About Methadone and Buprenorphine - Drug Policy Alliance

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BuprenorphineBy Sharon Stancliff, MDBuprenorphine, when appropriatelyprescribed and taken, is an effective,safe medication approved by theFDA for use in the treatment of opioidaddiction. Buprenorphine relieveswithdrawal, reduces craving andblocks the effects of heroin in wayssimilar to methadone. Maintenancedoses are generally between 12 and32 milligrams but (like methadone)should be individualized.Unlike methadone, buprenorphinemay be prescribed for treatment ofopioid addiction by any doctor whohas received training (available viathe Internet or as a one-day course)and a waiver from the DEA. This is itsprincipal advantage over methadonefor most doctors and patients. Misuseof buprenorphine is less likely thanmethadone to result in death.Prescribed in the U.S. as Suboxoneor Subutex, buprenorphine is usuallytaken daily as tablets to be dissolvedunder the tongue. There is littleeffect from the drug if it is swallowed.Suboxone contains not just buprenorphinebut also naloxone, an opioidantagonist that may precipitatewithdrawal symptoms if injected.For people dependent on any opioid,taking the first dose of buprenorphinewhen not in withdrawal can result inacute withdrawal symptoms.Buprenorphine, like methadone,can be used as a short- or long-termdetoxification medication or indefinitelyas a maintenance medication.The risks of relapse followingdetoxification appear to be similarwhether methadone or buprenorphine(or any drug-free treatmentmodality) is used.A directory of physicians approvedto prescribe buprenorphine can befound at http://buprenorphine.samhsa.gov/bwns_locator/.10About Methadone and Buprenorphine
MaintenanceMethadone maintenance isintended to do three things forpatients who participate:1. Keep the patient from going intowithdrawal. The standard initialdose, as currently recommended,is 30 to 40 milligrams a day. Afterseveral days, providers adjust apatient’s dose as needed.2. Keep the patient comfortable andfree from craving street opioids.Having a craving means more thanjust having a desire to get high.It means feeling such a strong needfor opioids that people may haveregular dreams about using drugs,think about doing drugs to theexclusion of anything else, and/ordo things that they wouldn’t normallydo to get drugs.Methadone won’t control a person’semotional desire to get high, but anadequate dose of methadone shouldprevent the overwhelming physicalneed to use street opioids.3. “Block” the effects of streetopioids. If the dose is high enough,methadone keeps the patient fromgetting much, if any, effect fromthe usual doses of street opioids.This result is often called the“blockade” effect.If a person’s opioid tolerance iselevated high enough withmethadone treatment, a greatdeal of heroin would be requiredto overcome it and produce asignificant high.www.drugpolicy.org11
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About Methadone and Buprenorphine - Drug Policy Alliance

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