Last Updated on June 11, 2014 by Morris Green
The warning message you see in this image about Buprenorphine or bupe for short is a part of the clinical advisory for this prescription drug used to treat heroin and opiate addictions. The very nature of this treatment is becoming the topic of discussion because the question still remains almost 12 years after the first pill was prescribed: Is bupe causing more harm than good?
In a previous post, we shared how bupe and its brand name, Suboxone, has caused many users to become so dependent that they wind up trading one addiction for another dependence. Is that fair to those who really want to get off of drugs and become “clean”? Is this the only way? We don’t want to get into the issue with the drug companies, lobbyists and the regulatory agencies. But what we do want to do through this discussion of the topic of bupe and Suboxone, is speak up as advocates for people who come to us and others in our field for help. Some people who are suffering from the effects of an addiction simply need someone on their side to look out for their long term wellbeing. With that in mind, we stand with the substance abuse professionals, addiction counselors, doctors and pharmacists who work together for monitored, assisted treatment for those who are trying to get real treatment for drug abuse.
Several studies show the effectiveness of bupe for helping people rehabilitate and survive heroin and opiate addictions. In a recent report Dr. Andrew Kolodny, the president of Physicians for Responsible Opioid Prescribing, stated that without bupe, the number of deaths from opiod overdoess would have been much higher than the numbers reported in the most recent 2010 study. The reason for that is because before bupe, the main prescribed treatment for opiate addictions was methadone, a drug that worsened side effects and increased withdrawal symptoms.
What does successful use of bupe to treat opiate addiction look like?
Every person who seeks help for a drug free life responds to treatment differently. Some people can quit cold turkey, others need assistance from a drug like buprenorphine, while others need more comprehensive care that involves their doctor, treatment provider or facility as well as their family. For those who use a prescribed drug to make the transition easier, there may be side effects from both the withdrawal from the illegal drug as well as the acceptance of the legal prescription. This is why the use of bupe in heroin addiction treatment is so delicate.
On the one hand, the patient/client is not using an illegal substance, but on the other hand, there is the possibility of becoming dependent on another drug. What we are seeing is with a more involved treatment plan that involves careful monitoring and management, people have been able to successfully be cured from their addiction to opioids and no longer need bupe to continue to live a normal life. But at this time, those cases are outnumbered by the people who still depend on bupe, even with a more comprehensive treatment plan.
We do know that the FDA does provide guidelines for clinical supervision and administering of buprenorphine. Here what the FDA recommends for monitoring patients who are prescribed bupe:
“When determining the prescription quantity for unsupervised administration, consider the patient’s level of stability, the security of his or her home situation, and other factors likely to affect the ability to manage supplies of take-home medication.
Ideally patients should be seen at reasonable intervals (e.g., at least weekly during the first month of treatment) based upon the individual circumstances of the patient. Medication should be prescribed in consideration of the frequency of visits. Provision of multiple refills is not advised early in treatment or without appropriate patient follow-up visits. Periodic assessment is necessary to determine compliance with the dosing regimen, effectiveness of the treatment plan, and overall patient progress.
Once a stable dosage has been achieved and patient assessment (e.g., urine drug screening) does not indicate illicit drug use, less frequent follow-up visits may be appropriate. A once-monthly visit schedule may be reasonable for patients on a stable dosage of medication who are making progress toward their treatment objectives…
The decision to discontinue therapy with Suboxone sublingual tablets after a period of maintenance should be made as part of a comprehensive treatment plan.”
What many doctors have found is that ending treatment that involves Suboxone or generic bupe has not been easy for many patients whose bodies have become dependent on the drug. This is where the question of whether the prescription of bupe to help patients overcome opiate addictions is an effective long term solution.
We want to hear from you: Do you or someone you know use buprenorphine or Suboxone? What success have you had with treatment? Have you prescribed Suboxone or generic bupe? What have you found to be most effective in the treatment process?