Basic Information About Buprenorphine
Federal Law
For the first time in nearly a century physicians may now treat opiate addiction. On October 17, 2000 Title XXXV of the Children’s Health Act of 2000 was enacted that permits the prescribing of certain medications to treat opiate addiction. Physicians may now prescribe Schedule III, IV, and V medications that are approved by the FDA for either maintenance or detoxification.
Only one medication has been approved – buprenorphrine with expectations of other medications receiving approval.
What is Buprenorphine?
Buprenorphine is an agonist/antagonist narcotic medication with partial agonist properties. Buprenorphine was initially developed to treat pain however it has been discovered that it is also a good medication to treat opiate addiction.
As an agonist buprenorphine has a partial opiate agonist properties. The easiest way to understand this is means that it only produces minimal opiate effects. Yes it will produce euphoria and can also produce respiratory depression but this is rare in comparison to opiates such as morphine.
When buprenorphine is prescribed in low doses it is sufficient for opioid-dependent individuals to stop their use of opiates and without experiencing any withdrawal symptoms. These effects are dose dependent and then reach a plateau where no effects are produced. This is referred to as the ceiling effect. For this reason buprenorphine is considered to have a reduced addiction liability. Their are also fewer side effects because of this property.
At high doses buprenorphine can block opioid agonists and can precipitate withdrawal symptoms in an acutely opioid-intoxicated individual. These are antagonist properties and for this reason it is sometimes referred to as an agonist/antagonist.
Subutex and Suboxone?
Subutex and Suboxone are the only substances that have received FDA approval to treat opioid addiction. Subutex and Suboxone are tradenames.
- Suboxone contains two medications buprenorphine and which is a pain medication and naloxone which blocks the effects of opiate drugs and is used to treat overdose.
- Why is naloxone added? It was added to keep patients from “shooting up” or injecting buprenorphine. If you inject Suboxone you will get withdrawal symptoms.
- Subutex contains only buprenorphine. It is used at the beginning of treatment because the naloxone in Suboxone can cause withdrawal symptoms and for other special circumstances. So patients can be started on Subutex and then switched to Suboxone.
Can Buprenex be Prescribed?
No, Buprenex is not approved for treatment of opioid addiction. And the status of methadone and LAAM are also unchanged. They still can be only dispensed, not prescribed, for opioid addiction, and only at Federally regulated OTPs.
How is Suboxone Prescribed?
You doctor will tell you how to take it. It is dissolved under the tongue and you need to let it completely disolve because that way the naloxone is inactivated.
Suboxone comes in two dosage forms: 2 mg buprenorphine/0.5 mg naloxone and 8 mg buprenorphine/2 mg naloxone. Subutex comes in 2 mg and 8 mg strengths.
What is the Difference Between Suboxone and Methadone?
During the past year many articles appearing the media have given the impression that Suboxone is equal or even more effective than methadone. It is not! Although it is new the patients that seem to benefit the most from Suboxone have shorter histories of opiate addiction. Most methadone patients that have attempted to switch to Suboxone from methadone because they want to leave the clinic system find that it does not work for them. For this reason it is recommended that patients starting Suboxone and new in treatment keep an open mind because if they continue to experience drug craving then they probably need methadone treatment.
How Do I Find a Doctor?
SAMHSA has set up the Buprenorphrine Physician Locator that allows you to search for a physician by state. Presently about 1200 doctors have applied to prescribe Suboxone.
Buprenorphrine Physician Locator
SAMHSA Links
Food and Drug Administration Links
FDA Subutex and Suboxone tablets
Other Resources
Buprenorpine An Alternative Treatment for Opioid Dependence. Blaine, J. (editor). NIDA Research Monograph 121. Rockville: DHHS, 1992.
Buprenorphine Approval Expands Options for Addiction Treatment. NIDA Notes November 2002, Vol. 17, No. 4