Buprenorphine For Heroin Addiction

Buprenorphine has been used for the treatment of heroin and opioid addiction for many decades in the UK and across the world.

Taken in tablet form which dissolves on or under your tongue it is a once a day medication. For some people, it can be taken every 2 or 3 days.

You can either stay on Buprenorphine, which is known as maintenance, or taper down which is known as detox.

Buprenorphine, also known as Subutex, Espranor and Buvidal (injection) is available at most rehab centres.

For those wanting to use Buprenorphine as a detox for opioids and heroin, the treatment time can be shorter than if you use Methadone.

Buprenorphine For Heroin Addiction: What is Buprenorphine?

Buprenorphine is an opioid.

It is known as a partial agonist. This means that unlike Methadone, when it reaches the opioid receptors it only attaches to some of them, not all of them as a full agonist will. However, when Buprenorphine does attach to receptors it will stick to them more strongly than other opioids. As a result, you need to be in withdrawal before you start taking it.

Precipitated withdrawal

Because Buprenorphine attaches itself, very strongly, to receptors it will knock off any other opioids that are already there. This means if you have opioids in your system, Buprenorphine will dislodge them making you go into withdrawal.

This means that you will need to stop using opioids for a period of time before you go into rehab. Alternatively, you must wait until you are in withdrawal at the rehab centre before starting treatment. You can discuss this with your clinician.

Buprenorphine For Heroin Addiction: How is it taken?

As soon as you are in a clear state of withdrawal, you normally start with 4MG on the first day. Next, you take 8MG the second day followed by 12MG the day after and then 16MG.

Some clinicians will move patients from 8MG to 16MG without the 12MG stage, depending on the individual.

There is no clinical evidence that taking any more than 16MG a day will provide any additional benefit though some people are given more. This is because Buprenorphine has what is known as a ceiling effect.

This means that if you take More Buprenorphine it will not be able to sit on the receptors because there is already Buprenorphine on them. It will simply not be actioned.

Buprenorphine For Heroin Addiction: What Does Buprenorphine Do?

As an opioid, it will stop you experiencing withdrawal symptoms.

Opioids take control of the brains reward system. The receptors in the reward system are also involved in pain relief because when opioids bind to these receptors the nerve signals that convey pain are inhibited. This means you feel pleasure. A very warm feeling.

This leads to a cycle of reward because of overwhelming cravings. Why wouldn’t someone want to recreate a pleasurable experience?

What role do Endorphins play?

Endorphins are naturally occurring neurotransmitters. They play a very important role in both pain regulation and producing feel good sensations.

When you use opioids/Heroin the body’s production of endorphins is significantly changed. If you continue to use opioids your endorphin levels drop. This is because the brain will re-programme itself due to the constant presence of opioids on receptors.

A state of tolerance develops. This means you will need to take more and more to have the same effect as the amount you started with.

How does opioid addiction progress?

Addiction doesn’t take long to have a profound effect.

When you first start taking opioids/Heroin you will get an intense feeling of euphoria. Because of the phenomena of tolerance, you will need to take more and more to have the same effect as the amount you started with.

If you can not feed your habit and opioids become dislodged from receptors you will experience withdrawal.

Within the brain is a region known as the locus coeruleus, which is crucial when managing opioid withdrawal. This area of the brain has many opioid receptors and controls noradrenergic activity. In other words, it controls a naturally occurring chemical known as norepinephrine. When this chemical is not properly regulated, physical withdrawal symptoms occur.

The body enters a state of autonomic dysregulation. The medical term is Dysautonomia. This is what causes the shivers, gooseflesh skin, etc. The body is in a state of chemical imbalance. Until this is restored, the symptoms will continue.

Withdrawal is nothing to do with willpower. You can drink as much water as you want: It won’t make any difference. Going to the gym, going to a sauna: It simply won’t work. Detox is all about science.

What Are the Symptoms of Heroin/Opioid Withdrawal?

Opioid withdrawal affects both the body and the mind.

Physically, someone withdrawing will experience troubling withdrawal symptoms within a few hours after their last hit. These can include:

• Muscle aches
• Sweating
• Nausea
• Vomiting
• Diarrhea
• Agitation
• Tremors
• Insomnia
• Dilated pupils
• Hypersensitivity to noise, light and touch
• Cravings
• Goose flesh skin
• Raised blood pressure and pulse
• Abdominal cramping
• Loss of appetite
• Runny nose
• Sneezing
• Yawning
• Altered body temperature

Psychological effects

Opioid withdrawal affects natural feelgood chemicals so it is logical that there will be significant psychological effects from withdrawal. These can include:

• Mood swings
• Irritability
• Anxiety
• Depression
• Memory issues
• Extreme fatigue

Buprenorphine For Heroin Addiction: The Dangers of Going Cold Turkey

Attempting to detox yourself from heroin/opioids at home, on your own is an extremely bad idea.

It isn’t just dangerous: It can be fatal.

Dealing with withdrawal is much more than just locking yourself in a room with a case of bottled water a bucket and a large pack of Andrex . The physical symptoms are bad enough but the cravings will be intolerable.

