Using Buprenorphine for Pain Relief– Buprenorphine is most commonly used in medication-assisted treatment (MAT) to help people reduce or stop the use of heroin or other opiates. However, current research has also found that buprenorphine-naloxone (Suboxone) may also provide relief for opioid-dependent patients suffering from chronic pain.
How Buprenorphene Works
Buprenorphine works by mitigating withdrawal symptoms when a person dependent on opioids discontinues use. Buprenorphine has a specific mechanism of action that makes it desirable for treating opioid dependence and possibly chronic pain.
Buprenorphine has a high attraction to specific opioid receptors that are responsible for pain relief. It remains attached to these receptors for a longer time than other drugs, and as a result, has a prolonged effect.
However, despite this affinity, it acts only as a partial agonist. This means that it prevents opioid withdrawal symptoms, but its effects are less potent than other opioids. Also, and perhaps most critically, buprenorphine does not act on opioid receptors that cause feelings of euphoria.
Moreover, the drug does not induce a “high,” meaning that it has a much lower potential for addiction than other opioids.
As noted, buprenorphine is often combined with naloxone in the form of a drug called Suboxone. Naloxone is a short-acting, opioid antagonist. When combined with buprenorphine, naloxone can neutralize the potentially dangerous effects of other opioids, including sedation and respiratory depression, without preventing pain relief.
Although not nearly as severe as other opioids, both buprenorphine and Suboxone can have adverse side effects, including the following:
- Stomach and back pain
- Blurred vision
- Difficulty with sleep
- Mouth numbness
More severe side effects, including difficulty breathing or swelling of the mouth or tongue, require prompt medical attention. Importantly, combining buprenorphine with the use of other drugs like benzodiazepines can be fatal.
Buprenorphine for Pain: Research
In a 2017 review, researchers examined the efficacy of buprenorphine for the management of chronic pain. They analyzed more than two dozen randomized controlled trials involving five buprenorphine formulations.
Overall, the researchers found that 14 studies suggested that buprenorphine in any formulation was useful for the treatment of chronic pain. More specifically, 10 of 15 studies revealed that transdermal buprenorphine (skin patches) were effective, and two of three studies showed that buccal film (film placed between gum and cheek) was also effective.
However, only one study indicated that either sublingual (under the tongue) or intravenous buprenorphine was useful for the treatment of chronic pain. Importantly, no serious adverse effects were reported in any of the studies, indicating that the use of buprenorphine is safe.
In 2014, researchers published a review that examined the effectiveness of sublingual buprenorphine for the treatment of chronic pain. They found that sublingual buprenorphine was, indeed, efficacious.
Researchers suggested some potential benefits of buprenorphine, including the following:
- Increased effectiveness in treating nerve pain
- Ease of use among the elderly and in renal impairment
- Less immunosuppression compared with morphine and fentanyl
- Ceiling effect for respiratory depression when administered without other depressants
- Less development of tolerance
- Antihyperalgesic effect
Treatment for Hyperalgesia
Due to buprenorphine’s binding properties, it’s believed that it may be able to help those who suffer from opioid-induced hyperalgesia. Opioid-induced hyperalgesia is defined as sensitization caused by exposure to opioids. The condition is hallmarked by a paradoxical response in which a patient using opioids for pain relief could become more sensitive to painful stimuli.
Prescribing Buprenorphine for Pain
In the U.S., buprenorphine is being used to treat chronic pain, and Suboxone is sometimes prescribed off-label for this purpose. Also, the transdermal buprenorphine patch is available for the treatment of severe chronic pain.
Suboxone Abuse and Addiction
Suboxone, when used as directed and under the supervision of a physician or addiction specialist, can be an effective tool for helping a person discontinue opioid use. In some cases, it may also help manage pain.
Suboxone, however, like any opioid-based drug, has some potential for abuse. It can be purchased illicitly, and those with legitimate prescriptions can still become dependent. While the drug does not induce the same euphoric high as other opiates, if used in large quantities, it can have psychoactive effects.
If the drug is tampered with, this can result in a condition known as precipitated withdrawal. This condition may occur if a person crushes the drug and snorts it or liquifies it for injection. Naloxone is an opioid overdose-reversal drug that is used in Suboxone as a deterrent against abuse.
When used orally, naloxone is inactive. However, if the drug is tampered with, the naloxone would become active and, in theory, cause the person to go into instant withdrawal from opioids. Also, one could surmise that it would be likely to neutralize buprenorphine’s already minimal rewarding effects.
That said, instances of abuse still do occur. People that abuse Suboxone or buprenorphine alone say they will swallow, snort, or inject the drug in an attempt to intensify the effects. Suboxone is more apt to be abused by those addicted to relatively small doses of other opioids.
So, although the naloxone should make abuse less likely, it does appear that Suboxone could potentially cause a high when snorted. A rewarding high would be more likely in those who are “opioid-naive,” meaning individuals who don’t regularly use opioids and are not currently on a buprenorphine treatment program.
Signs of Suboxone Dependence
When someone is dependent on Suboxone, they may not exhibit significant symptoms, unless he or she is going through withdrawals. This may be the first sign there is a problem.
Several common behaviors may be associated with a drug dependency, and the following signs may indicate that someone you know has a problem:
- Doctor-shopping for drugs
- Isolation from family and friends
- Drowsiness or insomnia
- Deception/manipulation of others
- Obsessiveness over obtaining and using the drug
- Stealing or frequently borrowing money
- Lack of interest in activities once considered enjoyable
- Neglect of essential responsibilities, such as work, school, or family
Abuse and dependence do not necessarily equal addiction. Addiction is a condition also characterized by compulsive drug-seeking in spite of adverse consequences that result. In fact, it is possible for a person to become emotionally addicted to a substance even without a particularly strong chemical dependence.
Suboxone Addiction Side Effects
Suboxone addiction can lead to several side effects, including the following:
- Slurred speech
- Impaired coordination
- Small pupils
- Impaired memory
- Erratic moods and behavior
Also, the abuse of Suboxone can result in significant risks to one’s health, such as central nervous system (CNS) depression and overdose. Due to the presence of naloxone, Suboxone overdose is uncommon. Most cases of overdose and respiratory distress tend to manifest when the drug is used in combination with other depressants or psychoactive substances, such as alcohol or benzodiazepines.
Treatment for Opioid Addiction
Buprenorphine is a drug used primarily for the treatment of opioid addiction. It is often found as the combined medication, Suboxone, which also consists of naloxone. However, doctors sometimes prescribe Suboxone or stand-alone buprenorphine for pain.
Buprenorphine alone has a relatively low potential for abuse and addiction compared to other opioids. Suboxone may be even more abuse-deterrent. That said, abuse still does occur, and when an opioid is involved, there is always the possibility that a person will become dependent and psychologically addicted.
Recovery By The Sea offers comprehensive programs comprised of services beneficial to the recovery process. These services include, but are not limited to, the following:
- Peer group support
- Health and wellness programs
- Individual and family counseling
- Medication-assisted therapy
- Aftercare planning
If you or someone you love is addicted to opioids, contact us today! Discover how we help people break free from the shackles of addiction for good!
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