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Buprenorphine is available by prescription only
as treatment for heroin dependence.
Buprenorphine is as synthetic opioid derivative closely related
to morphine. It has been found to be effective for use in heroin and
methadone withdrawal (detox.) and for maintenance treatment of
opioid dependent people. Buprenorphine is also prescribed to treat
severe pain.
Buprenorphine is prescribed by medical doctors
who have specialist training in the uses of buprenorphine and have
been granted a permit from the Department of Human
Services.
The Drug
Buprenorphine
is classified as a "partial opiate agonist" because it binds tightly
to the opiate receptors in the body, but only partially activates
them. This makes buprenorphine safer—less risk of overdose and
respiratory problems. When used as an opiate substitute for
maintenance treatment, buprenorphine stops or greatly reduces
cravings for heroin and stops withdrawal symptoms.
Buprenorphine is a tablet
which is dissolved under the tongue. If the tablet is swallowed, it
is much less effective because it gets broken down too quickly once
it passes through the liver.
The tablet works within 30–60
minutes and lasts 24–48 hours, depending on the dose.
There
are two types of uses for buprenorphine:
1. For heroin
detox. A 5–7 day short course can be used to wean addicted people
off heroin.
- Most patients find a buprenorphine detox
much easier than any other detox that they have tried in the
past.
- Withdrawal symptoms are usually very mild,
but some people get aches and anxiety symptoms at the end of the
buprenorphine detox.
- Usual doses for detox are 4mg on the first day, then 6–8 mg
for two days, then reducing to 2mg per day.
Once the medication has finished, some patients find that
cravings return and relapse may occur. The option then is to stay on
buprenorphine longer, or to consider a course of naltrexone for 2–3
months after the detox.
2. Buprenorphine maintenance
program. Like methadone, buprenorphine works best when people stay
on it for a while so that they have time to sort out the rest of
their social/financial/emotional problems.
Buprenorphine maintenance doses may range from 2 mg to 32mg per
day. Once a person is stable on a daily buprenorphine dose, they can
have the dose adjusted so that they only need to pick up a dose
every 2 or 3 days.
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Starting Buprenorphine
As buprenorphine
competes for the opiate receptors in the body, it can produce strong
withdrawal symptoms if there are other opiates in the body at the
beginning of treatment.
It is strongly suggested that people
wait for 12 hours after their last heroin use, or 24 hours after a
methadone dose, or start to have some withdrawal symptoms, before
they take the first buprenorphine tablet.
Side Effects
A small percentage of all
people on buprenorphine suffer from side effects. Many of these will
occur in the first week of treatment and are often due to the
combined effect of withdrawal from opioids and taking
buprenorphine.
Symptoms are often similar to those experienced
during buprenorphine withdrawal and may also include:headaches
- sweating
- restlessness
- nausea
- weakness
- dizziness
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Pain Control whilst on
Buprenorphine
Patients
maintained on buprenorphine will have a diminished response to
opioids prescribed for analgesia. This is due to the blocking
effects on the receptors. To overcome this, considerably higher
doses of opioid analgesia will be required for treatment of acute or
chronic pain in these patients. It is preferable therefore to try
non-opioid analgesics first such as non-steroidal anti-inflammatory
drugs or paracetamol or aspirin.
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Using Buprenorphine and Other Drugs
It is
particularly important to avoid using other depressant drugs, such
as benzodiazepines with buprenorphine.
Using benzodiazepines and
buprenorphine together may lead to breathing difficulties, coma or
death.
Using buprenorphine with other opiates, such as heroin or
methadone, increases the chances of experiencing ongoing withdrawal
symptoms.
Buprenorphine Withdrawal
Withdrawal from long-term use of buprenorphine may produce
symptoms similar to those experienced from heroin withdrawal.
However, withdrawal symptoms from buprenorphine tend to be milder
than those from methadone and other opioids.
Symptoms may include:
- Cold or flu-like symptoms
- Headaches
- Sweating
- Sleeping difficulties
- Loss of appetite
- Nausea
These effects usually peak in the first 2-5 days. Some milder
effects may last a number of weeks.
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(Southcity Clinic acknowledges the assistance of the Australian Drug Foundation in
compiling this information)
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