addiction specialist, can be an effective tool for assisting an individual in stopping opioid use. In some instances, it may also help control pain.
However, Suboxone, like any opioid-based drug, has some limited potential for abuse. It can be obtained illegally, and those with legitimate prescriptions can still become dependent. While the medication does not produce the same euphoric high as other opioids, it can have intoxicating effects if used in large amounts.
If the Suboxone is manipulated in any way, this can lead to a highly unpleasant set of symptoms known as precipitated withdrawal. This condition may occur if an individual crushes or grinds up the drug and snorts it or liquefies it for intravenous delivery. Naloxone is an opioid overdose remedy that is included in Suboxone as an abuse-deterrent mechanism.
When ingested orally, naloxone remains inactive. However, if the drug is tampered with, naloxone will become active and cause the individual to go into instant opioid withdrawal. Also, one could surmise that it would be likely to neutralize buprenorphine’s already minimal rewarding effects.
That said, misuse does occasionally occur. Individuals who abuse Suboxone or buprenorphine alone report they will swallow, snort, or inject the drug in an attempt to enhance the effects. Suboxone is more likely to be abused by those dependent on relatively small doses of other opioids.
Therefore, although the naloxone should make abuse less likely, it does appear that Suboxone could potentially induce a high when snorted. A rewarding high would be more probable in those who are “opioid-naïve,” meaning persons who don’t routinely use opioids and are not currently on a buprenorphine treatment regimen.
Signs of Suboxone Dependence
When a person is dependent on Suboxone, he or she may not exhibit significant symptoms unless they are undergoing withdrawal. This may be the first sign that there is a severe problem.
Various common behaviors may be linked to drug dependence, and the following signs may suggest that you or someone you know has a problem:
- Isolation/withdrawal from loved ones
- Loss of interest in activities once regarded as important or enjoyable
- Neglect of essential responsibilities, such as work, family, or school
- Excessive drowsiness or insomnia
- Deception and manipulation of others
- Obsessiveness over obtaining and using the drug
- Stealing or frequently borrowing money
- “Doctor-shopping” for multiple prescriptions
Abuse and dependence do not necessarily equate to addiction. Addiction is a disease also hallmarked by compulsive drug-seeking despite the incurrence of adverse consequences. In fact, a person can become psychologically addicted to a substance even without having developed a significant chemical dependence.
Suboxone Addiction Side Effects
Suboxone addiction has been associated with several side effects, including the following:
- Nausea and vomiting
- Slurred speech
- Impaired coordination
- Impaired memory
- Erratic moods and behavior
Also, the abuse of Suboxone can pose a significant risk to a person’s health, such as profound central nervous system depression and overdose. Due to the inclusion of naloxone, Suboxone overdose is rare. Most overdose and respiratory distress cases tend to manifest when the drug is used in conjunction with other depressants or intoxicating substances, such as alcohol or benzodiazepines.
Getting Treatment for Addiction
Just Believe Recovery offers comprehensive programs comprised of services and activities beneficial to the recovery process. These include, but are not limited to, the following:
- Peer group support
- Health and wellness programs
- Individual counseling
- Family counseling
- Substance abuse education
- Art and music therapy
- Aftercare planning