Opioid use disorder is a serious problem in the United States that is hard to overcome due to the highly addictive nature of opioids. People trying to address an opioid addiction often have to deal with the severe effects of withdrawal and the risk of a setback occurring. New and improved treatment options for opioid addiction are highly sought. Cassipa is a relatively new treatment for opioid use disorder.
What is Cassipa?
Cassipa is the brand name for a combination of two drugs, buprenorphine and naloxone. They are combined into a sublingual film, which is placed under the tongue and dissolved. Other brand names for this drug combination include Bunavail buccal film, Suboxone sublingual film and Zubsolv sublingual tablet.
Cassipa was approved by the FDA on September 7, 2018, for the treatment of opioid dependence. It is a maintenance treatment, meaning that it is used to help prevent a relapse from occurring once opioid use stops.
Cassipa for Opioid Addiction
Buprenorphine is approved for the treatment of opioid dependence. It is a partial opioid receptor agonist, meaning it binds to the same receptors as opioid drugs that are misused. Since Cassipa is only a partial agonist, the euphoric effects are weaker than what would be experienced with opioids. Cassipa also has a ceiling that once reached, no matter how much buprenorphine is taken, it will not increase the effects. This factor makes it safe from causing an overdose and decreases the risk of dependence developing.
Once a person is stable on buprenorphine, they can be switched to buprenorphine and naloxone sublingual film. Naloxone is an opioid receptor agonist, so it binds to the same receptors as opioids but prevents their effects from occurring. It is commonly used when a person is overdosing to limit the toxic effects of the opioid. When used in combination with buprenorphine, it likely reduces the risk of buprenorphine abuse.
Cassipa Dosage and Administration
Cassipa is used for the treatment of opioid use disorder after the person stabilizes from treatment with buprenorphine and the dose of buprenorphine was gradually reduced to 16 mg. Cassipa is a combination of buprenorphine and naloxone containing 16 mg of buprenorphine and 4 mg of naloxone. One segment of Cassipa film should be taken daily for maintenance therapy.
Cassipa comes in the form of a sublingual film that is 22.3 x 25.4 mm. It is placed under the tongue and allowed to dissolve. The film should be dissolved completely and should not be chewed, cut or swallowed. Allowing it to dissolve under the tongue causes it to absorb into the bloodstream quickly. The medication will not be absorbed from digestion in the stomach.
Cassipa for Maintenance Treatment
Cassipa is used for maintenance treatment for opioid addiction. According to the FDA, it should not be used for the induction of opioid addiction therapy, but rather after a person is considered stable on buprenorphine treatment. The naloxone and buprenorphine combination can be used for long-term maintenance as long as the person stays stable and does not relapse to opioid use.
Cassipa should be used in combination with therapy and psychological support to provide a comprehensive treatment plan for individuals recovering from opioid addiction.
Risks and Contraindications
There are some side effects that can occur with Cassipa treatment, including:
- Excessive sweating
- Signs and symptoms of withdrawal
- Aches throughout the body
- Swelling of the arms and legs
- Painful sensation in the mouth or throat
- Loss of sensation in the mouth
Cassipa should not be used in people who are hypersensitive or allergic to buprenorphine or naloxone. It should also not be used in combination with many other types of drugs. It is best to speak with a physician before using it in combination with any other drug.
There is a risk of abuse with Cassipa since buprenorphine works in a mechanism similar to other opioids and illicit drugs. Likewise, if treatment is abruptly stopped, the person may experience withdrawal symptoms similar to those of opioid withdrawal. There is also a risk of overdose in patients who do not have an opioid use disorder. Therefore, it should not be used as a pain relief medication or for people who have not previously been exposed to opioids.
The data on the risks of buprenorphine during pregnancy is limited. However, most conclude that there is not a risk of birth defects due to buprenorphine exposure. When a mother is taking opioids, whether illicit or prescribed, there is a risk that the baby will have neonatal opioid withdrawal syndrome after it is born, which can be dangerous if not treated properly.
How Long is Opioid Addiction Treatment with Cassipa?
Cassipa can be used for as long as a patient needs to remain stable and not relapse in their opioid dependence. There is not a recommended length of treatment for maintenance therapy. A person using Cassipa for maintenance therapy may use it as long as it is beneficial to their treatment plan. It is recommended that physicians closely monitor the use of Cassipa, including limiting the amount that is prescribed to avoid abuse.
Benefits and Effectiveness
The effectiveness of buprenorphine for the treatment of opioid addiction has long been documented. The addition of naloxone to buprenorphine makes it less likely to cause abuse of the substance. Both are equally effective in treating opioid use disorder. These treatment options are effective in reducing opioid cravings, preventing severe withdrawal symptoms and improving treatment retention.
Key Points: Understanding Cassipa Treatment & Your Recovery
The following are a few key points to remember about Cassipa:
- Cassipa helps people avoid returning to opioid use
- Cassipa is a combination of buprenorphine and naloxone in a sublingual film that is placed under the tongue to dissolve
- The film needs to dissolve completely so the drug can quickly enter the bloodstream
- When used in combination with counseling and psychological support, Cassipa can be a highly effective treatment for opioid use disorders
If you or a loved one struggle with opioid addiction, contact The Recovery Village Palm Beach to speak with a representative about individualized treatment programs that address substance use disorders alongside any co-occurring mental health disorders. Take the first step toward long-term sobriety, call today.
Food and Drug Administration. “Cassipa prescribing information.” September 2018. Accessed July 19, 2019.
Substance Use and Mental Health Disorder Services Administration. “Buprenorphine.” May 7, 2019. Accessed July 19, 2019.
Substance Use and Mental Health Disorder Services Administration. “Naloxone.” April 11, 2019. Accessed July 19, 2019.
Soyka, Michael. “New developments in the management of opioid dependence: focus on sublingual buprenorphine–naloxone.” Substance Abuse and Rehabilitation, January 6, 2015. Accessed July 19, 2019.
Drugs.com “Cassipa Side Effects.” February 10, 2019. Accessed July 19, 2019.
Sutter, M; Leeman, L; Hsi, A. “Neonatal opioid withdrawal syndrome.” Obstetrics and Gynecology Clinics of North America, June 2014. Accessed July 19, 2019.
Gunderson, Erik; Sumner, Michael. “Efficacy of Buprenorphine/Naloxone Rapidly Dissolving Sublingual Tablets (BNX-RDT) After Switching From BNX Sublingual Film.” Journal of Addiction Medicine, March 2016. Accessed July 19, 2019.