Buprenorphine Maintenance

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

Our experience with buprenorphine maintenance has revealed this medication to be a very helpful tool in the treatment of opioid addiction. We have used a somewhat unique maintenance program, so it has been exciting to see people use it during outpatient addiction treatment and have successful transitions into recovery.

Maintenance treatment of opioid addiction is used around the world. It is primarily done with methadone, which is often prescribed for years if not for life. Maintenance treatment with methadone helps to eliminate use of the opioids, reduces psychosocial problems, reduces the risk of medical problems associated with IV drug use (HIV, Hepatitis C) and results in less illegal activity and increased employment. It appears that maintenance treatment with buprenorphine provides similar benefits. Unfortunately, many methadone programs provide limited addiction treatment and people are left entirely relying on the medication. Recovery from addiction using a 12 Step model is seldom emphasized.

We have taken a different approach, combining the standard use of buprenorphine with our outpatient addiction treatment program. As a result, people receive medication that allows for resolution of craving and prevention of relapse, while they are advancing their lives and learning to live without drugs and alcohol. We use the buprenorphine to help people transition into recovery. They are involved in the outpatient program, and attend 12 Step meetings. As a result they establish personal recovery programs and the confidence needed to remain abstinent. We also treat co-existing mental health problems during the maintenance treatment period, so psychological stabilization occurs as well.

After 6 – 8 months on buprenorphine, once good recovery has been established, we taper people off of the buprenorphine. This is always scary for the individual who has been using opioids, but has worked out remarkably well. They are tapered while attending treatment once a week so we can provide support and help them through the transition to a medication free state.

We have gone through this with several people who have had great success. They often request the taper before we bring it up. They tolerate the taper with minor withdrawal symptoms. They remain involved in addiction treatment and 12 Step programs. And they have remained abstinent from opioids without buprenorphine. This exciting use of a pharmacological intervention for addiction has resulted in more people staying in treatment and getting sober.