Buprenorphine

Uses of buprenorphine

Stopping use of heroin, fentanyl, prescription pain relievers, or other opioids can be physically and mentally taxing. That’s in part why many people who are dependent on an opioid have trouble stopping use: They don’t want to feel opioid withdrawal symptoms such as body aches, cravings, diarrhea, nausea, sweating, and vomiting. Yet continued use of opioids makes an overdose more likely.

Buprenorphine is an FDA-approved medication for opioid use disorder (OUD). It helps people with OUD reduce and stop use of these powerful drugs by reducing cravings and withdrawal symptoms. It does this in part by simulating the euphoric effects of stronger opioids but at lower and safer levels. Buprenorphine lessens the pain of opioid withdrawal so that patients can focus on therapy and recovery.

Buprenorphine treatment typically starts six to 24 hours after a person has stopped using opioids. This time frame depends on the type and amount of opioids taken. Before starting buprenorphine, consult a medical professional who is experienced in buprenorphine treatment and can help you develop a treatment plan.

Buprenorphine is administered according to these general steps:

1. Patients who haven’t used opioids for 12–24 hours and are experiencing withdrawal symptoms are first prescribed small doses of 2–4 milligrams. The dosage might be adjusted for a few days until patients reach an amount that effectively relieves symptoms.

2. Patients are stabilized on buprenorphine when their craving and withdrawal period has ended and use of other opioids has stopped. The dose is increased until the patient is no longer experiencing cravings to use other opioids. A dose between 8 and 24 milligrams per day may be needed, depending on the individual’s opioid tolerance and metabolism. Even higher doses may be needed for some, especially those who also have pain.

3. The maintenance dose is continued to prevent a return to opioid use. A provider can temporarily or permanently increase the buprenorphine dose if the patient experiences opioid cravings or new or increased pain. Providers can cautiously decrease the dose in other cases — for example, if the patient requests it or is experiencing side effects. Decreasing buprenorphine may increase the risk of resumption of other opioid use, so it must be done with close monitoring.

Buprenorphine is most often taken as a film or tablet that must be dissolved under the tongue. It can also be delivered by injection or implant. Some of these medications are formulated with naloxone to deter misuse of the drug. The following are brand names of OUD medications that contain buprenorphine:

• Suboxone, a combination of buprenorphine and inactive naloxone in a film or tablet that is dissolved under the tongue. It must be fully dissolved to be absorbed into the body and should not be swallowed. The naloxone remains inactive as long as the medication is taken appropriately and not injected or snorted.
• Zubsolv, a combination of buprenorphine and inactive naloxone in a tablet that is dissolved under the tongue.
• Probuphine, buprenorphine administered through a skin implant.
• Sublocade, buprenorphine administered in an extended-release injection under the skin.
• Subutex, buprenorphine in a tablet that is dissolved under the tongue.

Buprenorphine-naloxone is also sold as a generic, under-the-tongue tablet.

The FDA has approved other formulations of buprenorphine to aid with managing acute and chronic pain. The formulations mentioned above, while not FDA-approved for pain management, are sometimes used off-label for this purpose.

Benefits of buprenorphine treatment

In 2002, buprenorphine became the first medication for OUD that could be given out or prescribed at the doctor’s office with ongoing dosing and treatment compliance overseen by a pharmacist. By contrast, methadone must be dispensed through federally certified opioid treatment programs or methadone maintenance programs. This makes buprenorphine a suitable treatment option for people who have trouble accessing a certified methadone clinic.

Buprenorphine is also sometimes recommended for those who had side effects when taking methadone, were not successful in methadone treatment, have a shorter history of OUD, or don’t need a drug as potent as methadone, a full opioid agonist that has a stronger effect.

Buprenorphine is approved for use as part of a medication for opioid use disorder (MOUD) program. These programs pair medications with short-term or intensive counseling and/or behavioral therapies to assist people in adjusting to life in recovery and motivate them to stay in treatment, follow prescribed therapies, and, if needed, address other physical and mental health issues.

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Side effects and precautions

Medications for OUD such as buprenorphine can be as effective as some medications regularly prescribed to treat common conditions like hypertension. But before taking this or any medication, consider the side effects and precautions, listed below. And consult with your medical provider before stopping use of buprenorphine, as withdrawal symptoms can occur.

The most common side effect of buprenorphine is constipation, which can usually be managed with a high-fiber diet or over-the-counter fiber supplements, stool softeners, or laxatives.

You can reduce withdrawal symptoms by waiting to take buprenorphine until it’s been at least 12–36 hours since you last used another opioid.

To prevent side effects and maximize the effectiveness, allow buprenorphine-naloxone formulations to fully dissolve under the tongue rather than swallowing them. You should not eat, drink, speak, brush your teeth, or smoke until the medication has fully dissolved, which may take 10–15 minutes. Some experts recommend tucking your chin to your chest to ensure that you do not accidentally swallow.

Report these more serious side effects to a licensed medical professional:

• Abdominal pain.
• Difficulty breathing.
• Itching, pain, swelling, or nerve damage at the implant site.
• Muscle weakness.
• Pain at the injection site.
• Severe symptoms of withdrawal such as nausea, vomiting, and diarrhea.

Considerations before taking

Risk of dependence and overdose. Buprenorphine is considered safe for most people when taken as prescribed. But it can be misused. Such cases include dissolving and injecting the medication or mixing it with alcohol, benzodiazepines, or other depressants. These and other misuses can lead to dependence and even to a dangerous or deadly overdose.

Pregnancy and breastfeeding. You can safely be treated for OUD with buprenorphine during pregnancy or if you’re breastfeeding. Newborn babies of mothers taking buprenorphine during pregnancy can experience neonatal abstinence syndrome, which causes withdrawal symptoms; however, the risk is very low. Store buprenorphine away from children, who can experience difficulty breathing and even die if they are exposed.

Interactions. Let your medical provider know if you’re taking other medications to make sure the class of drugs doesn’t interact with buprenorphine. Ask about being monitored if you have any liver-related issues.

Cost. The out-of-pocket cost for generic buprenorphine-naloxone ranges from $60 to $300 for a one-month supply. Insurance may cover much of this cost, and copay assistance programs can lower or eliminate copays. If you’re uninsured or underinsured, or you otherwise have trouble paying for this treatment, ask a buprenorphine treatment center near you if they offer or know of financial assistance.

Other considerations. Consult with a licensed medical provider before taking any medication, including buprenorphine.

Content reviewed by Jasleen Salwan, M.D., MPH, FASAM, April 2023. 

Sources

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