Buprenorphine is NOT Used for Alcohol Addiction
Buprenorphine is FDA-approved exclusively for opioid use disorder, not alcohol use disorder. The medication acts as a partial mu-opioid receptor agonist and has no established role in treating alcohol addiction 1, 2.
FDA-Approved Indications
Buprenorphine received FDA approval in 2002 specifically for treatment of opioid use disorder/opioid dependence 1. The medication works by:
- Acting as a partial agonist at mu-opioid receptors with high receptor affinity 2, 3
- Reducing opioid cravings and withdrawal symptoms 2, 3
- Providing a ceiling effect on respiratory depression, making it safer than full agonists like methadone 3
FDA-Approved Medications for Alcohol Use Disorder
For alcohol use disorder, there are four FDA-approved pharmacotherapies, none of which include buprenorphine 1:
- Disulfiram - approved for increasing abstinence 1
- Oral naltrexone - approved for increasing abstinence 1
- Extended-release injectable naltrexone - approved for increasing proportion of subjects with no heavy drinking days 1
- Acamprosate - approved for increasing abstinence 1
Clinical Context
The evidence consistently demonstrates buprenorphine's role in opioid addiction treatment:
- Therapeutic dose range of 8-16 mg daily, with 16 mg being optimal for most patients 2, 3, 4
- Must be combined with counseling and behavioral therapies 2, 3, 4
- Can only be initiated during active opioid withdrawal to prevent precipitated withdrawal 2, 3
- Demonstrates clinical equivalence to methadone in retaining patients in treatment and reducing illicit opioid use 4
Critical Distinction
While naltrexone (an opioid antagonist) is approved for both opioid use disorder AND alcohol use disorder 1, buprenorphine (a partial opioid agonist) has no such dual indication. The pharmacological mechanisms are entirely different - buprenorphine's partial agonist activity at mu-opioid receptors is specifically designed to address opioid dependence, not alcohol dependence 5, 6.