As the American opioid crisis continues to grip the nation and spur government action, the dilemma of how to best heal its damage grows more complicated. Nearly 400,000 Americans have died from opioid-related overdoses since 1999, and over 130 people die each day from opioid overdoses. The stakes of the crisis’s continued impact are dire enough that every medical and governmental response must be effective and low risk.
Accordingly, the implementation of medical-assisted treatments (MAT) have come under understandable scrutiny. It’s the MAT’s use of opioid replacements like methadone and buprenorphine that can seem suspect as a way to help patients recover from opioid addictions. Both methadone and buprenorphine generate pain-reducing effects similar to those of fentanyl and heroin (to a smaller and less harmful degree). Given that opioid treatment has become so crucial in the United States, it seems reasonable to point out that MATs might simply exchange one addictive painkiller for another addictive painkiller. In this criticism, no one can recover; the harm is simply disguised and permitted by way of a FDA-approved brand.
But this skepticism misunderstands the working components of medical treatments like suboxone, with uses buprenorphine. Its opioid-like effects are not interchangeable with those of more harmful opioids, and while it does reduce pain, it also counteracts the addictive euphoria which cause patients to suffer withdrawal during their treatment periods.
Let’s step back to clarify what buprenorphine is and what it does. The drug was first patented in 1969 and has provided pain relief in both the United States and Europe since then. Its design combines both agonist and antagonist opioid features to help patients recover from addiction. An opioid agonist is a substance that creates the chemical euphoria which so easily hooks users of heroin and fentanyl with escalating addictions. An opioid antagonist is a substance that rejects the chemical effects of opioid agonists by preventing the body’s reception of the agonists. Buprenorphine contains both of these mechanisms to combat withdrawal symptoms and to wean patients’ bodies off addiction to opioids.
It’s no secret that buprenorphine contains the partial-high of stronger opioids, namely because the presence of its chemical agonists lessens the discomfort of withdrawal symptoms. If buprenorphine didn’t possess its agonist components, then those patients using it would have no defense against the worst levels of nausea, cramps, anxiety, and depression which opioid withdrawal causes. These pains are relieved by buprenorphine use, but the agonist level isn’t high enough to recreate the chemical euphoria which the body has become addicted to. And this effect is only half of what buprenorphine does. Its opioid antagonist half acts upon the body’s receptors until they can no longer fully receive opioids as they once had. This chemical reaction tapers down patients’ physiological need for the addictive opioids, decreasing their dependency so that they can begin the process of building a new, opioid-free life following their treatment.
To be sure, all medical treatments have risks. Buprenorphine carries some expected side effects of varying discomfort: feelings of dizziness or drowsiness; nausea or vomiting; headaches or constipation; shallow breathing or dry mouth; feeling less hungry or more flushed; and feelings of anxiety or confusion. Not every patient treated with buprenorphine will experience every one of these symptoms, but this list contains the most common ones. The discomfort of these effects do lessen when placed in the context of much harsher withdrawal symptoms, however.
Buprenorphine is a stable and effective MAT when compared to its peer medications, specifically the more commonly-used methadone. Research comparing the two medications suggests that buprenorphine is six times safer than methadone concerning the chance of fatal overdose. Though research is still quite new and continues to develop, current conclusions support buprenorphine over its competitor MATs. Add to this that the treatment is associated with a better chance of opioid abstinence in the years after rehabilitation. These two benefits—relative safety and likely efficacy—can outweigh the risks and misconceptions which buprenorphine carry.
Count up the positive aspects of buprenorphine listed here: balanced opioid agonist-antagonist treatment, withdrawal protection, decreased dependency, proven stability, and demonstrated adequacy. These compensate for the possible side-effects of buprenorphine, never mind the misconception that buprenorphine replaces opioids as an addictive drug. So consider buprenorphine as an effective treatment of opioid addiction. Make sure that its treatment plan and medical personnel are sound first, but realize that its opioid characteristics do not disqualify the good it can do for recovery.