Is buprenorphine an opioid?
Buprenorphine is an opioid, but it is what we call a partial agonist. That is, it sticks to the opioid receptors that other opioids (like hydrocodone, oxycodone, heroin and fentanyl) bind to, but it does not activate the receptor fully. This usually means that the person who takes it does not experience euphoria (or a high) taking the medication. Rather, the medication simply serves to remove opioid withdrawal symptoms as well as cravings, so you can properly focus on both your recovery and living a regular, productive life. In addition, the fact that buprenorphine is a partial agonist means the risk of overdose is very low.
Isn’t buprenorphine just replacing one addiction with another?
There is an important difference between opioid addiction and dependence. A person who is suffering from addiction not only takes opioids frequently, but they also engage in destructive behavior to obtain the opioid (such as spending significant time on the streets hunting for opioids rather than holding down employment or caring for their family) and use it in dangerous ways (such as snorting and IV drug use). A person on medically-supervised buprenorphine therapy is opioid-dependent, in that they can still suffer physical and mental withdrawal symptoms if they abruptly stop it. However, they do not engage in destructive and dangerous addictive behavior. This allows them to focus on their physical and mental health and pursue recovery, often with the help of trained counselor.
Can you come off of buprenorphine successfully?
The answer is yes. There are numerous patients whose goal is to be free of all opioids. Once the patient has remained stable in buprenorphine therapy for at least several months, it is reasonable to discuss a taper plan.
How long does it take to come off of buprenorphine?
That varies a lot depending on numerous factors, such as a person’s genetics, support system, their mental health state, how long and what type of opioid they have used and their overall willingness to come off of all opioids. It can happen within a few short months or be a several year-long process.
Do patients ever stay on buprenorphine long term?
The answer is yes. Some patients, for various reasons, have great difficulty completely stopping opioids altogether, even when buprenorphine is tapered off very slowly. This is NOT a character defect. It happens to many patients and if they need to remain on buprenorphine long term in order to lead productive lives and stay safe, then that is ok.
Is there another treatment option besides buprenorphine?
In our clinic, the other medication-assisted therapy we offer is with naltrexone, which is called an opioid antagonist. This means that the medication sticks to the opioid receptor, but doesn’t activate it. This keeps other opioids from binding to the receptor. It comes as both an oral and injectable form. This is a great option for patients who want to take something that would keep them from relapsing by preventing any kind of “high” should they take an opioid. However, this medication does not reduce withdrawals or opioid cravings when somebody has just come off taking opioids.
Another medication used in opioid use disorder is methadone. Like buprenorphine, it can stick to the opioid receptor without inducing euphoria in the vast majority of people. Methadone for opioid addiction, however, can only be provided through a methadone treatment clinic. We do have a close relationship with Shoals Treatment Center in Sheffield, AL and can make a referral to this facility if needed.
For patients not wishing to use any medication in their opioid treatment, we can refer them to one of partners to provide intensive outpatient therapy or, when necessary, help set the patient up for inpatient rehabilitation.
So wait, there is medication that can help you come off of methamphetamines and cocaine?
It is important to know that there are currently no FDA approved medications to treat stimulant use disorders. However, there are several medications that have been very successfully used in the treatment of methamphetamine and cocaine addiction. We can discuss treatment options at your initial consultation and follow up visits.
Is Antabuse the only treatment for alcoholism?
The answer is no. There are several medications that have been successfully used in treatment of alcohol use disorder. Some are used for reducing withdrawal symptoms when stopping alcohol use while others reduce the desire to drink alcohol.
Who gets counseling services?
Anyone can have access to counseling services if they feel like they need it. We do believe that everyone’s addiction treatment plan needs to be individualized, that there is no “one-size-fits-all” method of treatment. Mandatory counseling as a condition of treatment is made on a case-by-case basis, depending on the individual’s mental health, whether the patient is stable in terms of their addiction treatment, the person’s overall support system and whether there is a belief that the person would genuinely benefit from counseling services. The frequency of counseling sessions will also vary depending on the clinical situation. We have access to numerous counseling services. Whether there is an additional cost to the counseling will depend on the health insurance coverage that the patient has. However, we will make every effort to minimize out-of-pocket costs for counseling services.