Introduction to Buprenorphine
Opioid addiction is a significant health problem in the US, with an estimated 2.5 million prescription drug-addicted patients and 800,000 heroin abusers (Loxterkamp, 2006). Opioid addiction negatively impacts the health of users, disrupts their families, and is detrimental to the public in terms of costs and crime. Until 2000, the only treatment for opioid-addicted patients was methadone maintenance therapy provided solely in federally regulated programs.
The passage of the Drug Addiction Treatment Act of 2000 (DATA) enables physicians to prescribe or dispense Schedule III, IV, and V narcotic drugs if they are waivered. Becoming waivered requires that specific criteria be met. As a consequence, physicians are playing an increasingly influential role in substance abuse treatment. Since buprenorphine is a Schedule III drug, physicians can now prescribe, dispense, or administer it to patients in their office, greatly expanding the availability and accessibility of opioid addiction treatment. Other characterisics and advantages of buprenorphine include:
- Combination buprenorphine/naloxone, sold as generic or brand name Zubsolv®* tablet or as brand name Suboxone™ film, or the monotherapy buprenorphine tablet
- Administered sublingually
- Can be prescribed to both patients abusing prescription opioids and patients abusing heroin
- Milder withdrawal symptoms due to its partial-agonist property (methadone is a full-agonist) (Krantz and Mehler, 2004)
- Minimal oral bioavailability, leading to less potential for diversion
- As effective as methadone treatment for reducing opioid use in addicts (Greenwald et al., 2002; Mattrick et al, 2002)
Over 10,000 physicians have received buprenorphine certification since the passage of DATA in 2000. Another recent step forward was the Office of National Drug Control Policy Reauthorization Act of 2006 (ONDCPRA), which increased the number of patients a qualified physician can treat with buprenorphine from 30 to 100. HHS announced changes that after a year of experience being waivered to treat 100 patients, physicians can apply to treat 275 (HHS, 2016). Certain addiction speicalists can also treat 275 patients.
*We are using brand names since there is a difference in the product that is not reflected in the generic name. We are not advocating one brand or the other.