The Buprenorphine Bias
Updated: May 7
Even though buprenorphine is an evidence-based treatment for opioid dependence, there are very few substance use facilities that will prescribe it.
According to one study in the Journal of the American Medical Association (JAMA), out of 368 treatment programs contacted in the US, only 29% offered buprenorphine as an option. 21% actively discouraged the use of buprenorphine.
A treatment facility here in Austin even has a blog article discouraging people from seeking out buprenorphine treatment, calling it a “quick fix solution”. The article has a clear bias and fails to point out that buprenorphine treatment is evidence-based, meaning it has been proven to be effective.
Why is our substance use treatment community so frequently failing to provide a potentially life saving medication? All people seeking treatment deserve to be made aware of their options.
What is Buprenorphine?
So, let’s backtrack and start by discussing what buprenorphine is. Buprenorphine is a partial opioid agonist. (Need help with terminology?) This means that it binds to our endogenous (within) opioid receptors but does not activate them as strongly as a full agonist (for example, methadone or heroin). It has been approved by the FDA and can be prescribed by doctors certified through the Drug Addiction Treatment Act.
Buprenorphine comes in several varieties and under several different brand names, though most people know it by the name Suboxone.
· Generic Buprenorphine/naloxone sublingual tablets
· Buprenorphine sublingual tablets (Subutex)
· Buprenorphine/naloxone sublingual films (Suboxone)
· Buprenorphine/naloxone) sublingual tablets (Zubsolv)
· Buprenorphine/naloxone buccal film (Bunavail)
· Buprenorphine implants (Probuphine)
· Buprenorphine extended-release injection (Sublocade)
How does Buprenorphine work?
Since it binds to our opioid receptors, several important things happen. It can lessen the effects of opioid withdrawal and cravings and increase safety in cases of overdose. Essentially it allows for people to regain some stability in their lives since they are not caught in the cycle of craving and withdrawal. Taking buprenorphine as prescribed typically has the effect of lessening other risks such as IV injection, risk of contaminated drugs, arrest for possession, etc.
Is Buprenorphine safe?
Yes, when given to you by a physician and taken as prescribed, buprenorphine is safe. There may be some side effects and no medication is right for everyone. However, buprenorphine is safe, effective, and evidence-based.
The Suboxone Stigma
“You are just trading one addiction for another.” Pardon, but I really have no more patience for hearing that from professionals any longer. First, let’s clarify something. People who take buprenorphine or methadone will become dependent. That is not the same thing as addiction. We are dependent on many things and without them, we might struggle and suffer. Addiction, or more accurately opioid use disorder typically implies a worsening of many life circumstances. For example, job loss, worsening health, legal issues, relationship problems, etc.
Research continues to indicate that buprenorphine reduces the risk of relapse, overdose, and death.
Many people participating in 12-step groups will be told that are not “really in recovery” if they are taking medications to help with their substance use. This is both harmful and inaccurate. And, according to an article on the American Society of Addiction Medicine website that belief is “not founded in scientific or 12-step philosophy and violates a long held 12- step policy of AA members should not give medical advice to each other.”
The education and research director for the National Association of Addiction Treatment Providers stated, “…spiritual and emotional change is fully compatible with use of a medication that helps you not crave and not overdose.”
The right treatment for you
No treatment is the right fit for everyone. If you are struggling with opioid dependence and are wondering if buprenorphine treatment is right for you, contact a prescriber to get more information. All decisions regarding prescription medication should be made between you and a professional who is licensed to practice medicine.
When it comes to your treatment, you should always have a choice.
Need help finding a buprenorphine prescriber? Use the Buprenorphine Practitioner Locator on the SAMHSA website.
Support if you need it
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, gambling, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.