64 Buprenorphine
Buprenorphine abuse is well documented in other countries, ranging from
Scotland and France to India and New Zealand.
People can become addicted to buprenorphine; one study found no differ-
ence other than age between buprenorphine addicts and heroin addicts, sug-
gesting the two drugs appeal to the same kinds of people. Given that finding,
it is unsurprising that buprenorphine’s experimental use as an alternative to
methadonehas been successful in switching heroin addicts to buprenorphine.
Various studies note that buprenorphine may create euphoria, an effect that
is normally considered a drawback if a drug is used for treating addiction.
Some researchers feel that buprenorphine has large potential for abuse. Treat-
ingcocaineaddiction with buprenorphine has had mixed success. Indeed, an
experiment indicated that buprenorphine increases pleasurable effects from
cocaine.
After a certain point, buprenorphine’s effects no longer increase as much
when dosage size increases; this characteristic may deter addicts from taking
too much buprenorphine and thereby make it a relatively safe substitute for
heroin. An experiment demonstrated that persons lacking dependence with
opiates could receive 70 times the normal medical dose of buprenorphine
without harm, a safety factor of significance in addiction treatment programs,
particularly since dependent persons (such as those in addiction treatment)
normally can withstand even higher opiate doses than nondependent persons
can. A statistical analysis of drug abuser fatalities in France concluded that
the death rate from buprenorphine is far less than the rate from methadone.
Another advantage to buprenorphine is that maintenance doses can be given
less often than with methadone. Still another advantage is that, unlike most
opiates, buprenorphine can provoke withdrawal symptoms when taken with
another opiate. Thus addicts may be deterred from continuing to take heroin
or other opiates while using buprenorphine. Some addicts, however, are able
to take both heroin and buprenorphine simultaneously.
Tolerance does not necessarily develop with long-term use, although evi-
dence of tolerance exists among buprenorphine addicts. Animals that are
dosed on buprenorphine develop little or no dependence, a finding duplicated
in a study of heroin addicts receiving maintenance doses of buprenorphine.
Experiments show, however, that when buprenorphine addicts receive a drug
that counteracts opiate actions, subjects experience classic symptoms of with-
drawal from opiate dependence: yawning, muscle ache, and general uneasi-
ness.
Drug interactions.An experiment showed that buprenorphine further ac-
celerates pulse rates that are already raised by cocaine. Another human study
and a monkey experiment found no significant interaction between cocaine
and buprenorphine, but still another primate study showed buprenorphine as
boosting cocaine effects. Researchers operating a rat study concluded that bu-
prenorphine boosts cocaine actions, but mice studies found that buprenor-
phine diminished some cocaine effects; such varying results from different
animal species indicate the difficulty of applying those results to humans. A
human experiment showed that blood flow damage in the brain caused by
cocaine can improve after taking buprenorphine.
People using buprenorphine have suffered collapse of breathing and blood