Buprenorphine, Naltrexone
Buprenorphine is a medication with the potential to be an important treatment in
some persons for opioid addiction. It is somewhat similar to methadone,
in that it is an opioid drug also used as a painkiller and it also blocks other
opioid drugs like morphine or heroin from working. It is less potent than methadone,
but can block methadone’s effects; so, switching a patient to buprenorphine must
be done gradually.
Previously, buprenorphine was only available for injection. Oral buprenorphine,
taken on a regular basis in sublingual (under the tongue) tablet form as
part of a comprehensive addiction recovery program, can help reduce withdrawal symptoms
and craving for opioids. Buprenorphine appears to have somewhat milder withdrawal
symptoms when it is stopped and relatively less potential for overdose than methadone.
However, since it is less potent, buprenorphine may not be appropriate as a treatment
for opioid-dependent persons who might require higher doses of an opioid agent to
control craving. And, as with methadone, research shows that buprenorphine has little
effect in reducing abuse of other substances, such as cocaine or alcohol.
On October 8, 2002 buprenorphine was approved by the FDA for prescribing by any
physician who has acquired adequate education on the drug and receives special licensing.
This includes qualified community-based private practice physicians, so patients
do not necessarily need to attend a special clinic on a daily basis to receive the
medication.
Buprenorphine is not viewed as a replacement for other approved therapies for opioid
addiction – such as, methadone or naltrexone – but as an added treatment that may
prove beneficial for certain patients. Various authorities, including government
agencies, have recognized that, “buprenorphine is unlikely to be as effective or
more effective as more optimal-dose methadone, and therefore may not be the treatment
of choice for patients with higher levels of physical dependence [on opioids].”
Also, without the close monitoring, psychosocial therapy, and other rehabilitative
services provided by MMT clinics, the long-term benefits of buprenorphine for many
patients must be cautiously considered.
For further information and FAQs, see government sites at:
http://buprenorphine.samhsa.gov/faq.html
or, http://buprenorphine.samhsa.gov/index.html
Also see, FDA Talk Paper: Subutex and Suboxone
approved to treat opiate dependence. Available at:
http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01165.html