opioid medication

Buprenorphine: A Medication for Addiction and Chronic Pain

Christina Lasich, MD Health Pro October 28, 2012
  • Long before Suboxone, a product containing buprenorphine, was marketed as a treatment for chemical dependency and addiction, buprenorphine was being used by veterinarians and anesthesiologist for the treatment of pain. In the past, buprenorphine was not readily available for outpatient use because it is not a traditional medication that is taken by mouth and absorbed through the gastrointestinal system. Buprenorphine has traditionally been an intravenously administered drug, until now. There are now products that are dissolved in the mouth and products that are applied to the skin. So, the buprenorphine horizon is expanding.

     

    As an outpatient drug, buprenorphine became widely recognized as a chemical in the product called Suboxone, which is used to treat opioid chemical dependency. Tablets containing buprenorphine only, without the additional nalaoxone found in Suboxone, are also available but are not readily prescribed because buprenorphine is well-like by intravenous drug abusers. Now, the Suboxone tablets will no longer be made by Rickett Benckiser, which primarily leaves the Suboxone film and the Butrans transdermal patch.

     

    Besides treating drug dependency, many doctors have found the Suboxone film to be equally effective for the treatment of chronic pain. Although that is considered an off-label use, it is a use that makes sense. Buprenorphine should be considered a very useful medicine for treating chronic pain because of its numerous, unique attributes.

     

    The drug stimulates the opioid receptors in unique ways that not only provide a pain-relieving effect but also prohibit respiratory depression and hyperalgesia. The other advantage that buprenorphine has over other opioids like morphine and fentanyl is it’s effective for a variety of different pains, even those considered difficult to treat.

     

    One difficult pain to treat is metastatic cancer pain, especially when liver and kidney function is failing. Buprenorphine has been proven safe and effective in that challenging situation even at high doses.1 Children with cancer pain could also benefit from this unique opioid.2 Besides treating cancer-related pain, buprenorphine is being used for post-operative pain,3 including post-amputation pain. In fact, buprenorphine has been so effective at treating amputation related pain and phantom pain; it is becoming the opioid of choice for amputees. The types of pain that buprenorphine can be utilized for seems to be endless.

     

    So why aren’t more people using buprenorphine to treat pain? Veterinarians are much more comfortable with this chemical than the average physician who is used to prescribing hydrocodone. But this hesitancy will be changing as more discover the advantages of buprenorphine, such as an improved safety profile and less problems compared with morphine, methadone and fentanyl. Because of the expanding usefulness of buprenorphine, look for more products that contain it including a buprenorphine implant. In an effort to eliminate the resale of buprenorphine on the blackmarket, an implant is being developed primarily for the treatment of chemical dependency, but from there who knows what the future will hold. For now, buprenorphine has a place in this world as a treatment for chronic pain, addiction or even both simultaneously.4

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    1. J Opioid Manag. 2012 Jul-Aug;8(4):253-9
    2. Pediatr Blood Cancer. 2012 Oct 3. doi: 10.1002/pbc.24332
    3. Curr Med Res Opin. 2012 Aug 9
    4. J Subst Abuse Treat. 2012 Sep 11. pii: S0740-5472(12)00145-6