Frequently Asked Questions (FAQs) - and Answers

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Responses to Frequently Asked Questions (FAQs) were developed by the editorial staff of Addiction Treatment Forum and made possible by an educational grant from Mallinckrodt Inc., a manufacturer of methadone and naltrexone.

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Buprenorphine, Naltrexone

What is buprenorphine? Is it better than methadone?

Buprenorphine is a medication with the potential to be an important treatment in some persons for opioid addiction. It is somewhat similar to methadone, in that it is an opioid drug also used as a painkiller and it also blocks other opioid drugs like morphine or heroin from working. It is less potent than methadone, but can block methadone’s effects; so, switching a patient to buprenorphine must be done gradually.

Previously, buprenorphine was only available for injection. Oral buprenorphine, taken on a regular basis in sublingual (under the tongue) tablet form as part of a comprehensive addiction recovery program, can help reduce withdrawal symptoms and craving for opioids. Buprenorphine appears to have somewhat milder withdrawal symptoms when it is stopped and relatively less potential for overdose than methadone. However, since it is less potent, buprenorphine may not be appropriate as a treatment for opioid-dependent persons who might require higher doses of an opioid agent to control craving. And, as with methadone, research shows that buprenorphine has little effect in reducing abuse of other substances, such as cocaine or alcohol.

On October 8, 2002 buprenorphine was approved by the FDA for prescribing by any physician who has acquired adequate education on the drug and receives special licensing. This includes qualified community-based private practice physicians, so patients do not necessarily need to attend a special clinic on a daily basis to receive the medication.

Buprenorphine is not viewed as a replacement for other approved therapies for opioid addiction – such as, methadone or naltrexone – but as an added treatment that may prove beneficial for certain patients. Various authorities, including government agencies, have recognized that, “buprenorphine is unlikely to be as effective or more effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence [on opioids].” Also, without the close monitoring, psychosocial therapy, and other rehabilitative services provided by MMT clinics, the long-term benefits of buprenorphine for many patients must be cautiously considered.

For further information and FAQs, see government sites at: http://buprenorphine.samhsa.gov/faq.html
or, http://buprenorphine.samhsa.gov/index.html

Also see, FDA Talk Paper: Subutex and Suboxone approved to treat opiate dependence. Available at: http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01165.html
Leavitt SB. A Community-Centered Solution for Opioid Addiction: Methadone Maintenance Treatment (MMT), available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/com_ctrd_mmt.pdf

Revised November 2004

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What is naltrexone? Is it helpful for treating opioid addiction?

Naltrexone was developed in 1963 as a long-acting, orally potent mu-opioid receptor antagonist drug. That means it blocks effects in the brain of opioid drugs, such as morphine, heroin, oxycodone, methadone, and others. If the person attempts to misuse an opioid drug it will not produce a “high” or other desirable feelings, so such drug abuse is automatically discouraged.

Naltrexone is sometimes used in long-term addiction recovery therapy, helping to eliminate opioid-drug cravings and drug-seeking behavior, and to prevent relapse to illicit opioids. First, however, the person must be gradually weaned-off all opioid drugs (withdrawn or “detoxed”); otherwise, taking naltrexone could cause severe withdrawal symptoms.

As a newer and still somewhat experimental approach, naltrexone or similar opioid antagonist drugs are used to rapidly detoxify an opioid-dependent person. For this, the person is first put to sleep (anesthetized), since the withdrawal would be too intense to endure, and detoxification takes hours rather than days or weeks. This is usually followed by the person taking naltrexone tablets daily for a period of several months or much longer. This approach – generally known as “rapid opioid detoxification” – can be expensive and its long-term benefits except for relatively few patients have been questioned by many authorities.

A third use of naltrexone is as a treatment for alcoholism. Naltrexone has been demonstrated as helpful in encouraging abstinence from alcohol, or at least in reducing the number of drinks taken at any one time and preventing full relapse to abusive drinking. The drug was approved by the FDA for this purpose in 1994. Naltrexone is not considered a cure for opioid addiction or alcoholism and must be used as part of a more comprehensive recovery program.

For further information and references, see:

Leavitt SB. Naltrexone in the Prevention of Opioid Relapse. Addiction Treatment Forum [Special Report]. August 2002. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/NTX-Opioid.pdf

Leavitt SB. Evidence for the Efficacy of Naltrexone in the Treatment of Alcohol Dependence (Alcoholism). March 2002. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/NaltrexoneWhitePaper.pdf

Revised November 2004

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