Buprenorphine Addiction

Doctors typically prescribe buprenorphine as part of a drug rehabilitation regime but, for some patients, this is simply replacing one addiction for another. Countless patients begin taking buprenorphine to overcome an addiction to another opioid and then end up addicted to buprenorphine instead.

In a collaborative statement, the American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine defines addiction as "a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving."

Addiction versus Dependency

This same group of medical professionals defines physical dependence as "a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist." In simple terms, drug dependence is a state where a person's body needs a drug in order to feel normal. Addiction is the compulsive use of a drug. Dependence is the physical manifestation and addiction is the behavioral aspect of drug use.

Addiction and dependence on drugs are independent from one another: you can be addicted to something without being physically dependent on it and vice versa. For example, a person may be physically dependent on blood pressure medication; this patient must take a drug for his body to function normally but his behavior will not change if he does not receive the drug. Heroin is an example of a drug that causes addictive behavior without the development of physical dependence. Buprenorphine use can result in both physical dependence and addictive behavior.

Both addiction and dependence cause real changes in your body and brain but addiction and dependence manifest themselves in different ways. When levels of buprenorphine decrease, you may exhibit signs and symptoms of withdrawal associated with physical dependence as your body tries to stabilize itself chemically.

Addiction: What Family Members Should Know

While medical science has not yet established the exact cause of drug addiction and dependence, scientists agree that genetics may play a role along with other environmental factors, including peer pressure, emotional distress, anxiety, depression and environmental stress. Fear of failure and relapse back to opioid use may cause some buprenorphine users to remain on this replacement drug longer than medically necessary. Family members learn improved methods of expressing support and reducing environmental stresses that enhance discontinuation of replacement therapies such as buprenorphine.

A child growing up in a household where illicit drug use is acceptable, or one or more parent is using buprenorphine therapy, is more likely to develop addictions later on in life. Scientists at the American Society of Addiction Medicine state that genetic factors account for about half the likelihood that an individual will develop an addiction.

Addiction Symptoms: Physical and Psychological

  • Inability to abstain from buprenorphine consistently
  • Behavioral control impairment; being unable to control one's own actions
  • Cravings for drugs or other intense reward experiences
  • Diminished capacity to recognize significant personal or relationship problems
  • Dysfunctional emotional response

Addiction causes changes in brain structure and function, especially in those areas of the brain associated with reward, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala. Addiction also changes the way the brain remembers rewards.

Behavioral manifestation and complications of addition:

  • Excessive use or participation in addictive behaviors, often at higher frequency or intensity than intended and frequently couple with an expressed intent and attempts to control behavior
  • Excessive time lost pursuing, using or recovering from substance abuse
  • Continued use of the substance despite understanding the consequences of abuse
  • Narrowing behavioral repertoire focusing on the reward aspect of addiction
  • Apparent lack of ability or interest in taking action to quit

Cognitive changes:

  • Preoccupation with substance abuse
  • Altered perception of the benefits and risks of drug abuse
  • Inaccurate belief that the individual's problems are due to other causes rather than as a predicable consequence of drug abuse.

Emotional signs of addiction include:

  • Increased anxiety, dysphoria and emotional pain
  • Increased sensitivity to stressors. "Things seem more stressful"
  • Difficulty identifying feelings or expressing them to others

Addiction and gender: how women and men are affected differently

Research statistics show women are more likely to abuse prescription drugs and are more likely to abuse more than one substance than are males.

Men are more likely to exhibit social disorders, such as criminal activity, whereas addicted women are more likely to experience mood disorders. Women with addictions are more likely to express dislike for their bodies than are addicted men and are therefore at higher risk for developing eating disorders. Addicted men are more likely to engage in drugs socially, whereas an addicted woman tends to abuse drugs in private. Since doctors now prescribe buprenorphine for take-home use, women may be more likely to use buprenorphine rather than methadone, which requires an in-patient stay at a rehabilitation facility.

