Buprenorphine
Buprenorphine mono products
Tablet: Sublingual: various generic products
Injection: Subcutaneous: Subcolade monthly injection under the skin of the abdomen
Implant: Subcutaneous: Probuphine for surgical implantation under the skin on the upper arm, to be removed and replaced every 6 months
Buprenorphine combination products (buprenorphine with naloxone)
Film: Sublingual: Suboxone, to be placed under the tongue
Film: Buccal: Bunavail, to be attached inside the mouth on the cheek
Tablet: Sublingual: Zubsolv, and various generic tablets
Other preparations with buprenorphine (film or skin patch) cannot be used for treatment of OUD.
How it works: Buprenorphine partially activates opioid receptors in the brain; works similarly to methadone.
What it does: Patients taking buprenorphine have less craving and use less heroin or prescription opioids, stay in treatment longer, have reduced risk of overdose, lower use of other drugs, overall lower addiction severity, and improved functioning.
Where to get it: Available in opioid treatment programs or from a medical provider (MD or DO physician, physician assistant, or a nurse practitioner) authorized by the DEA to use buprenorphine products approved for OUD. Buprenorphine is a controlled substance (schedule III). It can only be used by a person with a prescription; giving it to another person is illegal.
Detoxification: Detoxification is not required before starting buprenorphine. Buprenorphine acts as an opioid, and patients treated with it will remain physically dependent. If taken daily, buprenorphine prevents withdrawal. If abruptly stopped, opioid withdrawal will begin 36–48 hours later; the severity of withdrawal will be mild.
Wait time: The patient has to be in the early stages of opioid withdrawal before taking the first dose of buprenorphine: 12 hours for heroin, 24 hours for long-acting painkillers or fentanyl, and 48 hours or longer in the case of methadone.
Dosing: Lower doses (2–8 mg/day) are sufficient to eliminate physical and subjective withdrawal; doses of 12–24 mg eliminate craving, block the effects of heroin, and decrease risk of opioid use.
Lag time to full effect: The first dose is usually low (2 mg) to make sure it can be tolerated; over the first one to three days, the dosage can be increased rapidly if needed to control symptoms, to 16–24 mg/day.
Possible side effects: Sedation during treatment initiation, dizziness, headache, constipation, abdominal pain, nausea, excessive sweating, and low blood pressure. Site where injection is given or implant is placed may be tender or painful, with possibility of itching, redness, or swelling.
Serious adverse effects: Low blood pressure (rare); injecting buprenorphine, especially in combination with other sedatives, may cause slowing of breathing, overdose, and death.
Contraindications: Acute asthma, severe breathing problems, obstruction of bowels
Blockade: Higher doses of buprenorphine (24–32 mg) are more effective in blocking illicit opioids but may not be sufficient to block very high doses of heroin or fentanyl.
Overdose risk: If buprenorphine is taken in combination with high doses of other sedatives such as benzodiazepines, sleep medicines, or alcohol, especially if buprenorphine is injected; after buprenorphine is abruptly stopped and heroin use is resumed, especially after several days of no opioids.
Potential for abuse: Buprenorphine can be abused through injection.
Limitations: Medical provider needs to be authorized to prescribe buprenorphine.