Buprenorphine: How It’s Used to Treat Opioid Use Disorder


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Introduction

If you’re looking at treatment options for opioid dependence, also called opioid use disorder (OUD),* your doctor may tell you about buprenorphine.

Buprenorphine is a generic medication. The tablet form of buprenorphine is used to treat OUD.

With OUD, it’s difficult to stop using opioid drugs. Examples of opioids include strong prescription painkillers such as fentanyl (Duragesic, Subsys, Fentora, and others) and illegal drugs such as heroin. With OUD, your body depends on opioids to feel normal. And you may have after effects such as withdrawal symptoms and opioid cravings if you stop taking these drugs.

Buprenorphine belongs to a drug class called partial opioid agonists. (A drug class is a group of medications that work in a similar way.) Buprenorphine helps relieve withdrawal symptoms and cravings you may have when you stop using other opioids.

Buprenorphine tablets are taken by mouth and dissolve under your tongue. They come in two strengths: 2 milligrams (mg) and 8 mg.

This article gives details on buprenorphine and its use in treating OUD. You can also see this in-depth article for more information about buprenorphine and its other uses.

* Throughout this article, the term “opioid use disorder” is used to describe this condition.

Brand-name version of buprenorphine

Buprenorphine tablets are not available as a brand-name drug. There used to be a brand-name version of the drug called Subutex, but it has been discontinued.

What are the side effects of buprenorphine?

Using buprenorphine tablets for opioid use disorder (OUD),* its only approved use, may cause side effects in some people. These side effects can be mild or serious.

The lists below include some of the main side effects that have been reported in people using buprenorphine tablets for OUD. For information about other possible side effects of the drug, talk with your doctor or pharmacist.

You can also learn more from the in-depth article on buprenorphine or from the drug’s prescribing information.

* Other forms of buprenorphine are approved to treat other conditions. It’s important to note that side effects from buprenorphine may differ slightly depending on the form of buprenorphine being used and the condition being treated.

What are buprenorphine’s mild side effects?

Examples of mild side effects that have been reported in people taking buprenorphine tablets include:

  • burning sensation or numbness in the mouth
  • increased redness inside the mouth
  • headache
  • nausea and vomiting
  • sweating
  • constipation
  • insomnia (trouble sleeping)
  • drowsiness
  • dizziness

In many cases, mild side effects from the drug can be temporary. Some side effects may be easy to manage, too. But if side effects last for a longer time, or if they bother you or become severe, talk with your doctor or pharmacist.

What are buprenorphine’s serious side effects?

Buprenorphine can cause serious side effects. Examples of reported serious side effects include:

  • risk of misuse and dependence
  • withdrawal symptoms if buprenorphine is suddenly stopped
  • respiratory depression (slow, shallow, weak breathing)
  • central nervous system depression (slowed brain activity)
  • hypotension (low blood pressure) that may cause dizziness, especially when getting up from sitting or lying down
  • allergic reaction
  • liver problems such as hepatitis
  • low levels of adrenal hormones
  • neonatal opioid withdrawal syndrome if used during pregnancy

Call your doctor right away if you have any serious side effects while using buprenorphine. If the side effects seem life threatening or if you think you’re having a medical emergency, call 911 or your local emergency number immediately.

Is buprenorphine used for pain?

Buprenorphine tablets are not used to treat pain, but other forms of buprenorphine are.

The buprenorphine extended-release patch is used to help control long-term, severe pain that needs continuous treatment.

One form of the buprenorphine liquid solution is given as an injection by healthcare providers for short-term relief of severe pain. For example, it may be used to relieve pain caused by surgery.

If you want to learn more about buprenorphine’s use for pain, talk with your doctor. You can also learn more from the in-depth article on buprenorphine.

What is opioid use disorder?

Someone with opioid use disorder (OUD) finds it difficult to stop using opioid drugs. This condition can be caused by using opioids on a regular basis.

With OUD, you become physically dependent on opioids. This means your body relies on opioids to feel normal. As a result, you can have physical withdrawal symptoms if you stop taking opioids. You may also be psychologically dependent on opioids. This means your mind relies on the effects of the drugs to feel normal. Physical and psychological dependence can cause cravings for opioids.

OUD used to be called opioid dependence, opioid abuse, or opioid addiction.

