The National Alliance of Advocates
for Buprenorphine Treatment
Buprenorphine (Suboxone®, Subutex®3, Zubsolv®4, Bunavail™5, Probuphine®6) is an opioid medication used to treat opioid addiction in the privacy of a physician's office.1 Buprenorphine can be dispensed for take-home use, by prescription.1 This, in addition to the pharmacological and safety profile of buprenorphine, makes it an attractive treatment for patients addicted to opioids.2
Opioid Addiction
This is a physical condition; not caused by lack of morals, nor controlled by willpower, nor cured by good advice. It is a disease as is diabetes or cancer.
Taking strong opioid painkillers, in large doses, for an extended period of time, will cause tolerance and physical dependence in humans. This means when the medication is discontinued abruptly, withdrawal symptoms and cravings occur. Anyone can become physically dependent. Physical dependence is normal physiology and does not require addiction treatments if the opioids were taken correctly and needed for a chronic pain condition. The problem occurs when opioid use continues after the pain subsides and/or despite negative consequences, such as loss of a job, and as the dependency progresses, there is a need for an increased quantity of drug to achieve the same effect. In some cases an uncontrollable compulsion develops. This compulsion defies reason or logic and even the patient may wonder why they have a never ending desire for opioids. These conditions are considered addiction and require treatment.
The brain experiences physiological changes that effect behavior. Neuro receptors in the brain change and the brain learns to crave opioids. When opioids are not present, the receptors send pain and discomfort signals to the brain. This is a physical condition; not caused by lack of morals, nor controlled by willpower, nor cured by good advice. It is a disease as is diabetes or cancer.
As a person takes opioids for an extended period of time, they become less sensitive to them and require more to achieve the same effect. This is called tolerance. This means the person needs to take more and more of the substance to achieve the same effect. When the body can no longer make enough natural opioids to satisfy the increased need of the less sensitive receptors, the body becomes physically dependent on the external source of the drug. This is physical dependence.
Physical dependence is a physiological state of adaptation to a substance, the absence of which produces symptoms of withdrawal. It is possible to be physically dependent on a drug without being addicted to it. But both are the result of physical changes in the brain. It is not a matter of willpower, but rather actual physiology.
Substance Addiction is defined as a behavioral syndrome characterized by the repeated, compulsive seeking or use of a substance despite adverse social, psychological, and/or physical consequences, along with the physical need for an increased amount of a substance, as time goes on, to achieve the same desired effect. Addiction is often (but not always, as with an addiction to gambling) accompanied by tolerance, physical dependence, and withdrawal syndrome.
“Addiction is a disorder that requires treatment while physical dependence is not.”
People are physically dependent on water and food but are not addicted to it. If a cancer patient is taking large doses of painkillers, he/she will become tolerant then physically dependent on them (meaning they will experience withdrawal symptoms if the drug is abruptly removed) but they are not necessarily addicted to it (meaning they will not seek out the drug compulsively despite adverse consequences once the drug is no longer needed for pain).
This is important to understand in order to be able to understand why medication treatments for addiction are not switching one addiction for another.
Withdrawal syndrome consists of a predictable group of signs and symptoms appearing with abrupt removal of, or a rapid decrease in the regular dosage of, a substance. Withdrawal symptoms are often characterized by over activity of the physiological functions that were suppressed by taking Opioids. For example, while taking Opioids the person feels euphoria, but in withdrawal she/he experiences depression. In other words, withdrawal produces the opposite of what the drug did. If the drug suppressed depression then the person would be depressed while in withdrawal.
The body tries to tell the brain that it needs more of the addictive substance by sending pain and other unpleasant signals to the brain. Symptoms of opioid withdrawal are sweating, vomiting, yawning, chills, diarrhea, anxiety, irritability, hypersensitivity to any pain, depression, stomach cramps, muscle cramps, and dysphoria (opposite of euphoria). With illicit opioids (heroin), withdrawal begins to occur 6-24 hours from last use. The symptoms immediately stop when opioids are taken again. The withdrawal symptoms only appear in patients that have become physically dependent, and are the result of structural and chemical changes to the brain.
The Purpose of Buprenorphine Treatment:
To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -
The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization charged with the mission to:
- Educate the public about the disease of opioid addiction and the buprenorphine treatment option.
- Help reduce the stigma and discrimination associated with patients with addiction disorders.
- Serve as a conduit connecting patients in need of treatment to buprenorphine treatment providers.
- U.S. Food and Drug Administration, FDA Talk Paper, T0238, October 8, 2002, Subutex and Suboxone approved to treat opiate dependence.
- Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004.
- Subutex Discontinued in the US market in late 2011.
- Zubsolv (bup/nx sublingual tablet) FDA approved 7/3/2013 see buprenorphine pipeline graphic -in pharmacies now.
- Bunavail (bup/nx bucal film) FDA approved 6/6/2014 see buprenorphine pipeline graphic -in pharmacies now.
- Probuphine FDA approved 5/26/2016 - FDA Probuphine press release