Buprenorphine

What it is buprenorphine?

  • Buprenorphine is a medication for treating opioid use disorder to help people reduce or quit their use of heroin or other opiates.
  • It is typically used in medication-assisted treatment in combination with behavioral therapy and other psychosocial supports.
  • When taken as prescribed, buprenorphine is a safe and effective.

How does buprenorphine work?

  • Buprenorphine is a long-acting opioid partial agonist.
  • Partial opioid agonists are chemicals that can switch back and forth to act as agonists (chemicals that bond and activate an opioid receptor) or antagonists (chemical that blocks the opioid receptor).
  • Because buprenorphine is a partial agonist, it can help to alleviate withdrawal symptoms resulting from cessation of opioids. However, it also can induce acute withdrawal in the presence of long-acting opioids or sufficient amounts of receptor-bound full agonists.
  • Buprenorphine’s opioid effects increase with increase in dose until at moderate doses they level off, even with further dose increases. This decreases the risk of dependency and its misuse.
  • Because buprenorphine is long-acting, some patients may not have to take it every day.

How is buprenorphine administered?

  • Physicians must have board certification in addiction medicine or addiction psychiatry and/or complete special training to qualify for the federal waiver to prescribe buprenorphine.
  • Click here for a list of physicians certificated to prescribe buprenorphine in your state
  • Under the Drug Addiction Treatment Act of 2000, qualified U.S. physicians can offer buprenorphine for opioid dependency in various settings, including in an office, community hospital, health department, or correctional facility.
  • However, unlike methadone, any pharmacy can fill the prescription.
  • Buprenorphine is typically administered daily.
  • It is usually prescribed in the form of an oral tablet or a film that is dissolved under the tongue.
  • Buprenorphine is currently available in two forms:
    • Pure buprenorphine (Subutex®)
    • Buprenorphine in combination with the opioid receptor antagonist naloxone (Suboxone®)

Can buprenorphine be misused?

  • While there is some risk associated with misuse of buprenorphine, the risk of harms, such as fatal overdose, are significantly lower than those of full agonist opioids (oxycodone, hydrocodone, heroin).
  • Because of buprenorphine’s opioid effects, it can be misused, particularly by people who do not have an opioid dependency.
  • In Suboxone®, naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product.
  • When taken as sublingual tablets of Suboxone®, buprenorphine’s opioid effects dominate and naloxone blocks opioid withdrawals.
  • If the sublingual tablets of Suboxone® are crushed and injected, the naloxone effect dominates and can bring on opioid withdrawals.
  • It also is recommended that individuals taking buprenorphine avoid other opioids, alcohol, benzodiazepines, or cocaine. Additional information can be accessed here.
  • Click here for additional information regarding misuse and diversion risk for buprenorphine.

Can buprenorphine be taken during pregnancy?

Where can I learn more about buprenorphine?