Buprenorphine Treatment

La Jolla Recovery believes immensely in the power of medication-assisted treatment, including Buprenorphine.

Buprenorphine was approved to treat opioid use disorder at the beginning of the century and has shown positive outcomes and reduced overdoses. It is often used on its own to relieve the symptoms of opioid withdrawal but is more commonly combined with Naloxone in a product most widely known as Suboxone.

Buprenorphine: The Opioid Agonist

Buprenorphine and Naloxone

Naloxone is an opioid antagonist, which means that it does not cause any opioid effects, and if taken improperly, causes immediate withdrawal symptoms, such as diarrhea, muscle cramps, nausea, and vomiting. To be considered improper use, Naloxone must be injected into the bloodstream. The combination of Naloxone and Buprenorphine is simply intended as a deterrent to abuse.

Buprenorphine/Naloxone typically comes in tablets that the patient places in the cheek or under the tongue to dissolve.

Detoxing with Buprenorphine

Stepping Away from Stopping "Cold Turkey"

Precipitated withdrawal is a condition where the patient may experience severe withdrawal symptoms when taking their first dose of Buprenorphine/Naloxone if they have other opioids still in their system. There are two reasons why this might happen.

  1. Buprenorphine/Naloxone has “low intrinsic activity” because it is a partial opioid agonist. This means when the molecule attaches to a receptor site in the brain, it does not activate or light up that receptor to the same extent most other opioids do, including methadone. It is like a light switch. Naloxone/buprenorphine acts like a dimmer switch when other opioids and methadone “turn the light on.”
  2. Buprenorphine/Naloxone is a sticky molecule (high affinity). Once attached to the receptor, it is not likely to come off. That’s why it is so long-acting.

So, what does this have to do with stopping cold turkey? If someone who takes Buprenorphine/Naloxone for the first time also has other opioids in their system, the Buprenorphine/Naloxone will compete with that other opioid for the receptor. It will win the battle due to its high affinity, throwing the other opioid off the receptor site and replacing it.

Once Buprenorphine/Naloxone is in the receptor, its lower intrinsic activity does not activate the receptor to the same extent as the opioid just kicked out. This is what causes the withdrawal. It comes on all of a sudden, and the acute symptoms are challenging to overcome for hours.

Treatment with Buprenorphine

The Positive Impact of Buprenorphine as MAT

The patient should show up for the first dose of Buprenorphine/Naloxone in a state of mild to moderate withdrawal to eliminate the possibility of unnecessary pain.

Patients must be in active withdrawal to start suboxone treatment. Initial withdrawal symptoms generally include sweating, nausea, muscle cramps, sneezing, and yawning. 

La Jolla Recovery center staff can help you determine whether you are in withdrawal or not. In general, most short-acting opioids (like oxycodone, fentanyl, morphine, and heroin) result in withdrawal symptoms starting about 5 or 7 hours after consumption, but this may vary in each person. If you have used methadone or any other long-acting opioid, you will need to wait much longer to enter the withdrawal phase.

La Jolla Recovery has a culturally rich atmosphere and wants to make you feel at home, including LGBT identifying staff and diverse backgrounds.

Buprenorphine and HIV prevention among injecting drug addicts

Change in the role of buprenorphine (and other medicines used in agonist pharmacotherapy of opioid dependence, like methadone) is generally recognized now as an effective treatment for opioid addiction. 

Buprenorphine maintenance treatment programs give opportunities for expanded HIV prevention among injecting drug users and a platform for implementing directly observed antiretroviral therapy for people with opioid dependence who also have HIV/AIDS. It works well as a therapy for opportunistic infections such as tuberculosis in such individuals.

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Sublingual tablets of buprenorphine

Given the great importance for public health of buprenorphine, sublingual tablets are of lesser interest for abuse and recreation, as they lack the physiological effect as immediate as injections have. 

There are large-scale programs of psychosocially assisted pharmacological treatment of people dependent on opioids with buprenorphine.  To explore this approach of exempting sublingual tablets from specific control measures to increase the ease of access for medicinal purposes. 

International health organizations recommend that countries could consider exempting combination sublingual tablets with buprenorphine and naloxone from specific control measures since buprenorphine is also difficult to extract from these pills. 

It is still considerable and even increasing abuse of buprenorphine by injection, though. However, as buprenorphine was included in the list of essential drugs, and its great usefulness in inpatient treatment was thus confirmed, it meets the criteria for schedule III of the Convention on Psychotropic Substances (1971) and should therefore remain, as it already is, under this Schedule. The risk of abuse of sublingual tablets is quite low.

At La Jolla Recovery, we want to provide a medication assisted treatment optional service including buprenorphine and suboxone to more readily attend the detox and withdrawal process of opiates such as heroin, fentanyl and other abused prescriptions. If concomitant use of opiates were done with alcohol or stimulants like cocaine, we will be providing a program specific to its detoxification with clinical supervision. If mental health disorders are also needing attention, we do provide dual diagnosis therapy. We believe by attending the mind with evidence based research wee are able to prolong sobriety and provide support in transitioning. At La Jolla Recovery buprenorphine rehab, we believe that a systems approach involving family is more effective that just treating the individual. Learn more about our family program to support medication assisted management. Other medication assisted treatment optional treatments include Vivitrol as well as other more modern approaches as opposed to detoxing from methadone.

If coming from out of state and requiring attention on intake and coordination, please let us know. Whether from New York, Texas, Arizona or Florida, we want to make San Diego your new home. Not into twelve steps or AA? No worries, we meet you where you are at and are here to provide a tailored program for your medication assisted treatment.

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