Heroin user interested in buprenorphine/naloxone treatment

Buprenorphine has been available in combination with naloxone since 2006 in most countries.

Taking buprenorphine/naloxone
Buprenorphine/naloxone tablets come as 2 mg/0.5 mg and 8 mg/2 mg and are taken under the tongue. Common daily doses of buprenorphine/naloxone are between 12/3 mg and 16/4 mg, although some people need higher or lower doses. You should normally reach your ideal dose of buprenorphine in a few days.

Buprenorphine/naloxone’s effects are identical to buprenorphine alone when taken as prescribed: very little naloxone is absorbed under the tongue and not enough to feel any effects. If crushed and injected or snorted, however, enough naloxone is absorbed to cause withdrawal if the person has other opioids (eg heroin or methadone) in their system.

What might I like or dislike?
Because the active ingredient in buprenorphine/naloxone for treating opioid dependence is buprenorphine, many of the things you’ll like or dislike about it are the same as for buprenorphine alone. To read more about buprenorphine, click here.

Other things you might specifically like or dislike about buprenorphine/naloxone are:

  • If you try to inject buprenorphine/naloxone, the naloxone in it will cause withdrawal and/or blunt the effect of the buprenorphine. You may like this if you wish to have an insurance policy against the temptation to misuse or you may dislike it if you wish to inject your medication.
  • Because of the presence of naloxone, some doctors are more confident in prescribing it on a take-home basis, so you may be able to get more freedom earlier in treatment. In many countries, it is the preferred buprenorphine formulation, unless circumstances require buprenorphine only to be given (eg pregnancy).
  • You could come across less pressure from others to sell your medication, as its street value is lower than many other opioids. On the other hand, there is also therefore less possibility of using ‘spare’ medication to raise money should you wish to do so.
  • Buprenorphine/naloxone can interact with other medications, causing unwanted side effects, so you may want to talk to your doctor if you have multiple prescriptions (eg some anti-retroviral medications used to treat HIV) though your doctor should quickly spot interaction effects and change your dose accordingly.

There are often myths on the street about certain treatments and it is important to separate facts from fiction. Here are a few common myths you may hear about buprenorphine/naloxone.

“Buprenorphine/naloxone can give you withdrawals”. When taken correctly, buprenorphine/naloxone works the same way as buprenorphine and is no more likely to give you withdrawals. It will only cause withdrawals if the tablets are crushed and injected or snorted. Despite this, some people do get anxious about being affected by the naloxone in buprenorphine/naloxone. This can be a vicious circle: according to research, this anxiety is enough to cause the feeling of withdrawal by itself.

Are there any side effects?
Not everyone gets side effects; some of buprenorphine/naloxone’s more common side effects are:

  • sweating
  • nausea
  • constipation
  • mild sedation
  • aching muscles and joints
  • fluid retention
  • headaches
  • insomnia.

Side effects often wear off over time; any new medication can take time to adjust to.

Returning to treatment?
If you’ve been on buprenorphine/naloxone or buprenorphine before and experienced difficulty, you should discuss this with the doctor. It may be that you were on too low a dose last time, or this may not be the medication for you.

As with all maintenance medications, the break from cravings and withdrawal that buprenorphine/naloxone should provide will allow you the opportunity to tackle any other health conditions that may have arisen through drug use, and focus on Staying healthy