What is a liquid, turns into a gel, and may fight opioid addiction? A magic substance? No, it is a drug known as Brixadi.

What are Brixadi and Buprenorphine?

Opioid addiction is a huge problem in the United States and the entire world. More than 47,000 people died due to opioid addiction in the United States in 2017.  If things do not change, experts predict that they will kill hundreds of thousands more.

The manufacturers of Brixadi are hoping to end such alarming trends. The pharmaceutical companies Camurus and Braeburn claim that this drug, also known as CAM2038, may combat opioid addiction and help people find recovery. Brixadi is a brand name for the opioid drug buprenorphine.

Buprenorphine is a drug known as a mixed opioid agonist-antagonist. This means it produces different reactions and different molecular changes based on how it reacts with opioid receptors.

Agonists are substances that trigger certain brain receptors. Buprenorphine triggers receptors in the brain but to a lesser degree, which makes it a partial agonist.

The drug buprenorphine is also an antagonist, which means it blocks other opioids from binding to the receptors. Such triggering and binding actions may make buprenorphine drugs such as Brixadian effective treatment for opioid abuse. When buprenorphine binds to opioid receptors, it works as an agonist, so users feel the effects of this drug.

At the same time, buprenorphine works as an antagonist by blocking other opioids from binding to the opioid receptors in the brain. Even if other people use heroin, fentanyl, oxycodone (OxyContin), or another opioid, they cannot feel the effects of those opioids because they are feeling the effects of buprenorphine, not the drugs they take after that.

They do not crave other opioid drugs or go into withdrawal because they are not using them. Buprenorphine is a similar drug that produces feelings similar to other opioids. Drugs such as Brixadi act as replacements for other, more harmful opioid drugs.

How do People Use Brixadi? 

The chemical reactions that involve triggering and binding may make Brixadi an attractive tool to fight opioid addiction. People who have already started using buprenorphine as part of a treatment regimen are the target market for this medication. Health care professionals administer Brixadi in the form of subcutaneous injections, or injections under the skin. One advantage of this mode of administration is that people can receive the shots in many different areas of their bodies, including their arms, abdomens, buttocks, or thighs.

When Brixadi comes into contact with fluids in tissues, the drug solution transforms from a liquid into a gel. Since it is a gel and no longer a liquid, the body releases Brixadi more slowly over an extended period instead of releasing it all at once.

As a consequence, people do not have to use the drug every day on an active basis. They may visit health care providers once a week or once a month for injections. They do not have to go daily for treatments, which may make it easier to incorporate treatment into their schedules.

Injections also mean that it may be more difficult to abuse Brixadi. People who use it visit health care settings to receive the drug from health care providers.

You often need a special waiver to administer buprenorphine, so many health care facilities may not have the drug. Not many professionals have such waivers, and those that do can only treat up to 275 people with the drug at any one time.

Even after it comes on the market, access to Brixadi, like other forms of buprenorphine, will likely be limited. People will not be able to use it at home. They will probably not be able to use it in many medical settings. Such restrictions will make it more difficult to misuse it unintentionally or abuse it intentionally.

What are Some Side Effects of Brixadi? 

Of course, no drug is 100 percent safe. Studies have found that some people experience side effects from using Brixadi, including:

• Pain, itchiness, irritation, or redness near the injection site

• Headaches

• Nausea

• Constipation

• Urinary tract conditions

Potential side effects are another reason Brixadi and other drugs are administered by medical professionals at rehab centers, hospitals, clinics, and other facilities. The professionals assess the health of potential users to determine if the drug will be right for them. They monitor the physical and mental health of people using the drug to help people become healthy and stay that way.

They monitor people because opioid addiction is rough on the body. Withdrawing from opioids can also be tough, since people may crave drugs and experience intense side effects when the drugs leave their systems.

The professionals help people remove drugs and the cravings for drugs gradually. Withdrawing cold turkey, or quitting all drugs abruptly at once, is not recommended. It can be extremely dangerous, even fatal. It is better to taper from many drugs, including opioids, gradually and with medical assistance. Using drugs such as buprenorphine (Brixadi) may assist in this process.

How Does Brixadi Relate to Mental Health? 

Using Brixadi is not just a matter of physical health. It is also important to consider the mental health of people who use the drug.

After all, addiction is both a physical and mental disease. People may detox from drugs physically but their cravings may persist. Mental health assistance may help people analyze their cravings and the factors that trigger their drug use.

For that reason, treatment programs that incorporate Brixadi will also incorporate mental health treatment, such as therapy or counseling and sources of social support. The assistance addresses all aspects of people and their problems, not just the physical aspects of their addictions.

Drug and alcohol abuse often dominates lives. When people stop abusing drugs, they remove a major focus of their lives. They may not know what to do or who to see, because their time and social lives revolved around finding and using drugs. Addiction treatment that includes social support and psychological assistance may help people find themselves and reconstruct their lives

Why is Drug Treatment Controversial? 

Addiction is a controversial topic. So is a treatment for addiction. Drugs such as Brixadi have garnered their fair share of controversy. Using drugs and other treatment protocols such as therapy to treat addiction is known as medication-assisted treatment (MAT).

Critics of MAT claim that it is not a healthy way to address substance use disorders because it is substituting one drug addiction for another. They claim that health care professionals are encouraging people who are dependent on opioids to become dependent on drugs such as Brixadi.

Some recovery organizations say that using any drug, even a drug used as medical treatment, is not living a truly sober life. They say that using drugs to treat drug addiction continues users’ physical and psychological dependencies on drugs.

Incorporating Brixadi and other drugs in treatment programs may provide some benefits, though:

• They may “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,” according to the U.S. Substance Use Disorder and Mental Health Services Administration (SAMHSA).

• They require people using them to follow federal laws, receive psychological counseling, and utilize social support resources while they are receiving the medications.

• They connect people to health care providers. MAT use prescription drugs in health care settings. People need medical supervision to receive them and they cannot use them outside of medical settings. Such assistance may help people develop more effective treatment plans, adjust treatment that may not be working, or provide assistance if things go wrong.

While no treatment is perfect or works the same for every person, MAT may be an effective component to help treat substance use disorders. At the very least, it puts people into contact with knowledgeable professionals who have experience treating substance use disorders and the physical and psychological components of addiction.

What is the Status of Brixadi? 

In December 2018, the U.S. Food and Drug Administration (FDA) granted tentative approval for Brixadi to help treat moderate to severe opioid use disorders. The FDA’s tentative approval means that the drug met all of the agency’s quality, efficacy, and safety standards but it cannot be marketed in the United States until 2020. At that time, another drug’s exclusivity period will expire, which would allow Brixadi to earn full approval from the FDA.

The European Union also approved the drug in 2018 and it is marketed under the name Buvidal on that continent. Its manufacturer, the Swedish pharmaceutical company Camurus, has partnered with the pharmaceutical company Braeburn to market the drug in the United States.

When Brixadi comes to the United States, it may garner immense profits. Camurus president and chief executive officer Fredrik Tiberg projected that the drug may capture a 10 percent market share, which means that 10 percent of people undergoing treatment for opioid use disorders would use the drug. This could generate around $1.4 billion in annual sales for the drug.

Brixadi has not been used extensively to treat opioid addiction, but it may be in the near future. One hopes it can be another tool to fight a growing, tragic problem and help people find lasting recovery.