The Riskier Side of Buprenorphine

Buprenorphine may be one of the go-to medications to combat opioid dependency, but it has some very serious risks that are often glossed over including misuse, addiction and withdrawal.

A collection of studies published in 2015 in the journal Innovations in Clinical Neuroscience cited research performed in the United States, which revealed that surveys conducted during 2006 and 2007, 20-35 percent of participants acknowledged the misuse of buprenorphine. The studies cited also examined 129 admissions to an outpatient-based narcotics treatment program and found that 49 percent of participants illicitly used buprenorphine in the past 90 days.

The method of misuse is commonly intranasal (snorting) or through injection, the latter of which can cause infectious complications or death.

Another common misconception about buprenorphine is that it’s a quick fix.

“We know that [buprenorphine, when used] short term, is not as effective,” said Dr. Mitra Ahadpour, director of the division of pharmacological therapies at the Substance Abuse and Mental Health Services Administration. “Patients that are placed on buprenorphine, and then detoxified of it rapidly between a few weeks, we found that retention is not great — those individuals go back to using illicit or opioid medication misuse.”

The side effects

Major side effects of buprenorphine include blurred vision, confusion, difficulty breathing, dizziness, faintness, drowsiness, pinpoint pupils, unusual fatigue, pale or blue lips, fingernails or skin, relaxed or calm feelings, and lightheadedness when standing from a lying or sitting position.

In addition, there are some common minor side effects including back pain, headache, nausea, stuffy or running nose, fever or chills, coughing, sneezing, stomach pain, vomiting, insomnia, constipation, and painful or difficult urination.

Less common minor side effects include diarrhea, sweating, faintness, lack or loss or strength, a sensation of warmth or heat, and redness in skin tone around the face and neck.

Withdrawal symptoms

Withdrawal occurs because the body is attempting to heal from a consistent and extensive use of buprenorphine and the severity of withdrawal symptoms varies depending on the length and method of use.

Buprenorphine releases distinctive chemicals throughout the brain and body, and those chemicals are needed for day-to-day functioning when a patient becomes dependent.

Once a patient gets off buprenorphine, the brain may stop producing those natural chemicals, which leaves a void in the way it functions.

This is when withdrawal symptoms including nausea, vomiting, diarrhea, confusion, insomnia, anxiety, mood swings, irritability, abdominal pain, restlessness, excessive sweating, insomnia, and flu-like symptoms can begin to kick in.

One of the more serious withdrawal symptoms of buprenorphine is pulmonary aspiration

when vomit is accidentally inhaled into the lungs. Although this symptom may cause little to no harm, it could also lead to pneumonia or death from asphyxiation. Dehydration can also occur, and if left untreated can become deadly.

Underlying mental disorders, like depression or bipolar disorder, can also worsen during the withdrawal period, and relapse is the most common complication.

Typically, withdrawal can begin shortly following the last dose and can peak within the span of two to five days.

Withdrawal symptoms can also become overwhelming, which can route patients back to buprenorphine abuse and possibly to severe addiction.

Buprenorphine can still be effective for some

Raney Young, 59, began taking opioid painkillers for “legitimate pain” when he was in college.

He soon became hooked, and his addiction lasted for three decades.

Young would spend much of his life obtaining painkillers both legally and illegally, but it would come with consequences. “I pretty much lost everything time and time again: family, jobs, friends, possessions, just from addiction,” the Louisiana resident said.

From age 19 to 48, he would only have one year of sobriety.

After treating addiction with methadone for about eight years, he built a tolerance and needed something different. “I heard about buprenorphine being legalized in 2002,” he said. “It has changed my life totally.”

Young said he has been on buprenorphine for seven years and has gone from using 24 mg per day to 4 to 6 mg per day.

“Most of the time I forget to take my little quarter of a pill in the morning,” he said. “I have to remind myself to do it. You’re not in that drug-seeking behavior mindset that you are on pills, always withdrawing, your body is constantly craving something. You’re not like that with [buprenorphine].”

Young said he expects to be completely drug-free in three years.

The potential for misuse and safety precautions

A pill is not a panacea for addiction.

And according to Ahadpour, physicians have to “really assist the patient to see what would be the best medication and best route for treatment. It should be a collaborative effort with the patient.”

Medications like Suboxone, which combines buprenorphine and naloxone, and are taken as a sublingual tablet (placed under the tongue for absorption) are intended to decrease misuse.

However, if the sublingual tablets are crushed and injected, the effects are overrun by the naloxone and can cause opioid withdrawals.

“Addiction is a treatable disease, and medication assisted treatment is not just about medication,” Ahadpour said. “For it to be effective, you need to have the medication behavioral therapy, counseling, and social support.”

Safety should be a priority when taking buprenorphine, and there are precautionary measures one can take: Avoid taking other medications before consulting your healthcare professional and especially avoid taking illicit drugs, alcohol, sedatives or similar drugs that promote slow breathing. Do no mix large amounts of other medications with buprenorphine, as it might lead to overdose or death. Lastly, be sure there are no liver-related issues before using the medication, as liver problems from the use of buprenorphine are rare, but can occur.