Buprenorphine vs Naloxone
These two medications are both approved by the FDA for the treatment of alcohol use disorder. Which is right for you?
Buprenorphine
Buprenorphine helps to alleviate the brain’s dependence on opioids—such as heroin, fentanyl, or other opioids like prescription painkillers—while also reducing withdrawal symptoms and cravings. More specifically, it is a partial agonist which produces some mild feelings like opioids, like euphoria and pain relief, but at much lower levels than full opioid agonists like heroin.
Naloxone (Narcan)
Naloxone (brand name Narcan) is an FDA-approved medication designed to rapidly reverse an opioid overdose. It works by binding to opioid receptors in the brain and reversing and blocking the effects of opioids.
Naloxone is an active ingredient within Suboxone. It is not present in a high enough dose to have the effects of Narcan, but it can limit the effects of other opioids when taken in the Suboxone formulation. It reduces the risk of overdose and protects against feeling a high if Suboxone is misused or diverted.
How does buprenorphine work?
Buprenorphine is a medication used to sustain recovery from opioid use disorder. It is called a partial opioid agonist, meaning it works in a similar way to opioids by binding to opioid receptors in the brain which causes limited pleasurable effects to stop withdrawal symptoms. However, for most people, it won’t provide the “high” associated with opioids like heroin.
How does naloxone work?
Naloxone is a full opioid antagonist. It dislodges opioid molecules from the brain’s receptors and blocks them from binding again. This effect can quickly restore a person’s breathing to normal if that person’s breathing has slowed down or stopped because of an opioid overdose. Naloxone WILL NOT improve breathing in people who have overdosed on other substances (such as alcohol) or for other reasons (such as asthma).
What are the side effects of buprenorphine?
The most common main side effects of buprenorphine include:
- Constipation
- Dizziness
- Headache
- Nausea
- Drowsiness
What are the side effects of naloxone?
The use of naloxone causes opioid withdrawal symptoms, including nervousness, irritability, body aches, feelings of restlessness, diarrhea, stomach pain or nausea, fever, chills, and sneezing or runny nose. These are not technically side effects of naloxone, as they are the results of the original opioid use, but they can be extremely uncomfortable.
Can I take buprenorphine alongside other opioids?
No. According to the American Society of Addiction Medicine, you will need to prepare for your first dose of medication-assisted treatment containing buprenorphine. This means stopping using opioids for a specified amount of time before you take buprenorphine in order to prevent unpleasant side effects. That time period depends on whether the opioid you have been taking is a short-acting or long-acting opioid. Generally speaking, short-acting opioids like Percocet, heroin, and Vicodin should be ceased 12-24 hours before your first dose. Longer-acting opioids, like morphine, methadone, and Oxycontin are generally discontinued 36-48 hours before your first dose of buprenorphine.
The key is checking in with an experienced physician licensed to prescribe this medication, who can advise you of the appropriate time frame based on your unique medical history.
Can I take naloxone alongside opioids?
No. Naloxone dislodges and blocks opioids from the opioid receptors in your brain. If you take opioids and naloxone, you are likely to trigger precipitated withdrawal, which can be particularly intense. Naloxone is a rescue medication that reverses opioid overdose.
Can I use buprenorphine to treat opioid use disorder?
Yes. Buprenorphine is approved by the FDA to treat opioid use disorder. Because it relieves withdrawal symptoms and opioid cravings, buprenorphine allows people that chance to heal physically and mentally and to develop coping skills. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that medication-assisted treatment like buprenorphine:
- Improves patient survival
- Increases retention in treatment
- Decreases opioid use and other related activities associated with substance use disorders
- Increases the ability of patients to gain and maintain employment
- Improves birth outcomes among pregnant women with substance use disorders
Can I use naloxone to treat opioid use disorder?
No. Naloxone can be a life-saving antidote in opioid overdose emergencies. But naloxone cannot treat the underlying problem that caused the overdose: addiction to opioids. A combination of behavioral health support and medication such as methadone, buprenorphine, or naltrexone is your best bet for recovery.
Where can I get buprenorphine?
Workit Health offers Suboxone (buprenorphine/naloxone) treatment in many states. If you aren’t in our area, learn other strategies for finding a buprenorphine treatment near you.
To find buprenorphine treatment in your area, the NAABT has a directory called Treatment Match which will connect you with local providers. And the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Buprenorphine Practitioner Locator.
Where can I get naloxone?
You can find naloxone at pharmacies without a prescription, through insurance, and from some community organizations. There are local drives in some areas that provide naloxone for free, to help reduce overdose deaths in the area. Its availability varies from state to state. You can find out how to get Narcan via the Narcan website.
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Citations
1. Buprenorphine. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. Accessed November 2021.
2. Davis, C. S., & Samuels, E. A. (2021). Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19. The International Journal on Drug Policy, 93: 102905. https://doi.org/10.1016/j.drugpo.2020.102905
3. Leshner, A. I, & Dzau, V. J. (2019). Medication-Based Treatment to Address Opioid Use Disorder. Journal of the American Medical Association, 4;321(21):2071-2072. https://doi.org/10.1001/jama.2019.5523.
4. Naloxone. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naloxone Accessed November 2021.
5. Naloxone DrugFacts. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugfacts/naloxone. Accessed November 2021.
6. Lifesaving Naloxone. Centers for Disease Control and Prevention. https://www.cdc.gov/stopoverdose/naloxone/index.html. Accessed November 2021.
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