Probuphine is a subdural slow-release form of the opioid drug buprenorphine.
The medication is implanted under the skin, most often in the arm. It releases buprenorphine into your system over a period of six months.
What is Buprenorphine?
Buprenorphine is a partial opioid agonist, meaning that it works similarly to opioid drugs, but it does not fully activate the opioid receptors in your brain. It does occupy the opioid receptors — the same neural receptors in the brain that are occupied by the major opioid drugs of abuse like heroin, hydrocodone products, and oxycodone products.
When you take buprenorphine, you will not receive the full psychoactive effects (the rush or buzz) of an opioid, but your brain will act as if you have taken those same drugs. If you use buprenorphine in recovery, you will not experience the severe withdrawal symptoms that you normally would in the early stages of opioid detox.
Subutex, Suboxone, Sublocade, and Buprenex are some of the brand names for medications that contain buprenorphine. They are used to manage withdrawal symptoms for people in the early stages of recovery from opioid use disorders.
Why is Buprenorphine Used?
Medications can be effective in the treatment of opioid dependence due to the very unique effects that opioids have on your brain.
The relapse rate associated with traditional medical detox for opioid use disorders is high. Use of buprenorphine has been demonstrated to improve long-term outcomes for people recovering from opioid use disorders.
An opioid use disorder is a substance use disorder (a form of substance abuse or addiction) that occurs when individuals abuse opioids.
Why a Subdural Form of Buprenorphine?
According to a recent review article in Therapeutic Advances in Psychopharmacology, buprenorphine has been very successful in the treatment of opioid withdrawal symptoms, but it has also become a victim of its own success. There are various downsides to using buprenorphine.
- The success of the medication has resulted in some diversion to people who are not under the care of a physician, indicating that the drug can be abused and used illegally.
- Most often, the drug is abused to help individuals who are addicted to other opioids avoid withdrawal symptoms until they can get their next fix.
- There are cases of accidental use and poisoning in children who got their hands on the pills or sublingual versions.
- Other forms of buprenorphine require daily administrations, typically self-administration, meaning that its primary effectiveness is dependent on the adherence of those using the drug.
- As mentioned above, short-term use of buprenorphine and then discontinuing the drug is often associated with relapse. Long-term use of the drug is probably needed in most cases.
- Oral use, and even sublingual use, of buprenorphine is relatively inefficient in delivering the drug to the brain.
The subdural implant addresses all of these issues.
How Probuphine Works
According to the website of the manufacturer of Probuphine, a physician places the implant of the medication under your skin, typically in your arm. The medication is slowly released into your bloodstream, where it travels to your brain.
The medication effectively blocks withdrawal from opioid drugs and also reduces cravings for opioids, although it is more effective at blocking withdrawal symptoms. Other medications like naltrexone (ReVia) may also be required to fully address cravings.
The implant remains in your arm for six months. It must then be removed by a physician. After the six-month period, you could opt to have another implant placed in your arm.
Does Probuphine Cure Addiction?
There is no cure for any form of substance use disorder (addiction). Medication-assisted treatments like buprenorphine can assist you in recovery from an opioid use disorder, but the use of medications alone is not sufficient to address your addictive behaviors.
Medications need to be combined with behavioral interventions, like substance use disorder therapy, group participation, family support, and education about addictive behaviors in order for you to have a well-rounded recovery program. No matter how successful you are in your treatment and recovery, you will always be at an increased risk for relapse compared to people who never developed a substance use disorder.
What Does the Research on Probuphine Say?
Probuphine was approved by the Food and Drug Administration (FDA) in 2016.
There have been several research studies that contributed to its approval for the treatment of opioid use disorders. There were three main preliminary studies.
- A 2005 study found that in the six opioid-dependent participants, the buprenorphine implants controlled withdrawal symptoms and cravings for opioid drugs.
- A 2009 study that evaluated the use of Probuphine in 12 chronically heroin-dependent participants found that 60 percent of their urine samples were negative for opioids in the six-month treatment time period. There were few side effects.
- A 2010 study using a randomized placebo-controlled method (RCT: the preferred method of research study to evaluate medications) involved 163 participants with opioid use disorders. Those receiving the implant had fewer withdrawal symptoms and were more likely to have abstained from opioids than those in the placebo group.
Several other subsequent RCTs delivered similar results regarding the effectiveness of Probuphine implants.
Pros of Probuphine
Based on the research studies and information provided on the manufacturer’s website, there are obviously several advantages to using Probuphine implants.
You do not have to worry about forgetting to take your medication, like you do with sublingual buprenorphine, pills, or even injections.
The medication cannot be stolen from you, and it cannot be abused by others.
The implant is a more effective way of delivering the medication to your brain.
The medication can also reduce urges to relapse because it is already in your system. You do not face the daily choice of taking your buprenorphine or trying to go back to using your opioid of choice.
There is no risk of accidental use of the drug by small children or pets.
For incarcerated people with opioid use disorders, implants present a great way to treat withdrawal symptoms and continue treatment while they are incarcerated. At the current time, it is unclear if the use of the implants would reduce recidivism rates in incarcerated individuals with opioid use disorders once they are released, but the speculation is that they would.
There is no such thing as a medication that is a panacea or that only produces positive effects. Any intervention induces some risk.
Based on the manufacturer’s website information, there is a risk of infection or nerve damage associated with the procedure of installing and removing the implant. An embolism (a blood clot) could form and be fatal in rare cases.
There has been some concern that physicians and psychiatrists who prescribe other buprenorphine products may not be motivated to learn the surgical procedure. Because of the regulations involved, it is also possible that a surgeon and the prescribing physician may be required to be present when the procedure is performed, leading to insurance concerns about paying for the services of two physicians when only one is really needed. This may lead to the product not being fully available.
There are some concerns that people who use the implant may believe this is a six-month cure and neglect other important aspects of their treatment. The treatment team should emphasize that the medication is not a cure for an opioid use disorder. Therapy and other interventions are still required.
The most common side effects of buprenorphine include:
- Flulike symptoms that can include headache, nausea, vomiting, and/or constipation.
- Back pain.
- Throat and mouth pain.
- Low blood pressure (hypotension).
- Depression.
- Allergic reactions, in rare cases.
- Potential liver problems with long-term use of the medication.
- Opioid withdrawal symptoms after long-term use.
Buprenorphine can interact with other medications. Discuss any medications you have been taking and any allergies you have with your physician prior to using any form of the drug. Certain medical conditions may disqualify you from using the medication.
Probuphine should only be used under the supervision of a physician, and the implant should only be installed by a qualified physician.
What is the Cost?
According to a 2018 article in American Family Physician, the cost per implant is about $1,294. Four implants are required for the six-month treatment regime, bringing the final cost to about $5,175.
Obviously, if your insurance covers this treatment, your cost could be significantly less. In most cases, insurance companies cover the cost of medically assisted treatments for people in recovery. However, due to the special qualifications needed to install the implant, you should check with the customer service department at your insurance provider to find out if the implant is covered under your policy.
Is Probuphine Worth It?
The question of whether the medication is worth the cost and risk is a personal one. Per the research studies, the implants are obviously effective. If you have relapsed previously when trying to recover from an opioid use disorder, this may be an approach that can benefit you.
Again, Probuphine is not a standalone treatment for any opioid use disorder, and it is not a cure for addiction. You will still have to be involved in therapy, support groups, family therapy, and other needed interventions as identified in your treatment plan.
The ultimate decision will be made by you and your treatment team. They will weigh the pros and cons with you, and they’ll help you make the best choice for your particular situation.
