Medication Assisted Treatment

Prescriptions To Help Manage Opioid Dependence

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Contact: Jerry Otero, MA  jotero@sachr.org Ext. 1015

In response to the COVID-19 pandemic, St. Ann’s Corner of Harm Reduction in partnership with Project Renewal, announces the operation of a free virtual telephonic buprenorphine (Suboxone) clinic providing continuity of care for existing patients, and to provide low-threshold MAT for new patients seeking easy access to the life-saving buprenorphine treatment.

Understanding MAT

Buprenorphine (Bupe), is a partial opioid antagonist sold under the brand name Suboxone (among others).  It is used to treat opioid use/withdrawal. It decreases withdrawal symptoms for about 24 hours. Bupe is available for use in two different forms, under the tongue or in the cheek. Naloxone, an opioid antagonist that blocks opioids by attaching to the opioid receptors without activating them, is poorly absorbed when taken by mouth and is added to some formulations of Bupe to decrease the chance that people will use it by injection.

Buprenorphine is an excellent intervention for someone that wants to stop using opioids or for someone that wants to re-define their relationship with them. If you are on Bupe and using other substances it can protect you from an accidental fentanyl overdose if what you have ingested has been adulterated with fentanyl. We are finding fentanyl in illicitly manufactured Xanax, crystal meth, crack, as well as heroin. Since the illicitly purchased drug market has been flooded with fentanyl, Bupe can protect you from an accidental opioid overdose if what you have purchased contains Fentanyl.   

Side Effects of Buprenorphine:

Side effects may include respiratory depression (decreased breathing), small pupils, sleepiness, and low blood pressure. The risk of overdose is lower with Bupe than with methadone. Methadone, or Bupe alone, are generally preferred when treatment is required during pregnancy.

Naltrexone, sold under the brand-names ReVia and Vivitrol (among others), is a medication primarily used to manage alcohol or opioid dependence.  You’ll need to be detoxed prior to beginning treatment or you will experience precipitated withdrawal.  It is taken by mouth or by injection into a muscle. Effects begins within 30 minutes and last approximately 28 days . A decreased desire for opioids, though, may take a few weeks.

Buprenorphine is currently available on Thursdays from 10:00 am – 1:00 pm

Side Effects of Naltrexone:

Side effects may include trouble sleepinganxietynausea, and headaches.  For those still on opioids, opioid withdrawal may occur. Use is not recommended in people with liver failure. It is unclear if use is safe during pregnancy.

Suboxone/Buprenorphine FAQ’s

Unfortunately, within the treatment community and among the public at large, certain myths about Suboxone persist, and these myths add a further barrier to treatment for people looking for help managing their opiate issues. In the following section, we take a look at the facts regarding Suboxone/Bupe use.

Can you be in "recovery" and still use Suboxone/Bupe?

YES! An individual has the right to define their own recovery. Additionally, abstinence-based models are moving towards a more modern conception of recovery that encompasses the use of medications such as Suboxone, that regulate your brain chemistry. As chronic substance use is increasingly viewed as a medical condition, Suboxone is viewed as a medication for a chronic medical condition, such as a person with diabetes needing to take insulin. To say that you aren’t really in recovery if you are on Suboxone is as stigmatizing as it is untrue.

Is it common to abuse Suboxone/Bupe?

Suboxone, unlike most medications, is more difficult to misuse. Since it’s a “partial” agonist of the “mu” receptor (the main opiate receptor), it causes less of a feeling of euphoria than other opiates. In most cases, people use Suboxone to help themselves manage their withdrawal or to get off of opiates. Reports of misuse or often fabricated and stigma-based.

Can you overdose on Suboxone/Bupe?

It is extremely difficult to overdose on Suboxone alone because it’s only a partial opiate receptor agonist, so there is a built-in “ceiling” effect. This means that there isn’t as great a risk of slowed breathing compared with opiates like heroin, oxycodone, methadone, or morphine. When people overdose on Suboxone, it is almost always because they are mixing it with sedatives such as benzodiazepines or alcohol, which also slow their breathing.

Do I have to be in therapy to receive Suboxone/Bupe?

Suboxone is a medication taken for treatment a condition like any other. If someone is receiving chemotherapy for cancer and not consulting a therapist they are still treating their cancer. There is no difference.

Can Suboxone/Bupe be taken as a long-term medication?

Suboxone should be taken for as long as the person requires it. Some people use it as a short term bridge to manage withdrawal or stopping using, while others may be maintained on it for the long term similarly to how a person would treat their diabetes with insulin for managed care.

What are the effects of Medication Assisted Treatment (MAT) during pregnancy?

Maintaining women on opioid use disorder medications during pregnancy is now the standard practice in medicine. A NIDA-supported clinical trial, the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, has found buprenorphine to be a safe and effective alternative to methadone for treating opioid dependence during pregnancy. Opioid withdrawal can cause significant medical complications to mother and child during gestation. Pregnant women or women thinking about becoming pregnant who have opioid use disorder should consult with their obstetrician/gynecologist but there appears to be no substantial added benefit of reducing buprenorphine dose during pregnancies. Moreover, the infants born to women who received buprenorphine had milder symptoms of neonatal opioid withdrawal than those born to women who received methadone.