How Does Buprenorphine Work?

Buprenorphine is a prescription medication often prescribed as part of programs that offer medications for opioid use disorder (mOUD). Instead of feeling sick and consumed with thoughts of drugs, people using buprenorphine products can focus on their therapy and develop healthy, sober habits. 

Years ago, people were required to visit clinics for mOUD therapies like methadone. Buprenorphine was the first at-home mOUD option, allowing people to preserve their privacy while combating OUD.[1] 

What Is Buprenorphine?

Buprenorphine is a generic prescription medication first marketed in 1985 as an opioid painkiller. In the early 2000s, researchers discovered the medication could also help treat OUD, and it was approved by the U.S. Food and Drug Administration for this purpose.[2] 

While buprenorphine shares characteristics with opioids like Vicodin and OxyContin, it works very differently than these other medications.

Buprenorphine is considered a partial opioid agonist, meaning it latches to brain cells used by drugs like Vicodin. While the latch is tight and long-lasting, buprenorphine doesn’t cause overwhelming reactions that lead to euphoria. Instead, it offers relatively weak reactions while blocking other drugs from latching.[1]

A person with OUD generally doesn’t feel intoxicated while using buprenorphine products. Instead, the weak effects of this partial opioid agonist help ease uncomfortable withdrawal symptoms (like vomiting) and intense drug cravings. People with OUD may feel normal while on buprenorphine, not high. 

Buprenorphine’s Impact on the Brain & Body 

Opioids like heroin and Vicodin are capable of slowing breathing rates while delivering an intense high. Buprenorphine is different. 

A typical opioid becomes stronger and more powerful with each dose. The more a person takes, the higher that person feels. At extremely large doses, opioids can cause severe sedation, leading to death. 

Buprenorphine has a so-called ceiling effect, meaning that after a certain point, it doesn’t get stronger with each increase in dose. It’s capable of triggering a limited amount of changes, and when that cap is reached, it can stop working. If people take more, buprenorphine can even begin to trigger withdrawal.[3]

Doctors consider buprenorphine a safe and effective mOUD option, as it’s extremely hard to overdose on this medication. Formulations like Suboxone are even safer, as they contain opioid antagonists that kick in at high doses. It is much more difficult to misuse these medications to the point that they would cause intoxication. They’re even harder to misuse to the point of overdose. 

Is Buprenorphine Addictive?

People with OUD rely on medications like buprenorphine to help them lead normal, healthy lives. Few people in mOUD programs misuse their medications and become addicted to them. 

Buprenorphine’s pharmacologic properties mean the drug isn’t rewarding or easy to use. And since it doesn’t deliver much or any high for people with OUD history (it’s not strong enough), there’s no incentive to misuse the drug. New addictions to buprenorphine are very rare in people with OUD.

But people without OUD can feel euphoria when misusing buprenorphine products. While they may not be at risk for overdose, they could develop a new opioid use disorder. 

People in mOUD programs must keep their medications safe, so no one can access and misuse them. 

mOUD 

Medications for opioid use disorder (mOUD) programs often rely on buprenorphine products. People who enroll can use their medications at home instead of heading to a clinic or hospital every day.

mOUD is part of a whole-person approach to OUD.[3] Medications ease chemical imbalances leading to withdrawal and cravings, and therapy teaches relapse prevention skills. When put together, these elements are powerful and capable of halting an active opioid use disorder. 

Experts consider mOUD and buprenorphine the gold standard of treatment for OUD. But close to 87% of people with OUD worldwide don’t get medications as part of their recovery plans.[4] 

If you’re struggling with opioid use, talk to your doctor about mOUD programs including buprenorphine, usually in the form of Suboxone. This type of program could help you change your life for the better. 

Sources

1. Buprenorphine. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine. January 2023. Accessed March 2023. 
2. Buprenorphine and Its Formulations: A Comprehensive Review. Health Psychology Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9392838/. August 2022. Accessed March 2023. 
3. What is Buprenorphine? UAMS Psychiatric Research Institute. https://psychiatry.uams.edu/clinical-care/cast/buprenorphine/. Accessed March 2023. 
4. History of the Discovery, Development, and FDA Approval of Buprenorphine Medications for the Treatment of Opioid Use Disorder. Drug and Alcohol Dependence Reports. https://www.sciencedirect.com/science/article/pii/S2772724623000033/ March 2023. Accessed March 2023.