Pharmacology and formulation

Buprenorphine acts as a partial opioid agonist by attaching tightly to the same receptors in the brain as other opioids, such as oxycodone, heroin, or methadone, blocking their effects and preventing withdrawal symptoms. Buprenorphine produces only weak morphinelike effects, without the euphoria triggered by full opioid agonists in opioiddependent individuals. Buprenorphine carries a lower risk of abuse, dependence, and overdose compared to full opioid agonists.However, a fatal overdose is still possible if patients combine buprenorphine with other central nervous system (CNS) depressants, such as sedative-hypnotics (e.g., benzodiazepines) or alcohol.

Effectiveness of Buprenorphine office-based treatment 

A 2006 evaluation of buprenorphine office-based treatment showed it to be effective. Most physicians surveyed (74%) found one or more months of buprenorphine treatment to be effective for their patients, with 60% of patients abstaining from all drugs and 84% from opioids (except buprenorphine) after a one-month period.

Slightly more than half the physicians (53%) had no previous experience with medication-assisted treatment (MAT) for opioids. (MAT is the use of medications, in combination with counseling and behavioral therapies, to treat substance-use disorders). At a six-month follow-up, 81% of patients said they had abstained from opioids, and 59% said they had abstained from all drugs.

Recognizing opioid abuse and dependence 

Clinicians should be alert to potential signs of substance abuse during routine and urgent visits, or while taking the patient history. Asking nonjudgmental, open-ended questions about a patient’s functioning with his or her family, at work or school, and in social situations may reveal a drug problem. It is important to avoid stigmatization. Primary care physicians can use screening tools such as the CAGEAID (Table 2), which are effective in identifying substance abuse problems. If the substance abuse screen is positive, be aware of signs associated with opioid intoxication such as drowsiness, slurred speech, memory impairment, and pupillary constriction.

After a thorough assessment, a formal diagnosis of either opioid dependence or abuse should be made. Substance dependence or abuse is based on a cluster of behaviors and physiological effects occurring within a specific time frame. The diagnosis of dependence is more severe and therefore supersedes one of abuse if the person meets the criteria for both abuse and dependence listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR).