Buprenorphine Treatment for Opioid Use Disorder

Buprenorphine is a Schedule III narcotic that is used as a daily dose sublingual tablet or filmstrip for managing opioid use disorder (OUD). It curbs cravings for opioids and decreases the intensity of uncomfortable withdrawal symptoms. Because buprenorphine produces opioid-like effects at low to moderate doses, it is also prescribed as a safer alternative to full opioids. Buprenorphine is sold under several brand names. 

Buprenorphine comes in several forms: sublingual tablets or film that are placed under the tongue for quick absorption; transdermal patches placed on the skin for slow, steady release; and modified-release injection under the skin.1 As with all medications used in addiction treatment, buprenorphine should be prescribed as part of a comprehensive plan that includes counseling and other services.2 

While the medication has proven groundbreaking in the treatment of opioid use disorder, its widespread availability and potential for abuse has raised concerns among medical professionals and regulatory agencies, prompting efforts to monitor compliance and prevent abuse.3

Buprenorphine is an opioid partial agonist, meaning that its mechanism of action is binding to the brain’s opioid receptors, much like full opioids, but activating them less strongly. In this way, it can reduce cravings in the user without producing opioids’ typical “rush” of euphoria. Buprenorphine also blocks the effects of other opioids, which inhibits misuse or abuse. 

Over time, buprenorphine use results in a mild abstinence syndrome following cessation.3 Treatment with buprenorphine is most effective when combined with counseling and other services as part of a comprehensive, whole-person approach to OUD recovery.

Side-Effects of Buprenorphine

Many medical professionals agree that buprenorphine is one of the most effective medications to help treat OUD. In fact, a study published by the National Library of Medicine stated that “buprenorphine is one of the most important developments in pharmacotherapy for opioid addiction.”3 

However, like most medications buprenorphine has its side effects. Common buprenorphine side effects include:2 

• Constipation 
• Headache 
• Nausea and vomiting 
• Drowsiness and fatigue 
• Sweating 
• Dry mouth 
• Blurred vision or dilated pupils 
• Muscle aches and cramps 
• Inability to sleep 
• Fever 
• Tremors 
• Palpitations 
• Respiratory distress 
• Pain at the injection site (if injected)

Is Buprenorphine Safe?

Yes, when taken as prescribed  by a medical professional, buprenorphine is safe and effective. Combining it with other substances, however—particularly alcohol or benzodiazepines—should be avoided, as such combinations can lead to respiratory depression. While there exists the potential for misuse and overdose, both are significantly low. 

Because of its unique pharmacological properties that diminish the effects of physical dependency to opioids, buprenorphine has been shown to be more effective than methadone in improving outcomes for people with opioid dependence.4

The first dose of buprenorphine can be administered after the patient has stopped taking opioids for at least 12 to 24 hours (35 hours for longer-acting opioids like methadone), which is typically when mild to moderate withdrawal symptoms start to develop. The initial dosage is low, usually 2 to 4 milligrams, but is adjusted every two hours until the patient’s withdrawal symptoms are under control and opioid cravings are reduced.3 

Buprenorphine can be taken anywhere from three months to two years, depending on the individual patient’s needs.4  Then, when patient and doctor agree to end buprenorphine treatment, the dosage can be slowly tapered off.

Yes, most insurance plans include Medication Assisted Treatment (MAT), which covers buprenorphine and any other treatment medications patients may need. The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurers and group health plans to provide the same level of benefits for mental health and substance use treatment that they do for medical care.5 

Of course, the precise amount of coverage depends on the specific plan the patient has. Therefore, before seeking rehab services, you should contact your insurance plan to ascertain which treatment services are covered. Also, the admissions team at Empowered Recovery Center can answer any questions you might have about paying for rehab with insurance and even verify your benefits.