pulmonary aspiration — when vomit is accidentally inhaled into the lungs. Although this symptom may cause little to no harm, it could also lead to pneumonia or death from asphyxiation. Dehydration can also occur, and if left untreated can become deadly.
Underlying mental disorders, like depression or bipolar disorder, can also worsen during the withdrawal period, and relapse is the most common complication.
Typically, withdrawal can begin shortly following the last dose and can peak within the span of two to five days.
Withdrawal symptoms can also become overwhelming, which can route patients back to buprenorphine abuse and possibly to severe addiction.
Buprenorphine can still be effective for some
Raney Young, 59, began taking opioid painkillers for “legitimate pain” when he was in college.
He soon became hooked, and his addiction lasted for three decades.
Young would spend much of his life obtaining painkillers both legally and illegally, but it would come with consequences. “I pretty much lost everything time and time again: family, jobs, friends, possessions, just from addiction,” the Louisiana resident said.
From age 19 to 48, he would only have one year of sobriety.
After treating addiction with methadone for about eight years, he built a tolerance and needed something different. “I heard about buprenorphine being legalized in 2002,” he said. “It has changed my life totally.”
Young said he has been on buprenorphine for seven years and has gone from using 24 mg per day to 4 to 6 mg per day.
“Most of the time I forget to take my little quarter of a pill in the morning,” he said. “I have to remind myself to do it. You’re not in that drug-seeking behavior mindset that you are on pills, always withdrawing, your body is constantly craving something. You’re not like that with [buprenorphine].”
Young said he expects to be completely drug-free in three years.
The potential for misuse and safety precautions
A pill is not a panacea for addiction.
And according to Ahadpour, physicians have to “really assist the patient to see what would be the best medication and best route for treatment. It should be a collaborative effort with the patient.”
Medications like Suboxone, which combines buprenorphine and naloxone, and are taken as a sublingual tablet (placed under the tongue for absorption) are intended to decrease misuse.
However, if the sublingual tablets are crushed and injected, the effects are overrun by the naloxone and can cause opioid withdrawals.
“Addiction is a treatable disease, and medication assisted treatment is not just about medication,” Ahadpour said. “For it to be effective, you need to have the medication behavioral therapy, counseling, and social support.”
Safety should be a priority when taking buprenorphine, and there are precautionary measures one can take: Avoid taking other medications before consulting your healthcare professional and especially avoid taking illicit drugs, alcohol, sedatives or similar drugs that promote slow breathing. Do no mix large amounts of other medications with buprenorphine, as it might lead to overdose or death. Lastly, be sure there are no liver-related issues before using the medication, as liver problems from the use of buprenorphine are rare, but can occur.