Subutex Dependency & Addiction Treatment

Subutex Withdrawal Treatment Center

ANR Clinic is Now in the US

Subutex is a trade name for the drug buprenorphine, which is a partial opioid agonist widely used for the medication-assisted treatment of addiction to strong opioids.1 Other buprenorphine preparations, known as Buprenex, Bultrans, and Belbuca, are used to treat severe pain.2 The medical use of Buprenorphine has markedly increased, and already in 2010 there were 190 million buprenorphine dosage units distributed to pharmacies in the United States.3 However, Buprenorphine itself has an abuse and dependence potential. Buprenorphine abuse through intravenous injections or powder snorting may lead to the development of opioid dependence.4 

How did the opioid crisis develop? 

Opioid drugs relieve pain and induce euphoria through activation of the opioid receptors and specifically, the µ-opioid receptors. When opioid drugs were first introduced to the market, their addiction potential was strongly underestimated, and they were prescribed for pain relief.

However, the number of cases of opioid analgesics diversion, misuse, and overdose increased, and it became clear that opioid drugs are highly addictive. It is estimated that approximately 21%-29% of patients with prescription opioid drugs for chronic pain would misuse them, whereas 8%-12% develop would opioid addiction.5 
The opioid crisis has led to devastating public health, social, and economic consequences. In 2018, reportedly, 128 people died every day in the United States due to an opioid overdose.6 The economic burden of the misuse of prescription opioid drugs alone in the United States has estimated at USD 78.5 billion a year.7

What is the biological basis of opioid tolerance and dependence?

Opioid drugs exert their analgesic and euphoric effects through binding to and activating the opioid receptors and mainly the µ-opioid receptors. The endogenous brain system that activates the opioid receptors includes the endorphins, peptides released in response to stimuli such as pleasurable activities, pain, or stress. Endorphins naturally promote the feeling of well-being, euphoria, and relieve pain. With continuous opioid use, the endogenous endorphin and opioid receptor system changes and adapts to a new functional level. Opioid receptors begin to respond to activation in a less pronounced manner leading to the development of opioid tolerance. Neuroadaptations in the opioid receptors and secondary messenger pathways develop with opioid abuse that leads to opioid dependence and addiction.8

Why is Buprenorphine used for the treatment of opioid dependence and severe pain?

Buprenorphine is a synthetic opioid drug that is a partial, long-acting µ-opioid receptor agonist. It also has effects on the κ- and δ-opioid receptors. Due to its partial agonist pharmacological profile, the effects of buprenorphine plateau at high doses, which is associated with a more beneficial safety profile. Buprenorphine is one of the drugs approved and widely used for medication-assisted treatment of opioid dependence.1 During the medication-assisted treatment, Buprenorphine substitutes a stronger agonist opioid on which the patient is dependent, and Buprenorphine’s dose is gradually tapered down. In this capacity, Buprenorphine has been included in the WHO list of essential medications.9 Buprenorphine is also used for the treatment of severe pain not adequately controlled by non-opioid drugs because it is a potent analgesic.

Does Buprenorphine have an abuse potential?

Initially, Buprenorphine marketed as a drug with a very low abuse potential due to its partial agonist profile at the μ-opioid receptor. However, with time it became clear that it has a misuse and abuse potential of its own. The number of cases in which Buprenorphine has been diverted to the black market, misused, or abused has markedly increased. Buprenorphine is most frequently abused by injecting it intravenously or snorting buprenorphine powder. One study found that among patients receiving medication-assisted treatment for opioid dependence, 23% misused Buprenorphine intravenously.10 In different groups of patients treated for opioid dependence, the number of individuals misusing Buprenorphine has varied between 20% to 89%, but it is consistently substantial, or high.10 Buprenorphine abuse can also develop in individuals who have not been prescribed the drug.3 

One of the strategies to decrease the abuse potential of Buprenorphine in the medication-assisted treatment of opioid addiction has been the development of the drug Suboxone, which is a combination formulation of Buprenorphine and the μ-opioid receptor antagonist naloxone. However, during the induction phase of the treatment, the buprenorphine-only preparation Subutex is preferred.

What are the dangers associated with buprenorphine misuse?

