The Controversies of Buprenorphine Maintenance

“The mortality rate amongst heroin users in the United States is 63 times that of non-users in the same demographic. Unfortunately, opioid use is now a major epidemic,” explained Sayeh Beheshti, M.D., M.A., during Solid Landings Behavioral Health’s Professional Networking Luncheon. “The cost of opioid use in the United States exceeds $1 billion annually due to many factors, including lost productivity in the workplace, healthcare expenses, and prosecution and incarceration expenses.”

Opioid use is a disease not a moral failure, according to Dr. Beheshti. When introduced to opioids, “the brain creates more opioid receptors, and the user then needs more of the drug to feed those receptors. This is called Receptor Up-regulation, and it leads to a chemical dependency.” In addition to the creation of more receptors in the brain, opioid use also creates what is known as Reward Pathway Activation. Dr. Beheshti compared this activation to the positive reinforcement a child receives from a parent for successes at school. “During Reward Pathway Activation, the user experiences the same feelings of pleasure as those of the child being rewarded for scholastic success. The desire for this feeling, in conjunction with Receptor Up-regulation, often can override the survival instinct.”

Some doctors prescribe Buprenorphine to treat opioid addiction. “Buprenorphine binds to opioid receptors, pacifying the receptors while simultaneously preventing opioids from binding to them,” explained Dr. Beheshti. But the use of Buprenorphine is controversial. For example, Solid Landings is an abstinence-based program, so the use of Buprenorphine after detoxification is not supported. However, Dr. Beheshti explains that used correctly, Buprenorphine can be successful in aiding in cessation. In her practice, Buprenorphine maintenance is never the first option, but for a small percentage of her patients it seems necessary. “Some patients are not good candidates,” she explained, but for someone with multiple attempts and failures at sobriety, it can offer a chance for change if prescribed and used correctly.

Some doctors prescribe Buprenorphine to treat opioid addiction. “Buprenorphine binds to opioid receptors, pacifying the receptors while simultaneously preventing opioids from binding to them,” explained Dr. Beheshti. But the use of Buprenorphine is controversial. For example, Solid Landings is an abstinence-based program, so the use of Buprenorphine after detoxification is not supported. However, Dr. Beheshti explains that used correctly, Buprenorphine can be successful in aiding in cessation. In her practice, Buprenorphine maintenance is never the first option, but for a small percentage of her patients it seems necessary. “Some patients are not good candidates,” she explained, but for someone with multiple attempts and failures at sobriety, it can offer a chance for change if prescribed and used correctly.

“It’s hammered into our heads in medical training that we need to follow evidence-based practices. And studies that we have do show significant improvement from Buprenorphine use. However, in the studies, we give the patient the medication and trust them to take it as prescribed,” explained Dr. Beheshti. However, it’s difficult to expect patients taking Buprenorphine to treat opioid use to follow the doctor’s recommendations at all times.

Dr. Beheshti explained that “Buprenorphine maintenance is possible, but that it’s not a solution in and of itself.” It’s necessary for patients to be willing to work a self-help program, including such options as AA, SMART Recovery, regular therapy or a combination of programs. Dr. Beheshti says both prescribers and patients need to be properly educated about misuse potentials and they need to monitor progress.

“Buprenorphine maintenance therapy is not for everyone, but that does not mean that it is not for anyone.”

Join Solid Landings Behavioral Health for our next Professional Networking Luncheon featuring:
Dr. Susan Writer
“Working with Transgender Individuals in Treatment Settings: Developing Cultural Competency”

Tuesday, November 25th, 2014
11:30am-1:30pm
The Center Club, Garden Level
650 Town Center Drive, Costa Mesa, CA 92626
1 CEU Credit Provided for MFT, LCSW
Free Lunch and Free Valet are provided

Mark Lamplugh Jr. is a fourth generation firefighter and former captain with the Lower Chichester (PA) Fire Company. He is now the Vice President of Business Development with Solid Landings Behavioral Health. He is nationally recognized in Crisis Stress Intervention through the American Academy of Experts in Traumatic Stress. Mark has placed and referred hundreds of firefighters, police officers, EMS personal and civilians nationwide. He can be reached for comment at mark.lamplugh@solidlandingsbehavioralhealth.com