Practice Goals
Buprenorphine maintenance treatment (BMT) is a medication-assisted treatment for individuals with opioid dependence. The goals of BMT are to alleviate withdrawal symptoms, suppress opiate effects and cravings, and decrease the risk of overdose as a result of the illicit use of opioids.
Practice Components
Opioids, such as heroin or morphine, cause a release of excess dopamine in the body. Users become dependent on the drug because they need opiates to continuously occupy the opioid receptor in the brain. Similar to methadone, buprenorphine works by occupying this receptor and blocking the high that usually comes from illicit opioid drug use. While methadone causes a stronger agonist effect because it is a full agonist, buprenorphine exerts a weaker agonist effect at opioid receptor sites because it is a partial agonist.
The effects of buprenorphine increase as the dosage of the drug is increased; however, at moderate doses, the effects reach a plateau and no longer continue to grow (known as the ceiling effect). Because there is no ceiling to the level of effects that methadone can induce, illicit drug use can lead to fatal overdoses. Thus, buprenorphine can be used as a viable pharmacological alternative to methadone because it carries a lower risk of abuse, overdose, and side effects than do full opioid agonists.
Another benefit to BMT is the dosing schedule. Although the effects of buprenorphine are not as strong as methadone, they last longer. While methadone requires daily dosing, buprenorphine can be taken once every 2 days. This can be an advantage because opioid-addicted patients may not be able to adhere to treatment that requires daily dosage and visits to the clinics.
In addition, buprenorphine can be dispensed in office-based settings. Although methadone can only be dispensed from federally licensed opioid treatment programs, buprenorphine can be administered by physicians in their offices.
There are generally three stages of BMT: induction, stabilization, and maintenance. During the induction phase, patients are medically monitored during the beginning of the buprenorphine therapy. The stabilization phase begins once patients have greatly reduced or stopped their opioid abuse. During this phase, they no longer have cravings and experience few or no side effects. The dosage may also be adjusted during this phase. The maintenance phase begins once patients are on a steady dose of buprenorphine. The length of time that patients continue to receive BMT varies by individual and may be indefinite (SAMHSA 2019).
In addition to medication, BMT can include providing patients with comprehensive rehabilitation services, such as group therapy, individual therapy, medical services, and referrals to community-based agencies.