As soon as you stop taking opioids your tolerance drops. This means you will need more than you were using to have the same effect. It is very common for people to overdose, accidentally, because they take an amount they think they need to settle themselves. The loss of tolerance leads to accidental overdose.

Timeline of Heroin Withdrawal

When you start to withdraw depends on a multitude of factors, including the type of opioid you have been taking, how long you have been taking it for and your general state of health.

Usually, you will start to experience symptoms within six to twelve hours after your last use. For some it can start earlier and for others, a little later.

Without treatment the symptoms would peak within a day to three days. Most people would see a significant reduction in symptoms within five to seven days.

Some symptoms can persist for weeks: If not months. It can take the brain six months to a year to fully recovery.

How Buprenorphine Can Help

Methadone is a fully synthetic opioid.

By replacing heroin/opioids with Buprenorphine the withdrawals will stop. You then have a choice: Maintain (stay on Buprenorphine) or taper down to zero.

As a tablet it is very easy to have a dose adjustment. In collaboration with your clinician you can go up or down with ease.

The first element of treatment with Buprenorphine is to eliminate withdrawals. This might take a day or two, depending on your state of withdrawal. You will need to be in a state of withdrawal before you commence treatment. This is because Buprenorphine dislodges opioids and heroin already on receptors.

If you start Buprenorphine before you go into withdrawal it will force you into it: This is unnecessary.

Adjunctive medication can be used to help with some of the symptoms of withdrawal such as lack of sleep and feeling sick.

Once you are comfortable on your dose of Buprenorphine, in that you are not experiencing any withdrawals, it is time to decide what you want to do.

Most people who go into rehab for treatment with Buprenorphine want to reduce to zero. This can be done, usually, within 4-6 weeks.

The Risks of Rapid Detox

Rapid detox does not work. In fact, it can make things much worse.

People who have a rapid detox relapse: FAST. Why? Because they will still be withdrawing and experiencing cravings. Their tolerance to opioids will have dropped: Significantly. To feel settled they will take what they think they need to settle themselves. This puts them at significant risk of overdose.

While Buprenorphine has a ceiling effect, it will not stop you overdosing on opioids.

Things to Consider When Taking Buprenorphine

Research has shown that those who are taking other drugs, such as crack, can sometimes experience a higher use of crack when taking Buprenorphine

People who use Methadone often report a phenomenon known as Dampening. This means that there desires to use other drugs are diminished. This is not always the case with Buprenorphine.

While it can be quicker to detox using Buprenorphine, the same effort and commitment to recovery is necessary.

Buprenorphine For Heroin Addiction: Rehab Options

Treatment at home for opioid and heroin detox rarely works, if ever.

Why? Because addiction is a chronic illness that takes time to develop and time to treat. Without the therapy, relapse prevention and aftercare a detox is like rearranging the deck chairs on the titanic: pointless.

Buprenorphine For Heroin Addiction: Detox

Until you feel well, your brain won’t respond to therapy.

No one can respond to help if they are feeling unwell.

Using buprenorphine (and sometimes some adjunctive medication at the start of treatment) the withdrawals will be reduced down to such a degree that you can attend therapy groups and sessions.

In agreement with your clinician, a reduction plan for your buprenorphine will be drawn up. This will enable you to leave rehab opioid free.

Timewise, It can take a day or two to establish how much buprenorphine you will need to stop you feeling unwell.

It is quite normal to go up, down and up again at the start of treatment. It is the same as getting settled on other medication such as insulin.

Buprenorphine For Heroin Addiction :Therapy

No one makes a conscious choice to be an addict.

People use drugs for many different reasons. Trauma, problems at home, PTSD. There could be a multitude of reasons. Sometimes, people become dependent on opioids after a legitimate prescription following a car crash or back injury.

Therapy is there to work through these issues. It will be hard work: No point otherwise.

All rehab centres, the world over, use a group therapy model. 12 STEP/SMART/eclectic: It matters not which model is used. Time spent worrying over this is time wasted.

Adjunctive therapies

Many centres provide additional therapies including art and music therapy, individual therapy and gentle exercise.

Relapse Prevention

Just as people with asthma and diabetes are taught how to manage their condition, so can people with opioid addiction learn the skills to stay abstinent.

Relapse happens: FACT. It doesn’t happen to everyone, but if it does it is best to know what to do.

Relapse prevention is about attaining skills for when challenges come around after rehab.

Your local chemist is not going to stop selling medications with opioids because you have been in treatment and neither is your dealer not going to answer the phone if you are craving at 2AM.

With the right skills you are in a much better place to deal with the challenges.

Aftercare

Recovery doesn’t stop when you leave rehab.

Every centre offers a weekly aftercare support group. This can be in person, if you live close by, or accessed through video conferencing.

There will also be regular telephone check in.

Should you be struggling, there will be a dedicated number to call for support.

Get Free Advice From an Experienced Addictions Clinician

You can get free, independent and impartial advice, in the strictest of confidence, from a clinician who has decades of experience prescribing Buprenorphine.

Should you choose to go into rehab, we provide free treatment referrals.

We only signpost to legally registered centres.

Our service is registered with the Information Commissioner’s Office.

Buprenorphine For Heroin Addiction is available.