What are the symptoms of OUD?

Symptoms of OUD may include:

  • taking opioids in a higher dose, more often, or in a different way than prescribed by your doctor
  • taking risks to get opioids illegally
  • taking opioids in secret
  • craving opioids
  • withdrawal symptoms if you stop taking opioids, which may include:
    • anxiety
    • feeling restless
    • muscle aches
    • shaking
    • sweating
    • diarrhea

Who is buprenorphine is prescribed for?

Buprenorphine is prescribed for adults with OUD who:

  • want to stop taking other opioids
  • need help with controlling withdrawal symptoms and opioid cravings
  • have decided to take part in a complete treatment program for OUD

OUD treatment programs aim to address all the reasons that led you to use opioids. They can help you avoid or cope with situations that might lead you to use opioids again.

Your program may include counseling, along with various forms of behavioral or emotional therapies. If needed, you may also be offered support with social issues such as employment or housing.

How does buprenorphine treat opioid use disorder?

Buprenorphine is used to treat opioid use disorder (OUD) in adults. You’ll take it to replace other opioids that you’ve been taking.

You’ll typically take buprenorphine tablets to help manage withdrawal symptoms you may have in the first few days after stopping other opioids. This is called induction (starting) treatment.

After the induction phase, you’ll move on to the next stage of treatment. This is called the maintenance (long-term) phase. For this part of treatment, you’ll keep taking buprenorphine every day to reduce your withdrawal symptoms and opioid cravings.

Buprenorphine tablets can also be used for maintenance treatment. But most people take a drug containing buprenorphine and naloxone for maintenance treatment. Combination products that contain both of these drugs include Zubsolv and Suboxone. These drugs have less risk of being misused than tablets containing buprenorphine only.

How does buprenorphine work?

Buprenorphine is an opioid medication. It’s a specific type of opioid called a partial opioid agonist. Opioids produce their effects by attaching to special sites in your brain, called opioid receptors. Buprenorphine also attaches to opioid receptors, but it doesn’t stimulate them as much as other opioids.

Taking buprenorphine won’t give you the same pleasurable or “high” feeling that other opioids do, even if you take a high dose. But it produces enough satisfaction to help stop you craving opioids.

When it attaches to opioid receptors, buprenorphine helps relieve the physical withdrawal symptoms you have after stopping other opioids. These include sweating, shaking, muscle aches, and diarrhea. With induction treatment, your doctor will adjust your dose of buprenorphine tablets until your withdrawal symptoms are well managed.

Buprenorphine can also block other opioids from attaching to your opioid receptors. So if you take other opioids while you’re taking buprenorphine, they are less likely to have a pleasurable effect.

Taking buprenorphine can also help you stay in your treatment program by reducing your urge to use other opioids. The therapies and social support you receive in your treatment program can help you avoid or cope with situations where you might want to use opioids again. If and when you feel ready, you and your doctor can develop a plan to help you gradually wean off buprenorphine.

Is buprenorphine used in children?

No, buprenorphine tablets are not used to treat OUD in children.

But the buprenorphine injection is used to treat pain in children. If you have questions about using buprenorphine in children, talk with your child’s doctor.

How effective is buprenorphine?

Buprenorphine is an effective and widely used treatment for opioid use disorder (OUD). It’s included as a treatment option for OUD in guidelines from the American Society of Addiction Medicine. Studies have shown that buprenorphine reduces use of other opioids in people with OUD. It also helps people with OUD to stay in a treatment program.

For information on how buprenorphine performed in clinical studies, see the drug’s prescribing information.

How is buprenorphine taken?

General information about taking buprenorphine tablets for opioid use disorder (OUD) is given below. But be sure to take buprenorphine as directed by your doctor.

What is the typical dosage for buprenorphine?

The dosage of buprenorphine your doctor prescribes may depend on the type and dosage of opioids you have been using. It may also depend on how severe your withdrawal symptoms are after you stop using other opioids.

A typical starting dosage for induction treatment is 2 milligrams (mg) to 8 mg per day. Your doctor may increase this dose until your withdrawal symptoms and opioid cravings are manageable.

If you continue using buprenorphine tablets for maintenance (long-term) treatment, you’ll take the lowest possible dosage that keeps your symptoms in check.

