be obtained only through specially-licensed
treatment programs.* 218
Buprenorphine. Buprenorphine is used in the
treatment of addiction involving opioids and,
when used as directed, functions both by
reducing craving for addictive opioids and by
easing withdrawal symptoms.^219 At low doses,
buprenorphine enables patients with addiction
involving opioids to discontinue their use of the
drugs without experiencing withdrawal
symptoms.^220
There are two forms of the medication:
buprenorphine alone (brand name Subutex) and
a buprenorphine/naloxone combination therapy
(brand name Suboxone).^221 Approved in 2002
by the FDA for treating addiction involving
opioids, Subutex generally is prescribed during
acute treatment followed by Suboxone for
maintenance therapy.^222 The naloxone
component of Suboxone serves to reduce the
rewarding effects of opioids and helps to prevent
the misuse of the medication which can occur if
Suboxone is crushed and then injected or snorted
to achieve a high.^223
Buprenorphine must be administered under the
supervision of a trained physician.^224 It can be
prescribed by physicians who are certified in
addiction medicine† or who complete at least
eight hours of training‡ in the treatment and
management of addiction involving opioids.§ 225
Once such training is completed, physicians may
submit an application to the Substance Abuse
and Mental Health Services Administration
(SAMHSA) and receive an identification
- Such restrictions apply only to the use of methadone
in addiction treatment and not when physicians
prescribe methadone to treat or manage pain.
† Through the American Board of Addiction
Medicine or the American Osteopathic Association.
‡ Approved training includes training provided by the
American Society of Addiction Medicine, the
American Academy of Addiction Psychiatry, the
American Medical Association, the American
Osteopathic Association, the American Psychiatric
Association or any other organization that the
Secretary of Health determines is appropriate.
§ Physicians also must have the ability to provide or
refer patients to any necessary ancillary services.
number from the DEA allowing them to
prescribe the medication.^226Buprenorphine provides moderate relief from
opioid withdrawal and has less risk of misuse
and overdose than methadone.^227 Another
advantage to buprenorphine is that it can be
dosed less frequently than every day and still
have a beneficial effect, which could help to
enhance medication adherence.^228 Promising
results are emerging from preliminary research
on low-frequency dosing with sustained-release
formulations of the medication.^229 Despite these
advantages, buprenorphine has similar side
effects to methadone and other opioids including
nausea, vomiting and constipation.^230Buprenorphine is equally effective as methadone
in treating addiction involving opioids.^231
Research reviews of pharmaceutical treatments
for addiction involving opioids have found that
regardless of the dose, buprenorphine is better
than placebos for ensuring patient retention,^232
and that higher doses increase the likelihood of
retention and abstinence relative to lower
doses.^233 A randomized, controlled trial found
that patients receiving buprenorphine were
significantly likelier to have negative urinalyses
than placebo patients and to report decreased
cravings for opioid drugs.^234Recent research has begun to explore, using
animal models, the benefits of using
buprenorphine to treat addiction involving
methamphetamine.^235Oral THC. Preliminary research suggests that
oral tetrahydrocannabinol (THC), made from the
psychoactive ingredient contained in cannabis,
may serve to reduce withdrawal symptoms and
cravings in patients with addiction involving
marijuana without producing marijuana-like
intoxication effects.^236 However, research on
oral THC and other pharmaceutical therapies for
use in the treatment of patients with addiction
involving marijuana, while promising, is in an
early stage and clinical trials are needed to
support their use in clinical interventions.^237