The National Alliance of Advocates
for Buprenorphine Treatment
Buprenorphine (Suboxone®, Subutex®) 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
Is buprenorphine treatment just switching one addiction for another?
No– With successful buprenorphine treatment as part of a complete treatment plan including counseling, the patient can put the addictive behavior into remission. Buprenorphine will maintain some of the preexisting physical dependence, but that is easily managed medically and eventually resolved with a slow taper off of the buprenorphine when the patient is ready. Physical dependence, unlike addiction, is not a dangerous medical condition that requires treatment. Addiction is damaging and life-threatening, while physical dependence is an inconvenience, and is normal physiology for anyone taking large doses of opioids for an extended period of time.
It is essential to understand the definition of addiction and know how it differs from physical dependence or tolerance.
The American Academy of Pain Medicine (AAPM), American Pain Society (APS), American Society of Addiction Medicine (ASAM), and NAABT recognizes these definitions below as the current accepted definitions.
I. Addiction:
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.II. Physical Dependence:
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.III. Tolerance:
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.
Physical dependence and tolerance are normal physiology. Addiction is a disorder that is damaging and requires treatment.
When a patient switches from an addictive opioid to successful buprenorphine treatment, the addictive behavior often stops. In part due to buprenorphine’s long duration of action, patients do not have physical cravings prior to taking their daily dose. The drug seeking behavior ends. Patients; regain control over drug use, compulsive use ends, they are no longer using despite harm, and many patients report no cravings. Thus all of the hallmarks of addiction disappear with successful buprenorphine treatment.
Therefore, one is not trading one addiction for another addiction. They have traded a life threatening situation (addiction) for a daily inconvenience of needing to take a pill (physical dependence), as some would a vitamin. Yes the physical dependence to opioids still remains, but that is vast improvement over addiction, is not life threatening, and it can easily be managed medically..
Addiction is a brain disease that affects behavior. This addictive behavior can be devastating to the patient and their loved ones. It’s not the need to take a medication that is the problem, many people need to take a medication, but rather it is the compulsive addictive behavior to keep taking it despite doing harm to one’s self or loved ones that needs to stop. Whether or not the person takes a medication to help achieve this shouldn’t matter to anyone. If a medication helps stop the damaging addictive behavior, then that is successful treatment and not switching one addiction for another.
How to find buprenorphine treatment.
Sources:
The Essence of Drug Addiction- By Alan I. Leshner, Ph.D., Former Director, National Institute of Drug Abuse, National Institutes of Health
http://www.nida.nih.gov/Published_Articles/Essence.html
http://www.naabt.org/tl/The_Essence_of_Addiction.pdf
What’s in a Word? Addiction Versus Dependence in DSM-V - CHARLES P. O’BRIEN, M.D., PH.D. NORA VOLKOW, M.D.
http://ajp.psychiatryonline.org/cgi/reprint/163/5/764
NIDA publication: The Neurobiology of Opioid Dependence: Implications for Treatment Thomas Kosten MD, Tony George MD http://www.nida.nih.gov/PDF/Perspectives/vol1no1/03Perspectives-Neurobio.pdf
The American Academy of Pain Medicine, American Pain Society, American Society of Addiction Medicine - consensus document – February 2001, http://www.painmed.org/pdf/definition.pdf
American Academy of Pain Medicine - http://www.painmed.org/
American Pain Society - http://www.ampainsoc.org/
American Society of Addiction Medicine - http://www.asam.org/
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- 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.