Process of Treatment

Those suffering from serious opioid addiction needs to undergo a Buprenorphine treatment. This treatment consists three phases that includes induction, stabilization and maintenance. Knowing about the process of treatment in details helps one to understand the treatment better and how it is going to help the patient in the long run.

Induction Phase

The duration of the induction phase is 1 week. This is the first phase of the treatment process where the patient learns to give up on their addiction to serious opioid agonists to Buprenorphine. The physician under whom the patient is being treated decides on the minimum dose of Buprenorphine that is to be administered to the patient. The dose should be correct as upon it depends whether the patient stops or reduces the intake of other opioids. At the point of administering the dose, care should be taken to note that the patient is not undergoing any withdrawal symptoms or side effects. The patient should also not show any cravings for the drugs which were the reason for addiction.

The patient should be looked after during this period. It should be noted that it is necessary to note the signs and symptoms of either withdrawal or inadequate dosing that the patient is experiencing for assessment.

During this time, patients undergoing Buprenorphine treatment are advised not to operate any heavy machinery or drive. This should continue till the point the user gets comfortable with the effects of the dose or until the dose is stabilized. It should also be kept in mind that the induction protocol is not the same for every patient. Rather it is much dependent on the opioid to which the patient has been addicted for such a long time (both short-acting- and long-acting) as well as whether the patient is experiencing withdrawal at the time of induction.

Further doses may be provided via prescription thereafter

Patients not experiencing excessive opioid agonist symptoms after the initial dose, following induction protocols are applicable.

Induction Days 1 and 2: Who Is the Patient and What Does He or She Need?

First of all, it is crucial to identify the opioid(s) that the patient has been using. Choosing the protocol depends on this. According to many physicians, individuals who have been addicted more to long-acting opioids might show a different response to Buprenorphine treatment compared to the ones who have been more on the short-acting opioids. Patients physically dependent on short-acting opioid like heroin, oxycodone, and hydrocodone are in the early stages of withdrawal are administered the first dose of buprenorphine.

Patients Dependent on Short Acting Opioids

As in the opinion of the physicians, there should be a time gap of at least 12-24 hours since the last use of opioid(s) and before administering the initial buprenorphine induction dose to the patient who has been addicted to short-acting opioids. The early signs of opioid withdrawal (like yawning, rhinorrhea, lacrimation, sweating) comes to notice very easily in the eyes of the physician. In case the physician does not find the patient to be experiencing active withdrawal since they have not abstained themselves from using the opioids, might be asked to wait. A proper explanation of the importance of waiting until they experience the symptoms of withdrawal is crucial and is a must.

Patients who have been undergoing objective signs of opioid withdrawal and whose last use of short-acting opioid was more than 12-24 hours prior to the beginning of induction can be administered the first dose of 4/1-8/2 mg of the buprenorphine/naloxone combination (buprenorphine monotherapy for pregnant women). If the initial dose of the buprenorphine/naloxone combination is 4/1 mg and opioid withdrawal symptoms subside but then return (or are still present) after 2 hours, a second dose of 4/1 mg is generally administered. It should however be noted that the total amount of buprenorphine administered on the first day should not exceed 8 mg.

Stabilization Phase

The stabilization phase lasts somewhere between 1 to 2 months. In this phase, the patient should not be experiencing any withdrawal symptoms, there should be minimal to no side effects and one should not be craving for any opioid agonists. As with any pharmacotherapy, the goal of buprenorphine treatment is to treat with the minimum dose of medication that is required to address target signs, symptoms, desired benefits, and laboratory indices while minimizing side effects. Elimination of objective evidence of opioid use (negative toxicology) represents the key target sign for which to strive. The goal is to reduce self-reported cravings and self-reported use of illicit opioids. One benefit worth achieving is a self-reported increase in opioid blockade such that self-administered illicit opioids induce little or no euphoria. One can be sure of the success of the treatment if there is a reduction in the opioid-positive toxicology specimens.

Dosage adjustments might be necessary in the early stages of stabilization with frequent contact with patient increasing the likelihood of compliance. Patients are to be monitored closely, weekly assessments carried out until full stabilization is achieved.

Maintenance Phase

This is the longest time that the patient is on Buprenorphine. There is no definite time period for this phase. Physicians can be liberal with their patients at this point in time. There is no necessity to keep a tab on the patients. However, serious and worth noting considerations cannot be overlooked. Many psychosocial and family issues that have been identified in the course of the treatment are not to be overlooked or forgotten.

There might be other issues too which will require attention. This includes cravings for opioids and preventing a relapse. Other issues related to opioid abuse are present and needs to be addressed during the maintenance treatment. Following are the ones:

  • Psychiatric comorbidity
  • Somatic consequences of drug use
  • Family and support issues
  • Structuring of time in prosocial activities
  • Employment and financial issues
  • Legal consequences of drug use
  • Other drug and alcohol abuse

The frequent presence of some or all of these problems underscores the importance of providing nonpharmacological services to address comprehensively the needs of patients and to maximize the chances of the best possible outcomes.

Long Term Medication Management

What should be the design of the long term treatment is dependent on two things. Partly it depends on the personal treatment goals of the patient and partly on the objective signs of treatment success. There is no definite time period for maintenance. It can be short-term (e.g., <12 months) or a lifetime process. The success of the treatment depends on the achievement of specific goals that are agreed on by the physician as well as the patient. Following successful stabilization, the decision to whether decrease or discontinue buprenorphine depends on the patient’s decision and confidence to give up on medication completely and lead a normal life. It equally depends on the physician’s confidence and belief that tapering would be successful.

For determining suitability for long-term medication-free status, the factors that are considered include adequate psychosocial support, stable housing and income and the absence of legal problems. A longer maintenance period is administered to patients who have not yet achieved the indices of stabilization. During this phase, the aim is to work through all the existing barriers. Data bears proof of the fact that longer duration of medication treatment is directly proportional to less use of illicit drug and fewer complications.