What is it?
Buprenorphine is one of the main medicines used in opioid pharmacotherapy programs (OPP) to treat opioid addiction or dependence. It is itself an opioid, but pharmacologically it behaves very differently from heroin, oxycodone, morphine and other full opioid agonists.
Buprenorphine is a partial agonist at the mu-opioid receptor. In simple terms, it attaches very strongly to the same receptors as other opioids but activates them only partially. Because it binds so tightly, it can suppress withdrawal and cravings while also blocking or substantially reducing the effect of other opioids taken on top of it. Its opioid effects also tend to plateau at higher doses a “ceiling effect” which contributes to a lower risk of respiratory depression than with full agonists, although overdose and dangerous sedation are still possible, particularly when combined with alcohol, benzodiazepines or other sedatives.
In an OPP, the purpose is not simply to replace one drug with another. The aim is to stabilise opioid dependence so that the person is not repeatedly cycling through intoxication, withdrawal, craving and drug-seeking. Once adequately dosed, a person can generally function without becoming intoxicated from each dose. This can reduce illicit opioid use, withdrawal, cravings, overdose risk and many of the social harms associated with maintaining an unpredictable opioid supply.
Traditionally, buprenorphine has been given as a tablet or film dissolved under the tongue, commonly as buprenorphine alone or buprenorphine/naloxone. The person may therefore need relatively frequent dosing and pharmacy or clinic attendance.
Buvidal
Buvidal changes that model considerably. It is a long-acting injectable formulation of buprenorphine given subcutaneously by a healthcare professional. In Australia, it is available in weekly and monthly formulations and is PBS-listed for opioid-dependence treatment. NSW Health
After injection, Buvidal forms a depot under the skin that releases buprenorphine gradually. Instead of having a tablet or film producing a daily cycle in drug concentration, the person receives relatively sustained exposure over the week or month.
For someone with opioid dependence, that can have some very significant practical benefits:
| Benefits of Buvidal | |
|---|---|
| Reduced Dosing | A monthly formulation can replace daily or near-daily pharmacy attendance. NSW guidance specifically identifies this as valuable for people whose work, travel, childcare, housing, health or other circumstances make regular attendance difficult. NSW Health |
| Stable Blood Levels | More stable medication levels. The slow release can provide continuous suppression of withdrawal and cravings rather than requiring the person to think about medication every day. |
| Reduced Diversion | There are no tablets or films to sell, lose, stockpile, inject or give to somebody else. |
| Less opportunity for missed doses. | Once the injection has been administered, the medication continues working without the person having to remember a daily dose. |
| Greater freedom and normality | Employment, holidays, family responsibilities and travel can become much easier when someone’s life isn’t organised around supervised dosing. |
| Reduced reinforcement of drug-taking rituals. | There is no daily tablet, film or medication-taking behaviour. For some people, separating treatment from the repeated ritual of obtaining and consuming an opioid can be psychologically useful. |
One of the most important conceptual benefits is autonomy. With older forms of opioid pharmacotherapy, treatment itself can occupy a substantial part of someone’s life. With a depot injection, the medicine essentially moves into the background while the person gets on with living.
There is an important induction issue with buprenorphine generally: because it binds so strongly to opioid receptors, giving it too soon after a full opioid agonist can sometimes precipitate withdrawal. Starting or transferring treatment therefore needs to be medically managed, particularly for people using methadone or very potent synthetic opioids.
Position in this Vault
Buvidal has been without joke one of the most “in the nick of time” medical interventions I have received. After the hard past work in rehab, 20 years of sobriety, I had begun to think that Recovery was done. The death of my last remaining family members combined with an insane amount of work pressure being applied had resulted in 2 psychiatric hospitalisations within 6 or so months. One for classical mania, euphoric and loud, the worse one for dysphoric mania.
Imagine all the thoughts of the darkest depression only you cant sleep, agitation is sky high and you cannot even get rest as your body and mind focus on the worst of negative Self sabotage. This is dysphoric mania. It is both that are hard on family but without doubt a bad case of dysphoric mania places you sky high on the suicide risk scale.
In this time I relapsed, first through a doctor drip feeding me opioids progressing to the inevitable next stage. It was a wild out here street back to being a “junky”. My habit instead was secretive, hidden in plain sight, binge at night small top-up, then front to and perform work as if nothing was happening. I must be a good actor or people genuinely didnt care a fuck about me because not one solitary person in nearly 2 years ever asked me that old chestnut RUOK.
Relapsing after 20 years sober I just felt like giving up, I so very did, save for the support from an unexpected place and a fine piece of peer education, connecting me up with counselling and Buvidal opiate pharmacotherapy. It was a game changer. I am still on Buvidal now. I enjoy an active life with my family and friends, recovery this time came as pharmacotherapy and ongoing counselling.
Whether I stay on Buvidal or not is something for later. I live to fight on again. Some very hard lonely days, but thanks to the unamed for the push in the right directions an Directions Health who have been outstanding.