Buprenorphine is an opioid-based medication that sometimes plays a role in the treatment of people addicted to stronger opioid substances. Normally, the medication is taken in a sublingual form that dissolves when placed under the tongue. However, in March 2013, the U.S. Food and Drug Administration (FDA) approved a new buprenorphine product, known as Probuphine, which a doctor must implant under the skin. In a study published in December 2013 in the journal Addiction, the medication’s manufacturer and researchers from 12 U.S. institutions compared the effectiveness of buprenorphine implants to the effectiveness of oral doses of the medication.
Since buprenorphine is an opioid substance derived from mind-altering chemicals contained in the opium poppy, it produces the same basic effects inside the brain as commonly abused opioid drugs and medications such as heroin, oxycodone (OxyContin), hydrocodone (Vicodin) and fentanyl (Duragesic). However, while the intensity of the effects produced by these abused substances is quite extreme, buprenorphine produces effects with a significantly lower level of intensity. If a person addicted to powerful opioids switches to buprenorphine, he or she will not experience the “high” normally associated with opioid use. Instead, he or she will experience a weakening of the opioid-fueled brain changes that support the continuation of addiction. In drug treatment programs, doctors use buprenorphine’s relatively modest opioid impact to wean addicts off stronger opioid substances while still providing enough of an opioid effect to prevent or sharply diminish the presence of opioid withdrawal. This is critical because problems with opioid withdrawal commonly play a major role in addicts’ failure to achieve drug abstinence and complete treatment. Buprenorphine is not easily absorbed by the body when ingested. For this reason, doctors typically prescribe the medication in sublingual (under the tongue) form to recovering addicts. In many cases, recovering addicts also receive simultaneous sublingual doses of another medication called naloxone, which helps prevent buprenorphine abuse by gradually decreasing the power of buprenorphine’s opioid effects.
Buprenorphine Implant Basics
Buprenorphine implants are placed under the skin in the upper arm during a short doctor’s visit. Once in place, they provide continual doses of the medication to the body for up to half a year. When the implants are no longer needed, doctors can remove them in another short office visit. Buprenorphine implants provide a potential benefit because they take the question of dosing out of the hands of patients going through addiction treatment. This has the simultaneous effect of eliminating the risks for buprenorphine abuse and ensuring that people in treatment don’t miss their required daily allotment of medication.
Effectiveness of Implants
In the study published in Addiction, the combined team of researchers compared the effectiveness of buprenorphine implants for opioid addiction treatment to the effectiveness of a commonly used buprenorphine/naloxone preparation. They also compared the effectiveness of buprenorphine implants to placebo implants designed to produce no medical benefit. During the course of the study, 114 opioid-addicted adults between the ages of 18 and 65 received buprenorphine implants, while 119 addicts from the same age range received sublingual doses of buprenorphine/naloxone. A third group of 54 age-matched opioid addicts received placebo implants. Over a period of 24 weeks, the researchers used urine drug testing to determine how many people from each group broke drug abstinence and relapsed into opioid use. The researchers concluded that, compared to recovering addicts who receive placebo implants, recovering addicts who receive buprenorphine implants experience a number of significant treatment benefits, including a lower rate of opioid relapse, lower levels of opioid withdrawal, lower levels of opioid craving during the recovery process and higher levels of general improvement. In addition, compared to placebo implant recipients, buprenorphine implant recipients substantially reduce their intake of cocaine. When compared to sublingual buprenorphine/naloxone treatment, buprenorphine implants provide a similar ability to avoid opioid relapse and experience other benefits commonly associated with buprenorphine-based treatment.
Significance and Considerations
Based on their findings, the authors of the study published in Addiction confirm the usefulness of Probuphine buprenorphine implants as an alternative treatment for opioid addicts going through the recovery process. Interestingly, the FDA did not unanimously approve the use of Probuphine. Stated reasons for this lack of unanimous approval included a lack of fully developed safety procedures for implanting and removing Probuphine tablets, lack of comprehensive information on proper dosing for the implants and lack of a fully developed training program for the doctors likely to prescribe, implant and remove the medication.