Opiate Dependency and Buprenorphine

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Opiate Dependency and Buprenorphine

What are opiates?

Opiates are the drugs that are derived from opium, the addictive substance which is produced by the opiate poppy plant. Some opiates are manufactured directly from opium, while there are a few that are synthetically manufactured. These drugs include codeine, hydrocodone, oxycodone, morphine, methadone and heroin. They have very strong pain relieving properties and so have been used in medical practice for 150 years to alleviate physical pain and suffering. In addition, these drugs produce euphoria-the “high”–which addicts seek to experience over and over.

What is opiate dependency?

With repeat dosing, opiates have less and less of the desired effect, whether that be analgesia or euphoria. The user has to increase the dose to get the same effect. Trying to get back the same effect as before is known as “chasing the high,” and usually, this is not possible. Gradually, the dependent person is pulled into a pattern of repeatly increasing the drug dose. This is known as “tolerance.” In addition, dependency means the development of withdrawal when the drug is discontinued. Opiate withdrawal consists of hot and cold chills, sweating, nausea and vomiting, diarrhea, and tremor. Opiate dependency means that you have developed tolerance to the drug and/or you experience withdrawal when discontinuing the drug.

What is opiate addiction?

When a person physically dependent on opiates begins to engage in unethical and/or illegal activity to obtain opiates, they are said to be “addicted” to opiates. You are addicted to opiates when you have developed physical dependence (tolerance and withdrawal) and are engaging in addictive behavior to obtain opiates at any or all costs. An opiate addict is out of control. There is a 90% failure rate for addicts trying to stay off opiates.

What is the success rate for overcoming opiate addiction?
Ninety percent (90%) of opiate addicts relapse within the first year of treatment. In other words, there is a 90% failure rate, even with all the different types of treatments recommended by health care professionals. Suboxone has changed this.

What is buprenorphine?

Buprenorphine is a unique medicine which works on the part of the brain that causes opiate addiction. It is not like opiate pain killers, and acts differently than addictive drugs.

Can buprenorphine be abused? Can addicts get “high” from it?

“People take drugs for pleasure, and there is no pleasure in buprenorphine.”-Tom, a former iv heroin user for 20 years

Drugs that are abused are those that cause euphoria or some other altered mental state that is desired. Addicts do not get euphoria from buprenorphine when used as directed. One patient summed it up this way: “Addicts use drugs for pleasure, and there is no pleasure in buprenorphine.”

Isn’t buprenorphine just another addictive drug?

Buprenorphine lacks the 3 fundamental characteristics of addictive drugs.

  1. Euphoria. Most opiate addicts do not experience euphoria when taking buprenorphine. They generally say that they “feel normal” after taking it. It is very difficult for them to get high from buprenorphine.
  2. Tolerance. There is no tolerance with buprenorphine. What that means is that instead of having to increase the dose repeatedly over time in order to get the same effect, most patients on buprenorphine gradually lower their dose and use less and less of it over time. Instead of developing tolerance, addicts develop sensitization to buprenorphine. This is the opposite of what addictive drugs do.
  3. Addictive behavior. Once stabilized on buprenorphine, opiate addicts stop having cravings for opiates; therefore, they stop engaging in unethical and illegal behaviors. They are freed from the “monkey on their back.”

Isn’t buprenorphine just like methadone? Aren’t you just substituting one addictive drug with another?

Comparing methadone to buprenorphine is like comparing apples to oranges.

Methadone is the classic “substituting one drug for another.” Methadone treatment does not aim to arrest the addiction; rather, it aims to control and contain it. Rather than having addicts go to the street to get their drugs, the purpose of methadone treatment is to simply give the addict their medicine so that they do not commit any more crimes. However, it effectively perpetuates the addiction.

Buprenorphine, on the other hand, aims to reverse the addiction. Buprenorphine acts very differently from addictive drugs; when used as instructed, addicts do not get “high” from buprenorphine, and there is no tolerance to buprenorphine. (In other words, you do not have to keep increasing the dose of buprenorphine over time because it “stops working”; rather, it continues to work just as well over time. As a matter of fact, about half of buprenorphine patients decrease the dose on their own over time.) Also, buprenorphine does not have the numerous side effects methadone does, such as sedation, clouded consciousness (“foggy brain”) and short-term memory loss.

Can buprenorphine patients continue to use other drugs, like methamphetamine and cocaine, while being treated with buprenorphine?

No, the addict must be committed to living a clean and drug-free lifestyle and be devoted to the recovery process in order for Dr. Rao to be able to prescribe buprenorphine on an ongoing basis.

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Peter Alan Rao, MD, PLLC

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