Even though Buprenorphine is a partial opioid agonist, its misuse and abuse may lead to devastating consequences. Opioid dependence and addiction may develop as with other opioid drugs. Even though Buprenorphine has a better safety profile than full opioid agonists, an overdose is still possible and may present with pinpoint pupils, dizziness, confusion, low blood pressure, seizures, respiratory depression, or coma. The concomitant use of benzodiazepines, alcohol, or other drugs that are central nervous system depressants may lead to severe respiratory depression and even death. This occurs due to the additive effects of Buprenorphine and benzodiazepines or alcohol. In newborns of women with buprenorphine abuse during the pregnancy, neonatal opioid withdrawal syndrome may develop. The newborn may experience irritability, tremor, convulsions, apnea, or respiratory depression. As with all intravenous drug abuse, the intravenous abuse of Buprenorphine places the individuals at an increased risk for hepatitis and HIV infections.

Detox from Buprenorphine

Accelerated Neuro-Regulation (ANR) is a treatment for opioid addiction developed by Dr. Andre Waismann more than 20 years ago. It has been used to successfully treat 24,000 patients worldwide with great success.

ANR represents an individualized approach that restores the balance of the brain endorphin and opioid receptor system in individuals with opioid addiction and reverses the brain’s neuroadaptive biochemical changes. The procedure is performed under sedation with an anesthetic to minimize the patient’s discomfort. Opioid withdrawal is precipitated by the opioid antagonist naltrexone. The sedated patient is monitored closely by the medical treatment team, and the precipitated withdrawal is controlled and modulated in a flexible and individualized manner with adjunctive medications.

This approach allows reversing the function of the opioid receptors toward a normal level. ANR differs from other methods for rapid or fast detoxification because it focuses on the biological basis of opioid addiction. Through the individually monitored and controlled precipitated withdrawal, ANR can bring the neurochemistry of brain opioid receptors and endogenous endorphins to normal levels. 

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Subutex Withdrawal Symptoms

Subutex withdrawal symptoms in individuals abusing the drug develop more slowly than with other opioid drugs.
The duration and intensity of the withdrawal syndrome depend on the duration and dose of the preceding drug abuse.

The beginning of the withdrawal syndrome will start  20-35 hours after the last buprenorphine dose and may continue until at least 10 to 21 days after the last buprenorphine dose.11, 12 This delayed timeline of the withdrawal symptoms is caused by the pharmacological profile of Buprenorphine and its long half-life.

The withdrawal symptoms are moderate and include anxiety, restlessness, yawning, bone and muscle aches, tearing eyes, runny nose, gastrointestinal discomfort, and dilated pupils.11, 12 The most frequently reported reason for buprenorphine misuse has been to try to manage symptoms of opioid withdrawal from other opioids or to remain abstinent from them. The second less frequently reported reason has been to achieve a euphoric effect, such as through snorting subutex.13

Buprenorphine Withdrawal Timeline

Subutex withdrawal (Buprenorphine withdrawal) may invoke symptoms similar to those experienced when stopping other opioid drugs, such as morphine, heroin, and methadone.

Common Symptoms of Buprenorphine/Subutex Withdrawal Include:

       Anxiety

       Insomnia

       Muscle aches and cramping

      Nausea

       Vomiting and diarrhea

       Fever chills and cold sweats

       Mood swings

       Cravings

When buprenorphine use is stopped suddenly,  symptoms typically begin about 48 hours after the last dose and continue for up to 10 days or longer. Buprenorphine withdrawal symptoms vary on an individual
basis, and dose and length of time of use can factor into how long withdrawal will last and how intense symptoms may be. The following is a sample timeline of what can be expected:

Days 1-2

Withdrawal symptoms begin about 48 hours after the last dose. Headaches and irritability are common during this time.

Day 3

The third day is the peak of withdrawal symptoms. Muscle aches will grow more intense. Fever, chills, vomiting and
diarrhea may occur. Cravings are at their strongest around the 72-hour mark.

Days 4-6

GI issues, insomnia, and cravings may still persist. Mood swings are common.

Day 7+

By one week after stopping buprenorphine, symptoms should begin to subside, although some individuals may still be enduring some rather uncomfortable symptoms like nausea, body aches, and anxiety. Psychological symptoms such as depression may begin to set in for an extended period of time.

It is not uncommon to relapse during Subutex withdrawal as many individuals will begin using buprenorphine again in order to mitigate the discomfort and often painful side effects. Cravings should be expected to continue so long as the endorphin-receptor system is left in a state of imbalance.

Buprenorphine Addiction Treatment

Opioid addiction is a disease that is characterized by biological changes in the brain. With continued opioid abuse, opioid receptors undergo neuroadaptive changes, and the natural production of endorphins is disrupted, leading to tolerance and the need to take increasing opioid doses.

