The following article, What is Buprenorphine? Medication Assisted Treatment (MAT) Options, was written by our Medical Director and Psychiatrist Dr. Matthew Bader, MD. This is part of a three-part series on Buprenorphine as an option for Medication Assisted Treatment (MAT). Dr. Bader is a board-certified adult psychiatrist with subspecialty training in addiction psychiatry. He completed his Psychiatric Residency at Duke University Medical Center and completed an Addiction Psychiatry Fellowship at the Medical University of South Carolina. To learn more about Dr. Matthew Bader, MD, please visit his bio.
Medication Assisted Treatment (MAT) Explained
For individuals who are addicted to either alcohol or drugs such as opioids, there is one treatment available that is particularly effective at helping them to quit. Medication Assisted Treatment, often abbreviated to MAT, helps clients through a combination of medication and behavioral therapy to heal drug addiction or alcohol addiction. Our medication assisted treatment program in Raleigh, NC has a “whole-body wellness” approach to treating drug addiction. With medication assisted treatment, you can overcome your addiction, as well as help heal any physical, emotional, or mental damage it has caused. Buprenorphine is one example of a Medication assisted treatment (MAT) option to treat opioid use disorder.
Overdose Deaths Continue to Rise – Why MAT is Needed
The Centers for Disease Control and Prevention (CDC) reports that more than one million people in the United States have died from a drug overdose since 1999. In 2021 alone, more than 100,000 drug overdose deaths occurred, and the numbers continue to rise.
Overdose Deaths in North Carolina
This is not an issue that is sparing North Carolina, as the North Carolina Department of Health and Human Services (DHHS) reports that overdose deaths in the state were increased by 22% in 2021 compared to the prior year. This represents 4,041 people in North Carolina losing their lives to overdose, the highest number of overdose deaths in a single year in the state’s history. These numbers represent friends, relatives, colleagues, and acquaintances here in Raleigh and throughout the state of North Carolina. As the death toll from drug overdoses continues to rise, it becomes more and more likely that these tragedies will impact your life if they have not already. The rising number of overdose deaths is also thought to be a key contributor to the recent concerning downward trend of the average life expectancy in the United States.
Opioids and Overdose Deaths
Opioids, specifically synthetic opioids such as fentanyl, are currently the main drivers of drug overdose deaths. Opioids were involved in over 75% of all drug overdose deaths in 2021. Combining opioids with other substances that may impact breathing and levels of alertness (such as benzodiazepines and alcohol) has been shown to increase the risk of overdose.
Opioid Use Disorders and Lack of Treatment
Not surprising given the rise in overdose deaths is the finding that more individuals are struggling with addiction to opioids. An estimated 2.5 million Americans suffered from opioid use disorder in 2021 yet only approximately 1 in 5 of them (22%) received any medication to help treat their condition. Sadly, many individuals are left suffering despite there being evidence-based treatments that could help alleviate much of this pain.
Buprenorphine as a Medication Assisted Treatment Option
Medication assisted treatment (MAT) is the use of prescription medications in combination with counseling and behavioral therapies to help treat substance use disorders. Buprenorphine is one example of a MAT option to treat opioid use disorder. Buprenorphine is a medication that works by binding to mu-opioid receptors in the brain, the same receptor that is actually also bound by commonly misused opioids. However, buprenorphine is what is called a partial agonist meaning that it only partially activates these receptors (as opposed to other opioids which can fully activate these receptors). This partial activation does enough to reduce cravings and eliminate withdrawal symptoms but should not cause euphoria or a “liking” of the medication. Buprenorphine also has a “ceiling effect” meaning that taking more and more of the medication will not produce any further effects. Thus, this medication has a wide safety margin with very low risk of overdose.
How is Buprenorphine Prescribed?
Buprenorphine is a prescription medication and thus must be prescribed by a licensed healthcare provider, such as a psychiatrist, nurse practitioner (NP), or physician assistant (PA-C). Buprenorphine is typically prescribed in a film form that dissolves under your tongue or on the inside of your cheek and is what is called a partial opioid agonist.
Buprenorphine & Naloxone
Most often buprenorphine is prescribed in a form that also contains another medication called naloxone. You may know naloxone as Narcan, which is what is administered when someone is suspected to have overdosed on opioids. Naloxone is what is called an opioid antagonist or blocker and thus can reverse the effects of opioids.
At this point, you are probably asking yourself why buprenorphine (a partial opioid agonist) is combined with naloxone (an opioid blocker). Wouldn’t they just cancel each other out? The naloxone is actually added to the buprenorphine to lessen the risk of misusing the medication via such methods as injecting, ingesting, or snorting. When the buprenorphine/naloxone combination medication is dissolved under the tongue or on the inside of the cheek, the body largely only absorbs the buprenorphine and not the naloxone. So, in general, someone taking buprenorphine/naloxone should get very little if any naloxone into their system.
“The naloxone is actually added to the buprenorphine to lessen the risk of misusing the medication via such methods as injecting, ingesting, or snorting.”
Though the combination film is the most widely prescribed form of buprenorphine, there are also tablet forms that contain both buprenorphine and naloxone as well as tablets that contain solely buprenorphine. Film and tablet forms of this medication have carried brand names such as Suboxone, Bunavail (discontinued), Subutex (discontinued) or Zubsolv. Whereas films and tablets need to be taken daily to be effective, there are also longer lasting injectable forms of buprenorphine such as Sublocade and Brixadi.
Impacts of Buprenorphine Treatment
Engagement in medication assisted treatment with buprenorphine has consistently shown an increase in positive outcomes. Specifically, such treatment significantly reduces the risks of overdose deaths while also increasing engagement in treatment over longer periods of time, reduces transmission of Hepatitis C and HIV, decreases criminal activity and subsequent legal charges, and reduces use of other illicit substances.
Does Medication Cure Opioid Addiction?
Buprenorphine can be a very effective medication for an individual suffering from active addiction to opioids and all the suffering and chaos that comes with this disease. However, it is only part of the puzzle in terms of building a path towards wellness and building a life that supports recovery, mental health, and vibrancy. We have to recognize, however, that it is very difficult to take any of these steps when caught up in the cycle of addiction where a substance is narrowing your life and seemingly making many decisions for you. This is where medication assisted treatment can help give you a more secure foundation that is free of powerful cravings and debilitating withdrawal symptoms. From that space, you can more effectively begin building that life of recovery.
Is Buprenorphine Right for Me?
If you are wondering if buprenorphine and medication assisted treatment could be beneficial for you or a loved one, please contact our office. We offer medication assisted treatment in Raleigh, North Carolina, and have experienced psychiatric providers. You can call our office at 919.893.4465, email our Patient Care Coordinators at info@aimwellbeing.com, or complete our online intake linked HERE to start the process of becoming a patient.
