How Does Buprenorphine Work?
Buprenorphine works by replacing harmful, high-dose opioids used in active addiction with a low-dose, less harmful opioid. In doing so, it prevents the shock to the brain and body that usually follows the cessation of opioid use.
Buprenorphine has such a strong affinity for opioid receptors in the brain that it actually removes other opioids, similar to how naloxone works. Furthermore, it remains attached to the opioid receptors for a long time, thus preventing the attachment of any other opioids.
How long does buprenorphine work? Buprenorphine has a long half-life (28 to 37 hours when dissolved under the tongue). The half-life is the time it takes the body to remove one-half of the drug. It takes three to five days before enough of the drug is removed from the body to produce withdrawal symptoms.
The only agents that are FDA approved for buprenorphine induction (the initiation of therapy) are buprenorphine-only products (such as Subutex) and Suboxone. Because of Subutex’s high affinity for opioid receptors, it will displace other opioids and may precipitate premature withdrawal symptoms if started too early.
Induction should not be started until the initial appearance of withdrawal symptoms, or at least six to twelve hours after the last opioid use for short-acting opioids (such as heroin) and 24 to 72 hours for long-acting opioids (such as methadone).
Buprenorphine induction therapy is usually done in an inpatient detox center, but may be done in a physician’s office or even, in select cases, at home.
Buprenorphine requires individualized testing to get the correct maintenance dose. The initial dose is low, but the dose is increased until there is a satisfactory effect. The level is based on individuals’ reports of symptom relief.
Once a proper dose has been established and treated, and individuals are satisfied with the buprenorphine stability, there is no set recommended time limit for the continuation of therapy.
Buprenorphine maintenance treatment is individualized because the duration of treatment and decision to taper off the drug depend on having adequate supports in place to ensure ongoing recovery following discontinuation.
Discontinuation of buprenorphine maintenance may result in mild withdrawal symptoms beginning three to five days after the last dose, which may continue for several weeks. Following discontinuation, people can be switched to naloxone treatment within a few days, thus reducing the risk of relapse. People who experience a setback may be restarted on buprenorphine if appropriate.