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Buprenorphine/naloxone — an important tool in the fight against opioid addiction

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If you’re among the nearly 3 million Americans living with an addiction to pain killers or heroin, this medication may be the path to a life without opioids.
Written by Hallie Levine
Updated on December 21, 2022

Almost anyone can find themselves addicted to opioids. Some people are put on pain medications for an injury but then can’t stop taking them. Others start using heroin or fentanyl as an alternative to prescription pain killers. Whatever the pathway, the results are the same: There are millions of Americans who are addicted to opioids.

It’s a disease, and it’s called opioid use disorder (OUD). It means you’re physically and emotionally dependent on opioids. You keep taking them even though they are harming your health. They’re impairing how you function at school, work or home. You’re also at risk of overdosing and even dying.

Thankfully, OUD is treatable. One of the medications that can help you fight an opioid addiction is buprenorphine/naloxone. If a doctor has recommended it to you or a loved one, here is what you need to know.

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What is buprenorphine/naloxone?

It’s a medication approved by the U.S. Food and Drug Administration to treat OUD.

When you’re on opioids for a long time, you become dependent on the drug and need it to go about your daily life. If you stop taking opioids, you’ll experience terrible side effects that may include:

  • Feeling anxious and/or hyperactive
  • Sweating
  • Vomiting
  • Diarrhea
  • Insomnia

But buprenorphine/naloxone works on your central nervous system to prevent those symptoms, says William Soliman, PhD. He’s the CEO of the Accreditation Council for Medical Affairs and a pharmacist in Norwood, New Jersey.

How does buprenorphine/naloxone work, exactly?

Buprenorphine/naloxone is a combination of 2 different medications. They act on the brain in different ways.

Buprenorphine: This reduces withdrawal symptoms and cravings. It’s similar to methadone. But it is safer, because methadone has a high risk of overdose, explains Arthur Robin Williams, MD. He’s an assistant professor of clinical psychiatry at the Columbia University Division on Substance Use Disorders in New York City. He’s also the chief medical officer at Ophelia, a digital telemedicine provider of medication-assisted treatment for opioid use disorder.

Buprenorphine sits on the opioid receptors in your brain for 24 to 36 hours. Those are the same receptors that get activated by opioids. Buprenorphine competes with the opioids and weakens their effects, says Dr. Williams. “Over time, this can help patients eliminate patterns of drug use and achieve recovery.”

There’s another advantage of buprenorphine. It has a long half-life. That’s the time it takes before the medication’s concentration in the body is reduced by half. Why is that important? “This allows people to avoid the peaks and valleys of opioid use and withdrawal that can be so uncomfortable,” Dr. Williams explains.

Naloxone: This works differently than buprenorphine. It’s an opioid antagonist. That means it binds to opioid receptors and can reverse and block the effects of other opioids. So when you’re on naloxone, you won’t get high or feel euphoric if you take an opioid medication.

How to take buprenorphine/naloxone

A big advantage of buprenorphine/naloxone is that you get the prescription at your doctor’s office. You don’t have to check into a methadone clinic, says Soliman.

Before you start treatment, do not take any opioids for at least 12 to 24 hours. Otherwise, you will go through severe withdrawal symptoms.

There are 2 different ways to take the medication: as a tablet (Zubsolv®) or film (Suboxone®) that you put under your tongue, or as a film (Bunavail®) that you put between your cheek and gums.

  • Take buprenorphine/naloxone once a day.
  • If you take Zubsolv, place the tablet under your tongue and let it melt.
  • If you take Suboxone, rinse your mouth with water. Then place the film under the tongue with your finger. Hold it there for 5 seconds.
  • If you take Bunavail, rinse your mouth with water, then apply the film against the inside of your cheek. (If you use 2 films, place the second one on the inside of your other cheek.)
  • Don’t chew or swallow the tablet or film. Don’t touch or move the film.
  • Don’t eat or drink anything until the tablet or film dissolves completely.

The length of time that you’ll need to take buprenorphine/naloxone varies. “It can be anywhere from a few days to a few weeks, depending on how bad the addiction is,” explains Soliman.

Once your cravings and withdrawal symptoms aren’t as strong, your doctor may tweak the dose. You may even be able to taper down to a dose every other day if you no longer have withdrawal symptoms or cravings.

Just don’t stop taking the medication unless your doctor approves it. If you do, it can cause withdrawal symptoms such as hot or cold flashes, sweating, chills, muscle pain, vomiting or diarrhea.

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What are buprenorphine/naloxone side effects?

Constipation is probably the most common, says Dr. Williams. Drink plenty of liquids and eat fiber-rich foods to help.

Other side effects include:

  • Headache
  • Nausea and vomiting
  • Dizziness
  • Drowsiness and fatigue
  • Sweating
  • Dry mouth
  • Muscle aches
  • Insomnia
  • Blurred vision or dilated pupils
  • Tremors
  • Trouble with attention
  • Tooth decay and cavities

In very rare cases, buprenorphine/naloxone can cause respiratory distress. Respiratory distress is when you have trouble breathing and need to work harder to get oxygen. It can be life-threatening.

That’s why it’s very important to remain under the supervision of your doctor. Your provider will be able to check how you’re doing.

It’s also important to avoid any type of illegal drug, including opioids. You cannot drink alcohol or take sedatives either. Doing any of those things could lead to an overdose and even death.

Is buprenorphine/naloxone successful in treating OUD?

It’s very effective. People who take buprenorphine/naloxone report fewer cravings, especially early on in treatment, compared with those on methadone, according to a study.

It also doesn’t matter what form you take. But if you’re not happy with the tablet or film, ask your doctor about switching. That may help you stick with treatment, researchers from the University of Virginia found.

Want to make your treatment even more successful? Combine buprenorphine/naloxone with medication-assisted treatment (MAT). MAT is the combination of medication use (i.e., buprenorphine/naloxone) along with counseling and behavior therapy, a type of talk therapy that works on changing behaviors.

“A lot of times, patients with opioid addiction need talk therapy to help them understand that they really don’t need the drug, especially to treat pain,” explains Soliman. Find a MAT provider or therapist through the U.S. Department of Health and Human Services.

Don’t let OUD ruin your life. There is help available. Just reach out. The people who love you will be glad you did.

Additional sources:
Opioid use disorder facts: Centers for Disease Control and Prevention
Dental side effects: U.S. Food and Drug Administration
Buprenorphine/naloxone compared with methadone: Drug and Alcohol Dependence (2022). “Buprenorphine/naloxone and methadone effectiveness for reducing craving in individuals with prescription opioid use disorder