Medication Assisted Transition

 It is important to have a clear understanding of all your options. Consulting with an experienced physician is a critical element in providing the patient with treatment  tailored to their needs. The complications of long term analgesic (prescription painkiller) use may be a factor in managing chronic pain.

According to research posted in the American Journal of Therapy in 2005, patients who failed to achieve lasting analgesia (pain relief) with long-term opioid therapy have achieved benefit using sublingual buprenorphine, a partial mu agonist. The medication was investigated in an open-label (i.e. no placebo) study with 95 consecutive patients who were referred by local pain clinics for detoxification from long-term opiate analgesic therapy (mean 8.8 years) due to increasing pain levels, and worsening function. In addition, 8 percent of the patients had a diagnosis of addiction to opioids. (Addiction is characterized by compulsive use of medications, an inability to self regulate consumption, in addition to the physiologic dependence that is characterized by withdrawal from abruptly stopping medication. Many patients experience dependence without addiction) This study showed that after discontinuing from all opioid analgesics for a minimum of 12 hours, patients received low doses of sublingual buprenorphine or Suboxone (buprenorphine/naloxone). The daily sublingual buprenorphine dose ranged from 4 to 16 mg (mean, 8 mg) for an average duration of 8.8 months. Eighty-six percent of patients experienced moderate-to-substantial pain relief, improved mood and functioning.

Being the first oral formulation of buprenorphine that has been approved in the U.S., physicians can now prescribe buprenorphine in their offices for people who are dependent or addicted to opiates such as opiate pain medication, heroin, or methadone. Buprenorphine is an effective medication for opiate addiction which does not require daily or weekly visits to a clinic. Buprenorphine can eliminate withdrawal symptoms, and has analgesic properties. Some patients choose to continue buprenorphine for a period of time, while others transition off of opioids altogether.

Subutex and Suboxone are the brand names for sublingual buprenorphine for the treatment  of opiate dependence. Both medications contain the same active ingredient: Buprenorphine Hydrochloride. Subutex contains only Buprenorphine Hydrochloride which was developed as the initial product.

Suboxone contains an additional ingredient called Naloxone, however minimal naloxone is absorbed when placed under the tounge. Primarily the naloxone is present to reduce the likelyhood the drug would be reconstituted for injection in an abuse scenario, as the Naloxone would render a person ill if injected. 

Incidentally, This medication is also being used very effectively by many physicians as an analgesic for people living with chronic pain. It is important to remember that medication is not FDA approved for the treatment  of chronic pain, and therefore this is an "off label use", and is only one method of treatment  for effective chronic pain management . Physicians have the authority to prescribe medications beyond the FDA approved indication, so long as there is some evidence to support that use in research literature. It is alsl crucial to develop non-medication based treatment  interventions, as well as learning to treat the psychological/emotional components of chronic pain. A interdisciplinary team approach always gives the best treatment  outcomes.

For someone with chronic pain who has developed an dependence, this medication has the advantage of stablizing intermittent withdrawal. It is also important to help people differentiate between the physiological and psychological/emotional components of their pain. Once that is done, then cognitive behavioral approaches can help people manage the psychological components more effectively.