Signs of addiction: For those around

Features of addiction include changes in a person's behavior, thinking patterns, emotions and interactions with others, such as family members, co-workers, friends and members of the community. Addiction alters an individual's executive functioning; these changes manifest themselves in problems with perception, learning, impulse control compulsivity and judgment.

Treatment options

Treatment can save the life of an individual addicted to Buprenorphine. The first step is to address physical dependence and then progress to counseling that focuses on addiction. A person who became addicted to Buprenorphine through recreational intravenous drug use may require advanced, life-saving medical treatment to reduce toxic levels of Buprenorphine in the blood before he can address his addiction. Advanced life support is administered to patients who have taken an overdose of buprenorphine concurrent with detoxification measures.

Treatment options are expanding for individuals with dependence and addiction to buprenorphine. Because they have been through standard treatment at least once before, some people may try self-detox at home. Without medications to ease withdrawal symptoms, an addict faces several days to weeks of overpowering physical discomfort, including nausea and vomiting, muscle aches, sweating, watery eyes, stomach cramps, overwhelming fatigue and tremors. The phrase, "quitting cold turkey" refers to a person's cold and clammy skin during withdrawal. Symptoms frequently prevent individuals from successfully self-detoxifying without the aid of anti-withdrawal medications.

Some individuals concoct recipes to address the symptoms of withdrawal. One such recipe, known as The Thomas Recipe, uses large doses of valium or some other benzodiazepine such as Xanax, Librium or Ativan to reduce the withdrawal symptoms in the first few days, tapering down the doses as withdrawal symptoms subside. Imodium reduces diarrhea while L-Tyrosine helps individuals overcome extreme exhaustion. Vitamin B6 helps your body absorb L-Tyrosine. Mineral supplements containing zinc, potassium, phosphorus, magnesium and copper help with restlessness. A hot bath, shower or Jacuzzi helps with muscle aches. While these concoctions help, self-detoxification does not replace professional assistance and may even be dangerous.

Outpatient care works for many individuals. During outpatient care, individuals receive treatment without spending time away from family or work. Buprenorphine addiction poses a special problem in outpatient care in that outpatient care physicians usually prescribe this drug to treat other addictions. Outpatient providers will need to monitor individuals with buprenorphine closely.

Inpatient care may be more beneficial to buprenorphine addicts. During inpatient detoxification, physicians administer drugs to chemically lower the level of buprenorphine in the body and dispense medicine to relieve the ensuing withdrawal symptoms. Even with this level of care, a person with buprenorphine dependence can experience unpleasant physical discomfort for five or more days.

Rapid detox may be the best solution for people dependent upon buprenorphine because it does not replace one addiction with another, nor does it make the dependent individual suffer needlessly. During rapid detox, physicians administer the usual detoxification and anti-withdrawal medications along with anesthesia and sedation. The patient sleeps comfortably through withdrawal and awakens with no memory of the uncomfortable process. Rapid detox reduces withdrawal to just a few hours instead of a few days.

Once free from physical dependence on buprenorphine, a person can focus on rehabilitation for his addiction. Behavioral treatments engage patients in their own treatment process, modify their attitudes and behaviors related to drug use and enhance healthy life skills. Behavioral treatments include cognitive-behavioral therapy, which seeks to help individuals identify, avoid and cope with situations that might lead them back to drug use. Multidimensional family therapy, originally designed to help adolescents with substance abuse problems, improves the overall functioning of the family in a way that reduces environmental stresses that lead to drug abuse. One type of motivational therapy that works well with buprenorphine addiction is motivational interviewing, which capitalizes on an individual's readiness to change his behavior and continue treatment. Motivational incentives keep patients on the right rehabilitative track with positive reinforcement.

Standard behavioral treatment programs last 28 days. Longer programs may be more effective for those with buprenorphine addiction, especially if they became addicted to buprenorphine as a result from a replacement program. A therapeutic community, or long term residential program, can last for six to twelve months or longer, depending on an individual's needs. Re-socialization is the main focus of therapeutic communities, offering the buprenorphine addict an improved lifestyle.