Counseling Points - September 2007 - (Page 11)

Figure 1. How Buprenorphine Works Buprenorphine Perfect fit – Maximum opioid effect. Empty Receptor Full-Agonist Opioid Opioid receptor in the brain Withdrawal Pain No Withdrawal Pain Euphoric opioid effect Opioid receptor is empty. As someone becomes tolerant to opioids, they become less sensitive and require more opioids to produce the same effect. Whenever there is an insufficient amount of opioid receptors activated, the patient feels discomfort. This happens in withdrawal. Opioid receptor filled with a full-agonist. The strong opioid effect of heroin and painkillers can cause euphoria and stop the withdrawal for a period of time (4-24 hours). The brain begins to crave opioids, sometimes to the point of an uncontrollable compulsion (addiction), and the cycle repeats and escalates. Imperfect fit – Limited opioid effect Opioids replaced and blocked by buprenorphine. Buprenorphine competes with the full agonist opioids for the receptor. Since buprenorphine has a higher affinity (stronger binding ability) it expels existing opioids and blocks others from attaching. As a partial agonist, the buprenorphine has a limited opioid effect, enough to stop withdrawal but not enough to cause intense euphoria. Reprinted with permission from naabt.org. Buprenorphine still blocks opioids as it dissipates. Over time (24-72 hours) buprenorphine dissipates, but still creates a limited opioid effect (enough to prevent withdrawal) and continues to block other opioids from attaching to the opioid receptors. primary route of administration. The tablet takes between 5-10 minutes to completely dissolve. Because buprenorphine is an opioid agonist (albeit a partial agonist), it has reinforcing effects and does have abuse potential. In order to minimize this potential, a combination formulation has been developed which contains buprenorphine HCI and naloxone HCI dehydrate in a 4:1 ratio (Suboxone®). An 8-mg tablet of Suboxone® contains 8 mg of buprenorphine HCI and 2 mg of naloxone HCI dihydrate. When administered as prescribed (sublingually), naloxone has relatively poor bioavailability, resulting in a predominant 1 SEPTEMBER 2007 11 http://naabt.org

Table of Contents Feed for the Digital Edition of Counseling Points - September 2007

Welcome Office-Based Medication-Assisted Treatment of Opioid Dependence Summary Continuing Education Posttest Postest Answer and Program Evaluation Form

Counseling Points - September 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.