Probuphine® was first approved by the Food and Drug Administration (FDA) in 2016 and prior to approval had several studies conducted that aided in approving its treatment for opioid use disorder (OUD). The test made significant progress in showing participants who continued their previous scheduled regimen for opioid detox with the addition of a probuphine implant. After thorough observation from the participant study those that implemented probuphine to their treatments showed significant positive change in energy, sleep, and overall quality of life.

What makes this treatment unique, is that it provides a continual, low-level dose for up to six months for those who are already stable on low-to-moderate doses of other forms of buprenorphine. Additionally, it is the only type of treatment that is in the form of an implant, whereas other opioid medications are typically found in forms of pills or films. This alone provides patients with a convenient means of not needing to resort to taking a pill daily.

Currently, over 10.1 million Americans misuse opioids at least once over a 12-month period. With treatment options like Probuphine, it revolutionizes the method of opioid treatment and controls cravings or withdrawal symptoms to result in balance, self-control, and management.


What is Probuphine®?


Probuphine® is an implant which contains Buprenorphine, the active ingredient in Suboxone, Subutex and Bunavail®. The implant is inserted under the skin and delivers a dose of the medicine for about 6 months. Buprenorphine tablets and film have been available since 2000 and they have become a very popular treatment option for many patients. Because the treatment works very similarly to an opioid drug, it is familiar in that it does not activate the brain receptors but does occupy the same receptors that heroin or oxycodone would directly affect

The main reason why Probuphine is used is due to its effectiveness on improving long-term outcomes for individuals recovering from opioid disorders and is said to have a lower relapse rate.


Benefits of Probuphine


Probuphine® has the potential to relieve both of these problems. Once patients receive their implants they will not be able to skip doses or sell their medicine, and it will be lot harder to override their treatment. There are other potential benefits from this treatment. A six-month implant will make it more likely that patients remain in treatment for at least 6 months. It has also been said that an implant can break the cycle of having to take a pill each day. This may help patients feel more normal and less like a drug addict. There is also less likelihood of children accidentally taking the medicine and suffering from an overdose.


Side Effects to be Aware of


With all treatments, there are potential side effects you should be aware of. And, because Buprenorphine relieves the withdrawal and cravings of opiates it attaches to the same opiate receptors similar to Heroin or OxyContin. What this means, is that it binds so tightly that most patients have more trouble getting off Suboxone than they do getting off heroin. Additionally, the withdrawal symptoms of any Buprenorphine product tend to last so long that most patients have a history of going back on their substance or they go back to using street drugs.

Another main concern for patients using Buprenorphine, is the diversion and misuse of the drug. Many patients will admit they frequently divert their medicine. They sometimes use less of the drug than they are prescribed, or they sometimes skip some doses in order to sell their "extra" doses to other people. There is quite a street value for Suboxone because it is cheaper than heroin and prescription opiates. It can tide heroin addicts over if they can't find or afford their drug of choice. Some people also misuse their Buprenorphine products by injecting them. More commonly, people misuse their treatment by skipping a few days so that they can then feel a stronger high from using heroin - not exactly what was intended by the FDA when they approved these treatments to help patients get into recovery.

One issue is the amount of Buprenorphine that is delivered - are they appropriate levels, and are they consistent over time? In fact, the implants deliver quite high doses of Buprenorphine initially, but over the 6-month life span of the implants, the amount delivered drops off somewhat. This could lead to a potential problem due to the lower doses of Buprenorphine and a cause of increased number of relapses as the dose goes down. We find that many patients also believe that this six-month regimen is the only cure and tend to neglect other important aspects. It's vital that those who do take buprenorphine understand the emphasis on the treatment drug and still follow with therapy and recovery plans.

A typical question we gain also surrounds what happens if people use extra drugs - either more Suboxone, or street drugs. In earlier studies, patients who received implants were also allowed to use extra Suboxone tablets for cravings - which many people did. But using extra doses of Suboxone while on the implant defeats the purpose of the implant, as far as diversion goes - people will still have "emergency" doses around that they can sell or use themselves.

Another issue concerns what to do after the treatment is over. The implants have to be removed after the 6-month period and questions remain about how easy they will be to remove. Another question arises for the patients who don't come back to have the implants removed and what effect it will have on their long term health if the implant stays in for an extra year or two. Finally, it is not clear what will happen to patients when they want to stop their implant treatment. After the implant loses its effectiveness, patients will definitely go into major withdrawal. Withdrawal of Buprenorphine is much worse to recover from prescription opiates or Heroin. Presumably, the intention will be for the patients to transition back to oral Buprenorphine products and detoxify from those.


Find out if Probuphine is right for you


Here at the Coleman Institute, we are seeing more and more patients who get onto Suboxone or other Buprenorphine treatment and are unable to stop taking it. They cannot stand the long and intense withdrawal symptoms coming off these products. Fortunately, our Accelerated Opiate Detox program works very well for these patients.

So, it may be that Probuphine® implants do have a place in the treatment of opiate dependence. There are a lot of questions, and as mentioned, we will likely have to wait for the product to be released before we really see how well it helps and what are the related problems. At the Coleman Institute, we have been using Naltrexone implants, as opposed to Buprenorphine Implants, for more than 17 years.

These Naltrexone implants block all opiates and dramatically reduce cravings, helping patients stay off opiates. I have to say that when I look at the research on Buprenorphine implants, I am more and more confident and satisfied with our treatment protocols. Our patients usually report no cravings at all. They are able to concentrate on their therapy and their recovery program. Many are able to use the Naltrexone implants to achieve long term recovery.



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