Buprenorphine

Buprenorphine

Buprenorphine is a long-acting opioid available in Europe as a treatment for heroin/opioid dependence since 1996.

Taking buprenorphine
Buprenorphine tablets come in 0.4 mg, 2 mg and 8 mg doses and are taken under the tongue. Your dose of buprenorphine will usually be between 12 mg and 16 mg, although some people need higher or lower doses. You can normally reach a stable dose of buprenorphine in 1–3 days.

What might I like or dislike?

  • Buprenorphine is effective and can be taken safely for long periods of time. At the right dose, it should stop you feeling withdrawals and you shouldn’t crave heroin/opioids as much.
  • Some people like the idea that they could change from buprenorphine to another treatment or stop taking it altogether if necessary without too much difficulty. On the downside, some find it a little harder to stick to treatment as it can be relatively easy to miss doses.
  • Although everyone starts on daily dosing, many find that by doubling or tripling the dose they are comfortable being dosed each second or third day. Your doctor may not be able to do this if your daily dose is too high, as it might go over the maximum dose allowed in one day.
  • If you aren’t taking other drugs, overdose on buprenorphine is unlikely due to its special chemical properties. As with methadone, however, people have died when buprenorphine and benzodiazepines have not been taken as prescribed, particularly if they are misused together (eg injected).
  • Although evidence suggests that buprenorphine has less impact on clear thinking than other opioids, patients can find the clear-headed feeling comfornting.
  • Buprenorphine can produce a high if injected and therefore does have a street value, so you may be tempted to misuse and/or sell it.
  • The sublingual tablet can take 5–10 minutes to dissolve and has a bitter taste.
  • Buprenorphine 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.

Myth-busting
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.

  • “You can’t take it if you’re a heavy user”. Evidence shows that neither how long you’ve been using nor how much heroin you’ve been using has any effect on how you’ll do on buprenorphine. It is just as effective as other treatments when it comes to keeping withdrawal and cravings at bay, as long as a therapeutic dose is taken.

  • “Precipitated withdrawal can last for weeks”. Precipitated withdrawal occurs rarely, usually only if you take the first tablet before you are in mild to moderate withdrawal from your previous opioid use. If it does occur, it should last for hours rather than days and, provided you don’t use again, should get much better when you take your next dose of buprenorphine. Your doctor may also be able to prescribe some medication to give you some relief and help you avoid using in the meantime. Longer-lasting withdrawal that progressively worsens is almost certainly a sign that you haven’t taken enough buprenorphine and need to speak to your doctor.

Are there any side effects?
Not everyone gets side effects; some of buprenorphine’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 or buprenorphine/naloxone 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 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.