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Tapering Buprenorphine Less Effective Than Maintenance Treatment for Opioid Addiction

Ongoing buprenorphine maintenance therapy is superior to buprenorphine detoxification in treating prescription drug addiction, researches from the Yale University School of Medicine Yale have found.

Buprenorphin is an opioid-based medication that doctors can use to help people addicted to opioid drugs or medications halt their uncontrolled substance intake. In some cases, the medication is used temporarily to ease the impact of opioid withdrawal; in other cases, patients/clients receive ongoing doses of the medication as part of an approach called buprenorphine maintenance. In a study published in October 2014 in the American Medical AssociAll Postsation journal JAMA Internal Medicine, researchers from Yale assessed the effectiveness of buprenorphine maintenance in supporting successful outcomes for people recovering from prescription opioid dependence/addiction. Discussing the need for the study, lead author Dr. David Fiellin, professor of internal medicine at the Yale School of Medicine, said that, currently, “primary care physicians lack evidence-based guidelines to decide between detoxification or providing patients with ongoing maintenance therapy.”

Buprenorphine

Buprenorphine is a manmade substance based on the chemical properties of a naturally occurring opioid called morphine. However, the medication is substantially weaker than morphine, the morphine derivative heroin and essentially all other commonly abused opioid drugs and medications. When given to a person used to consuming a highly potent opioid, buprenorphine produces a much smaller “high” inside the brain; still, the medication triggers enough of an opioid effect to stop that person from going through severe forms of opioid withdrawal. This property makes buprenorphine valuable as a treatment for people recovering from an addiction to illicit/illegal street opioids, as well as people recovering from an addiction to powerful opioid medications such as oxycodone and hydrocodone.

Buprenorphine is frequently combined with an anti-opioid medication called naloxone, which blocks the brain’s ability to experience an opioid “high.” When present in the proper amount, naloxone gradually cuts off buprenorphine’s access to the brain and thereby limits the brain’s opioid exposure. This action lowers the risks that a person with a buprenorphine prescription will attempt to use/abuse the medication recreationally as a substitute for other opioid substances.

Buprenorphine Maintenance

Doctors can use buprenorphine in two basic ways. First, they can use the medication on a temporary basis in order to reduce the risks that a person going through opioid withdrawal will halt his or her recovery participation and return to the uncontrolled intake of an opioid drug or medication. Doctors can also prescribe ongoing, strictly monitored doses of buprenorphine as a longer-term substitute for the opioid substance previously consumed by a client/patient in an uncontrolled (and therefore highly dangerous) manner. This approach, known as buprenorphine maintenance, is analogous to the common use of another opioid medication called methadone. However, generally speaking, buprenorphine maintenance is less likely to produce severely negative consequences in any given individual than methadone maintenance.

Effectiveness for Opioid Addiction Treatment

In the study published in JAMA Internal Medicine, the Yale University researchers used a project involving 113 people to explore the effectiveness of buprenorphine maintenance as a treatment for prescription opioid dependence/addiction. Half of these participants were randomly assigned to receive gradually decreasing, temporary doses of buprenorphine over the course of 14 weeks. The other half received ongoing, steady doses of the medication as part of buprenorphine maintenance. In addition, the participants in both groups received supportive medical care and had access to counseling resources. The researchers used three main measurements to compare the effectiveness of the two treatment approaches: self-reported intake of other opioids, intake of other opioids as detected by urine drug testing and the ability to stay actively involved in the recovery process.

The researchers found that, while receiving buprenorphine, the group that had only temporary access to the medication had a substantially smaller chance of using/abusing another opioid substance than the group receiving buprenorphine maintenance. However, after the temporary use of buprenorphine came to an end, these individuals used/abused other opioids more frequently than their counterparts. In addition, the individuals in the group that received only short-term buprenorphine typically managed to avoid using other opioids for fewer consecutive weeks and also had smaller chances of staying actively involved in treatment. Roughly one-third of the short-term medication recipients relapsed back into uncontrolled opioid intake during the study.

Overall, the study’s authors concluded that buprenorphine maintenance is an effective treatment for people recovering from prescription opioid dependence/addiction. They also concluded that buprenorphine maintenance produces treatment results that are superior to the results produced by temporary buprenorphine use. Specifically, the authors note that compared to people who only receive short-term doses of the medication, people who receive ongoing doses have lower chances of experiencing opioid overdoses and other seriously negative consequences of uncontrolled opioid intake. The authors believe their findings underscore the chronic nature of addiction and the need to view addiction recovery as a long-term, ongoing process.

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