RAPID BUPRENORPHINE DETOX UNDER SEDATION
When MAT (medication-assisted treatment) with buprenorphine is used for the opioid-dependent patient, it is done to satisfy the need of the opioid Mu receptors dependent on opiates. By this replacement therapy, the patient is still dependent on drugs. Basically, it is trading one opiate for the other. Consequently, the patient will still be dependent on the opiate buprenorphine and will go through withdrawals when it is discontinued. Patients wanting to be opiate free reach out to us. We detox all opiates, rather than substituting one opiate with another opiate.
Rapid Buprenorphine Detox under sedation is a medical detoxification treatment offered by All Opiates Detox for patients dependent on Buprenorphine. It consists of sedating the patient and removing Buprenorphine from the brain receptor while the patient is sleeping. Acute withdrawals are precipitated with an opiate blocker. These withdrawals will pass during the sedation period. Once the withdrawals are over, and the brain receptors are free of the opiate Buprenorphine, a blocker is placed to prevent any opiates from getting back into the brain receptor.
The blocker of choice used at All Opiates Detox is an implant. Dr. George prefers the Naltrexone implant blocker for several reasons. First, the Naltrexone implant lasts approximately two months, as opposed to Vivitrol (lasts approximately 28 days) or tablets (have to be taken daily). Another reason our physicians prefer the implant over the injection is for patients that may not be able to tolerate Naltrexone due to side effects, sensitivity or allergies. The implant can be removed from under the skin, whereas the injection stays in the body for about 28 days and therefore cannot be removed once it is administered. It is recommended to remain on Naltrexone maintenance therapy for at least one year to allow the brain to heal from the damage caused by the drug use and abuse.
Our success rate is near 100% for helping patients detox off opiates without the excruciating pain and discomfort of the withdrawals. Aftercare consisting of the Naltrexone opiate blocker, psychotherapy, and 12 step programs are recommended to ensure long-term abstinence and success.
Buprenorphine (trade name Buprenex) is an opiate used to treat moderate to severe pain. It is derived from the baine of the opium poppy seed. It is a partial agonist of the Mu opioid receptor and antagonist at the Kappa opioid receptor. Buprenorphine differs from other opiates in that it has a ceiling effect. That means once the therapeutic effect is reached, the brain opiate receptor would not require more dosing and thus there will be no tolerance.
In 1981, Buprenorphine was approved for medical use in the United States. In 2002, Buprenorphine was approved for the treatment of opioid addiction as brand name Subutex. Buprenorphine is an orally disintegrating tablet and achieves its effect by being absorbed from the buccal mucosa. Buprenorphine is also prescribed in combination with Naloxone, known as brand name Suboxone. When Suboxone tablets became generic, the strip film form of Suboxone was introduced.
The drug manufacturer industries have produced more Buprenorphine and Buprenorphine with Naloxone combination products with various doses and methods of administration. Trade names for the buprenorphine products are Buprenex for intravenous or intramuscular injectable use, Butrans transdermal patches (delivery through the skin) and Probuphine opioid implant. Some of the trade names for the Buprenorphine combined with Naloxone products are Suboxone oral disintegrating tablets and film strips, Zubsolv oral disintegrating tablets and Bunavail buccal mucosal patches.
Buprenorphine starts to work about 30 minutes after sublingual administration, with maximum effects one to two hours later. The half-life is long and varies between 20-73 hours. Buprenorphine has a slow onset of action with a longer duration of action.
Buprenorphine SIDE EFFECTS
Side effects due to Buprenorphine include nausea, vomiting, constipation, drowsiness, dizziness, headache, itching, and dry mouth, difficulty with ejaculation in males along with decreased libido.
Buprenorphine is an opiate. Hence the user will go through withdrawals when it is discontinued. Since it is a long-acting opioid, withdrawals start several hours to days after its discontinuation.
Buprenorphine withdrawals are reported to last longer and are more severe and intense than some of the other potent opiates due to its long half-life. Withdrawals include nausea, vomiting, hot-cold flashes, difficulty sleeping, restlessness, leg cramps, muscle jerking, anxiety, and sweating.
Insomnia usually lasts several weeks to months. The intense and prolonged withdrawals are the reason the majority of patients go back to the use of opiates and stay in the cycle of dependence/addiction.
When mixed with benzodiazepines or alcohol, buprenorphine can result in respiratory depression and death. Buprenorphine overdose symptoms include cold, clammy skin, coma, fainting, hypotension, very sleepy and sluggish, slow, shallow breathing.
Buprenorphine can be abused as some patients report a “high” with its use. Buprenorphine products are used by some patients to prevent withdrawals when they are not able to find their opiate of choice. Although overdose is less likely with buprenorphine as opposed to other opiates, patients feel as if they’re “trading one opiate for another” since buprenorphine dependence and withdrawals occur when they try to stop using.
Also, Buprenorphine withdrawals are more intense and painful than withdrawals from other opiates, causing the opiate dependent user to go back and forth between Buprenorphine and their opiate of choice.
Improper use and abuse of Buprenorphine can lead to dependence, tolerance, and addiction.
Opiates can be habit forming, causing not only physical, but also psychological dependence. Withdrawals may occur if the dose of the opiates is reduced or discontinued after long term use.
Using opiates for an extended period of time can lead to tolerance, where the user needs to increase the dosage of their opiates to achieve the desired effect, whether the desired effect is pain control or euphoria.
Once the patient develops a tolerance, it becomes even more difficult to stop using due to the withdrawals. Symptoms of withdrawals are an indication of physical dependence and addiction to the opiate Buprenorphine. Most patients describe withdrawals as the worst, most frightening experience one will ever encounter. One can only imagine the excruciating pain when the opiate user says that they’d rather die than go through the withdrawals. Buprenorphine physical dependence symptoms, such as withdrawals, lead to psychological dependence. That is when addiction takes over the mind and life of the Buprenorphine opiate user.
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