Medication-Assisted Treatment and Buprenorphine FAQ

What is Medication-Assisted Treatment (MAT)?
Medication-assisted treatment, or MAT, is the use of FDA-approved medications in the treatment of substance use disorders.

What medications can be used to treat opioid addiction?
The FDA has approved the use of methadone, buprenorphine and naltrexone for the treatment of opioid dependence and addiction to short-acting opioids such as heroin, morphine and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone.

Who is MAT for?
MAT is primarily used to help individuals who are dependent on opioids such as heroin and prescription pain relievers that contain opiates.

How does MAT help?
The prescribed medication operates to normalize brain chemistry, block the euphoric effects of alcohol and opioids, relieve physiological cravings, and normalize body functions without the negative effects of the abused drug.

What is buprenorphine?
Buprenorphine is a schedule III medication approved by the FDA for the treatment of opioid use disorder, acute and chronic pain and opioid withdrawal. Buprenorphine has been around since the 1970’s; however, in early 2002, a safety profile sublingual buprenorphine was approved for opioid substitution treatment. 

How does buprenorphine work?  
Buprenorphine is an opioid partial agonist. When taken as prescribed it is safe and effective. It has unique pharmacological properties that diminish withdrawal symptoms and cravings.  

Sublingual buprenorphine takes 15 minutes to act when held under the tongue and peaks in one hour. 

What is the difference between buprenorphine, naloxone and SUBOXONE?
SUBOXONE is the trademark name for buprenorphine and naloxone. The naloxone component is an abuse deterrent that is not active when taken sublingually, and the naloxone is only active if injected. 

Is MAT and buprenorphine treatment replacing one drug for another?
No. Buprenorphine is not an opiate substitute and does not provide feelings of getting “high” or extreme euphoria. Research has identified that patients undergoing buprenorphine treatment do not suffer the same social and behavioral destabilization that correlates in active drug addicts and abusers.

Buprenorphine is a medication, prescribed by physicians and taken under supervision. It is a safe and effective medication for treating opiate dependency and substance use disorder. 

Treatment with buprenorphine and methadone, both opioid agonists, is effective in reducing withdrawal symptoms, cravings, HIV transmission and other infectious diseases, interactions with the judicial system, as well as improving social relationships and becoming functional members of society.

Will we see an increase in patients at our emergency department if we start offering buprenorphine?
Emergency department’s that have ED-initiated buprenorphine protocols have not noted an overwhelming number of patients in their emergency department. In fact, the patients with opioid use disorder are already visiting emergency departments, whether that be for life-threatening conditions like overdose or less urgent concerns such as skin infections or withdrawal.

Should I worry about diversion?
Diversion of buprenorphine is less frequent than with other opioids. When individuals are obtaining buprenorphine off the street, they are mainly trying to reduce withdrawal symptoms. Anytime time there is one less use of injection drugs on the streets, there is one less opportunity for overdose and death.

Do I need a buprenorphine waiver to administer buprenorphine in the ED?
No, buprenorphine may be dispensed by a non-waivered practitioner for up to 72-hours in the ED. "The 72-hour rule" (Title 21, Code of Federal Regulations, part 1306.07(b)) allows physicians to administer narcotic drugs for the purpose of reliving acute withdrawal symptoms when necessary while arrangements are being made for referral to treatment."

Our toolkit has more FAQs and information about buprenorphine, including administering buprenorphine in your ED.