Buprenorphine is Potentially a New Gold Standard for Opioid Use Disorder
By Dr. Eric Geisler, Serenity Lane
In the struggle to help patients recover from opioid addiction, professionals have needed additional and more effective tools. Now, success is frequently achieved by prescribing buprenorphine.
What is Buprenorphine?
Buprenorphine is a partial opioid agonist and antagonist that is approved by the Food and Drug Administration for use in the treatment of opiate use disorder. It is also endorsed by the American Society of Addiction Medicine and the U.S. Surgeon General. Because buprenorphine is effective and relatively easy for patients to access, it has the potential to become a new gold standard of maintenance therapy for people recovering from opiate use disorder. From initial stabilization from withdrawal to maintenance therapy in a medical office, buprenorphine succeeds in achieving harm reduction, a lower overdose risk than methadone and improved patient management.
This evolution of thinking is based on practicality and the successful hands-on experiences of practitioners.
I’ve seen the difference myself with the residential patients on the campus of Serenity Lane in Coburg where I treat over 600 patients a year. Opiate patients may have tried to detox on their own or experienced daily trips to a methadone clinic for treatment. At every point along that path, relapse is a real possibility. In contrast, buprenorphine provides consistency that the overwhelming majority of these patients appreciate. By the second week of treatment, they typically no longer experience withdrawal symptoms or cravings. Because of the ease and effectiveness of buprenorphine, these patients have much less temptation to leave treatment or start using again.
In reality, methadone clinics are not the best treatment model for all patients. They often find it difficult to return to the clinic every day, particularly when methadone is not controlling their use or when there is a conflict with the clinic schedule. For practitioners, methadone clinic licenses can be difficult to obtain and maintain. If, instead, patients can visit a private physician office for a prescription renewal or a monthly injection of buprenorphine, recovery becomes more manageable.
The two oral prescription options for daily administration of buprenorphine are a tablet or film preparation administered under the tongue with absorption through the mouth. Some patients prefer a sublingual film because the texture of the tablets bothers them; others prefer the taste of the tablets compared to the films. Either option may be prescribed by physicians, nurse practitioners or physician assistants who have received a federal waiver. Any pharmacy can fill the prescriptions for patients to self-administer in private. Alternately, the medical provider can administer a monthly injection of Sublocade®. This third option is a subdermal implant. The medication is injected as a liquid under the skin and then transforms into a solid mass the size of a marble. The implant slowly dissolves over 30 days, releasing the medication evenly.
Whichever option is used to administer the medication, it is difficult to misuse or overdose on buprenorphine. A patient who is ready to stop using buprenorphine will experience opiate withdrawal symptoms, but these are often less severe than withdrawal from opioids themselves. It is recommended that medical providers manage the tapering from buprenorphine.
Once a patient is stabilized on buprenorphine, psychosocial therapy should be added to the treatment plan. The combination of medication and therapy has proven to be far superior in treating opioid addiction compared to abstinence-only based programs. When patients are in recovery, they benefit from the counseling and other modalities. They become aware of the consequences of their drug addictions and the toll it has taken on their relationships, careers, finances or other social functioning. The counseling may be done in group therapy or one-on-one sessions; the bottom line is that both medical and clinical elements help patients maintain their recovery.
Opioid addiction is affecting many American families. We need to move past shame to diagnosis, treatment and the resumption of a healthy life. Medical maintenance that is achieved with buprenorphine is potentially the new gold standard to do it.
Originally published in the Lane County Medical Society’s magazine Medical Matters’ September 2020 edition.
READ MORE ABOUT IT: Opiate Withdrawal with Buprenorphine »
Eric Geisler MD, ABAM, ABFM, is board certified in addiction medicine. Since 2016, he has served Serenity Lane as its director of medical services. Previously, he had a family practice clinic in Thurston for 20 years. He is available to medical professionals who have questions about addictions and treatments. Dr. Geisler will be presenting more about this work at our upcoming webinar on October 1, 2020 entitled: “Medication Treatment Options for Patients with Opiate Use Disorder”.