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I went to a conference where virtually every public and community health agency in the area where I live was represented. There is a change...

WHAT IS BUPRENORPHINE? WHAT IS METHADONE?

Buprenorphine is an "analgesic", aka pain medication, aka narcotic. It is man made from something "natural" and altered chemically to become a semi-synthetic compound. Yes it is considered a narcotic and treated as such by the DEA. It is in the "Opioid" category. When taken, this medication will merge with opioid receptor sites just as morphine, heroin or methadone does. But this med has other slightly different properties. 

Buprenorphine is a partial agonist opioid. Heroin and methadone are full agonists. I mention this since you might hear those terms, not to conduct an opioid course. Because it is a "partial agonist" Buprenorphine can give pain relief same as the other opioids but it doesn't affect your breathing as much as methadone would. It is faster and easier to get stable with this medication and when you are ready, faster and easier to detox off.  It is considered to be less addicting and with fewer side effects. It is shorter acting compared to methadone. You can't be on any benzodiazepine prescriptions (or illicit) such as xanax since it is not medically safe. You must be illicit drug free after you are stabilized or usually you get terminated. Remain illicit drug free and you get "take home" doses for several days or a week so you don't have to go everyday. Some clinics have you go every other day. Of course there is a catch: buprenorphine has what is called a "ceiling" effect. Meaning, once you reach a certain dose, taking additional doses does not give you more pain relief and it is not suppose to get you euphoric or high. Once you reach a certain level, that is it. Okay if your drug use has been 5 years or less or your daily use is not real high. For some
 people with substance use disorder  this works very well!  If you are taking buprenorphine and still have cravings then you need methadone. With the carfentanil, it is hard to judge if this treatment would work well with heroin users until one tries it. Doesn't hurt to try. 

Heroin users usually need methadone; WHY? Because of the large amount of daily use and recently because of the carfentanil potency. Methadone is a full agonist. It has no ceiling effect. It gives full pain relief but take too much and you will stop breathing and die. Plainly put. It affects your breathing so anyone with a respiratory disease such as asthma or COPD must be monitored and must be very careful in taking this medication. Methadone can also affect your heart rhythm. A very high dose (> 200 mg) or a dose above 80 mg in combination with certain prescribed meds such as clonidine or seroquel can be deadly. That is why methadone clinic patients are monitored so closely. For medical safety. Methadone is dispensed by nurses only (not counselors) and you are assessed before you take that daily dose, for medical safety. Methadone has a very long half life....it lasts for days in your body until it is totally out of your system. When you take it at a methadone clinic daily, as you should, it builds up in your body to a therapeutic level and then it is maintained at that level. A therapeutic level is when you have no physical withdrawal symptoms at all AND no cravings. You almost forget that you take it because you feel "normal". Not high. Not sick. No cravings. Just live and enjoy life. When I say methadone clinic, I mean methadone for addiction NOT pain. Methadone for pain is a totally different program, different approach and different rules. 




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