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How does buprenorphine work in the brain?

Imagine your brain is covered in opioid receptors. For a person without an opioid addiction, these receptors are used-to being empty most of the time (there are NO opioids on the brain’s receptors). For a person with an addiction, these receptors are used-to being completely filled-- with fentanyl, heroin, oxycodone, percocets, vicodin or other opioids. If a person runs out of opioids, the receptors that are used to being occupied instead go empty and the person feels awful opioid withdrawal symptoms (like having the flu! Sweating, nose running, body aches, chills).

So how does Suboxone work on people’s brain chemistry?

Buprenorphine/naloxone (Suboxone) is a partial-agonist opioid. It contains buprenorphine (the active opioid component) and naltrexone (which is not absorbed by the body but prevents misuse of the medication). When Suboxone binds to the opioid receptor, it PARTIALLY STIMULATES it, enough so the person does not feel cravings or withdrawal symptoms.  

At the same time, it blocks the opioid receptors from other opioids (like fentanyl and percocet) preventing relapse and overdose. Buprenorphine/naloxone (Suboxone) also has a CEILING effect, meaning that taking more and more does NOT produce a “high” or euphoria feeling AND it is very difficult for a person to overdose on Suboxone. So, it is considered a VERY safe medication that makes people feel NORMAL, not “high” or sedated, just normal so they can carry out their everyday activities and build a new life in recovery.

Randi Sokol, MD, MPH, MMedEd

Randi Sokol, MD, MPH, MMedEd, is an Assistant Professor at the Tufts Family Medicine Residency Program and Instructor at Harvard Medical School. She is Board Certified in both Family Medicine and Addiction Medicine. She earned her B.A. at the University of Pennsylvania, her Medical Degree and Masters in Public Health from Tulane University, completed Family Medicine Residency at UC-Davis, and earned a Masters in Medical Education through the University of Dundee.

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