The developing neurobiological brain alterations lead to craving and compulsion to seek out the opioid drug despite its harmful causes. Patients who abuse Buprenorphine have a complex medical history. They may have undergone treatment for another opioid addiction and may have different comorbidities. 

ANR targets the neuroadaptations of the brain endogenous endorphin system and opioid receptors. It induces a withdrawal and brings the functioning of the endogenous endorphin system and opioid receptors to a normal, for the individual, functional level.
The ANR method focuses on the main biological cause of addiction, bringing the central nervous system back into balance and utilizing an individualized approach based on the individual’s medical and substance abuse history.

Thus, ANR returns the biochemical and opioid receptor balance toward its pre-addiction level, which counteracts the biological basis for cravings. For each patient, an individual approach and dosing of naltrexone and adjunctive medications is used during the ANR procedure based on the duration and extent of opioid addiction and the presence of any other medical conditions. The fact that the treatment is carried out under deep sedation minimizes the discomfort from the Subutex withdrawal symptoms. During the precipitated withdrawal syndrome, the patient is supported by an experienced medical team with expertise in anesthesiology, intensive care, and internal medicine.

The ANR treatment achieves a reset of the biological state of the opioid receptors. After the procedure, the patient is prescribed a daily naltrexone regimen. Its duration is determined on an individual basis, taking into account the patient’s personal medical history and needs. This personalized approach ensures the stabilization of the opioid receptor functional balance.

Buprenorphine Rehab near me/you

The ANR Clinic offers an individualized approach to the treatment of buprenorphine abuse and dependence. The ANR procedure is performed during a short hospitalization, which allows patients more flexibility. The ANR Unit of the Landmark Hospital in Naples, Florida, provides ANR treatment for patients with opioid dependence in the United States. ANR clinics also exist internationally in Thun, Switzerland, and Tbilisi, Georgia, in Europe and in the Barzilai Hospital, Ashkelon, in Israel.

Buprenorphine Rehab Facility

We conduct the ANR procedure in a hospital with state-of-art medical facilities, and our team includes experienced medical staff. ANR is performed in an intensive care unit, which gives the opportunity to collect advanced patient data in real-time and to ensure the safety of the patients. Our medical team includes a board-certified anesthesiologist with experience in critical care, internal medicine physicians, and nurses with vast critical care experience. Consultants include expert cardiologists and nephrologists, which allows to safely treat patients with opioid addiction who have cardiovascular or renal comorbidities. The combination of the highly qualified and experienced team and state-of-art facilities ensures that we can safely treat the biological roots of opioid addiction even in patients with a complex medical history or comorbidities.

Literature sources

  1. United States Food and Drug Administration. Information about medication-assisted treatment (MAT). Link
  2. Webster L, Gudin J, Raffa RB, Kuchera J, Rauck R, Fudin J, Adler J, Mallick-Searle T. Understanding buprenorphine for use in chronic pain: expert opinion. Pain Med. 2020; 21(4):714-723.
  3. Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014; 8(5):315‐326.
  4. Kumar R, Viswanath O, Saadabadi A. Buprenorphine. [Updated 2020 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: Link
  5. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015; 156(4):569-576.
  6. CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018. Link
  7. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016; 54(10):901-906.
  8. Waldhoer M, Bartlett SE, Whistler JL. Opioid receptors. Annu Rev Biochem. 2004; 73:953-990.
  9. WHO Model List of Essential Medicines, 21st List (2019). Link
  10. Moratti E, Kashanpour H, Lombardelli T, Maisto M. Intravenous misuse of Buprenorphine: characteristics and extent among patients undergoing drug maintenance therapy. Clin Drug Investig. 2010; 30 Suppl 1:3-11.
  11. Tripathi BM, Hemraj P, Dhar NK. Buprenorphine withdrawal syndrome. Indian J Psychiatr 1995; 37(1):23-25.
  12. Derbel I, Ghorbel A, Akrout FM, Zahaf A. Opiate withdrawal syndrome in buprenorphine abusers admitted to a rehabilitation center in Tunisia. Afr Health Sci. 2016; 16(4):1067‐1077.
  13. Chilcoat HD, Amick HR, Sherwood MR, Dunn KE. Buprenorphine in the United States: Motives for abuse, misuse, and diversion. J Subst Abuse Treat. 2019; 104:148-157.
  14. U S National Library of Medicine. Medline Plus. Opiate and opioid withdrawal. Link

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