Buprenorphine is an important part of treatment for many with substance use disorder, and coupled with therapy and support it can save lives. However, Tennessee Department of Health data show an increase in deaths associated with buprenorphine when the drug is used with another respiratory depressant. As organizations and individuals across Tennessee work to reduce the impact of the epidemic of drug overdoses in our state, TDH is raising awareness of risks associated with buprenorphine when combined with other drugs.
The TN Dept of Health found a total of 67 deaths associated with buprenorphine in 2016. Most people had taken multiple drugs prior to death. However, the latest TDH analysis of drug overdose death data shows abuse of buprenorphine alone can sometimes lead to death. TDH data show ten Tennesseans only had buprenorphine present when they died between 2013 and 2016.
"These tragic and preventable deaths remind us buprenorphine is a powerful opioid drug which can be dangerous when combined with other drugs like alcohol or benzodiazepines like Valium or Xanax," said TDH Commissioner John Dreyzehner, MD, MPH. "Buprenorphine can only legitimately be used for treatment of a substance use disorder in Tennessee, making it incumbent on physicians and pharmacists to take great care and provide clear direction in its use and risks."
Buprenorphine is used in medication-assisted treatment to help people reduce or quit their use of heroin or other opiates such as pain relievers like morphine. Buprenorphine reduces cravings for other opiates, helping people regain stability in their lives. Medications such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to treatment of opioid dependency. When taken in this way, buprenorphine is safe and effective.
"Medication-assisted therapy, the collaboration of personal work, commitment to therapy, professional and peer counseling and support combined with the medication, can be an effective and critical treatment for people suffering with a substance use disorder," said Tennessee Department of Mental Health and Substance Abuse Services Commissioner Marie Williams, LCSW. "We urge anyone struggling with substance abuse and addiction issues to seek treatment."
"Buprenorphine can be prescribed or dispensed in doctors' offices, which significantly increases access to treatment for addiction, unlike methadone treatment which must be performed in a clinic," said TDH Chief Medical Officer David Reagan, MD, PhD. "Buprenorphine is an important option for treating substance abuse disorders and has been shown to help decrease use of illicit opioid drugs. But like any drug, it can increase risk of overdose when taken with other addictive drugs."
Like opioids, buprenorphine produces effects such as euphoria, and as a result it can be misused. However, the opioid-like effects of buprenorphine are weaker than those of drugs such as heroin and methadone. Buprenorphine's opioid effects increase with each dose until at moderate doses they level off, even with further dose increases. This lowers the risk of misuse, dependency and side effects, but does not eliminate it.
People should use the following precautions when taking buprenorphine:
- Do not take other medications without first consulting your doctor.
- Do not use illegal drugs, drink alcohol or take sedatives, tranquilizers or other drugs that slow breathing.
- Mixing other medications with buprenorphine can lead to overdose or death.
Substance abuse is a treatable and preventable disease. Call the Tennessee REDLINE at 1-800-889-9789 for immediate help for anyone suffering from a substance abuse disorder.
The National Alliance of Advocates for Buprenorphine Treatment report, "Buprenorphine (BYOO-pre-NOR-feen) ('bu-pre-'nor-feen) is an opioid medication used to treat opioid addiction in the privacy of a physician's office.1 Buprenorphine can be dispensed for take home use, by prescription.1 This in addition to buprenorphine's pharmacological and safety profile makes it an attractive treatment for patients addicted to opioids."