Note: Buprenorphine has other uses in addition to treating OUD. The dosage may be different for these other uses. To learn more, talk with your doctor.

How do you take buprenorphine?

You take buprenorphine tablets by placing them under your tongue and letting them dissolve. This can take a few minutes. The buprenorphine gets absorbed into your system through the blood vessels under your tongue. You shouldn’t swallow, chew, or crush the tablets because this will make them less effective.

If you need to take more than one tablet for your dose, you can place them under your tongue at the same time. But if this is uncomfortable for you, you may take your doses as up to two tablets under your tongue at a time. Repeat until you’ve taken your full dose.

You shouldn’t eat or drink anything while you have buprenorphine tablets in your mouth.

For induction (starting) treatment, you’ll typically take buprenorphine tablets in your doctor’s office or clinic. This allows your doctor to monitor you for side effects and give treatment if needed.

You’ll take your first dose of buprenorphine only when you start to have withdrawal symptoms from stopping other opioids. Buprenorphine can block the effect of any opioids that you still have in your system. So if you take it too early, it could actually cause withdrawal symptoms.

Your doctor will determine when you should take your first dose. But typically, you shouldn’t take it until at least 4 hours after you stopped using a short-acting opioid such as heroin. And you shouldn’t take it until at least 24 hours after you stopped using a long-acting opioid such as methadone.

If you continue using buprenorphine tablets for maintenance (long-term) treatment, you may be able to take the tablets at home. Talk with your doctor about whether this is right for you.

How often should I take buprenorphine?

You’ll typically take buprenorphine tablets once a day, at around the same time each day.

Can buprenorphine be misused?

Buprenorphine has a risk of being misused. Buprenorphine tablets don’t produce the same “high” feeling as other opioids, but some people may try to create a high by taking the drug in other ways.

You should take buprenorphine tablets by mouth and let them dissolve under your tongue. It’s dangerous to take buprenorphine tablets in other ways (such as by crushing, snorting, or dissolving and injecting them).

Misusing buprenorphine tablets is dangerous for the following reasons:

  • It could lead to buprenorphine overdose.
  • If you have other opioids in your system, it could block their effect and cause opioid withdrawal.
  • Injecting the drug can cause life threatening infections.

Due to the risk of misuse, buprenorphine tablets are typically only used under the supervision of a doctor for induction (starting) treatment.

For maintenance (long-term) treatment, medications that contain buprenorphine and naloxone are usually preferred. These drugs have less risk of being misused. Naloxone is an opioid blocker that has no effect if it’s taken by mouth. But if it’s injected, it will block the effects of all opioids in your system (including buprenorphine) and cause rapid opioid withdrawal. As with any drug, you should only take drugs containing naloxone exactly as prescribed by your doctor.

If you have concerns about your risk for misusing buprenorphine, talk with your doctor.

What should I know before using buprenorphine?

Before you use buprenorphine, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.

If any of the following medical conditions or other health factors apply to you, talk with your doctor before using buprenorphine.

  • if you have a history of breathing problems or lung problems
  • if you have a history of liver problems
  • if you have a history of Addison’s disease or adrenal insufficiency (underactive adrenal glands)
  • if you have a history of urination problems
  • if you have a history of pancreas or gallbladder problems
  • if you have a history of seizures
  • if you’ve had a recent head injury, brain tumor, or increased pressure in your brain
  • if you have a condition that affects your biliary tract
  • if you’re pregnant or breastfeeding
  • if you’ve had an allergic reaction to the drug or any of its ingredients

FAQs about using buprenorphine

Here are the answers to some common questions you may have about using buprenorphine.

How does buprenorphine compare with methadone?

Buprenorphine and methadone are both medications that treat opioid use disorder (OUD) in adults. These drugs are similarly effective for treating OUD. But there are some key differences between them.

Methadone is a full opioid agonist, while buprenorphine is a partial opioid agonist. This means that buprenorphine doesn’t produce the same pleasurable effects as methadone, so it has less risk of being misused. There’s also a lower risk of overdose with buprenorphine. And buprenorphine can block the effects of other opioids you may take, while methadone does not.

Buprenorphine comes as a tablet that dissolves under your tongue, and methadone comes as a tablet that you swallow. Methadone also comes as a liquid. Both buprenorphine and methadone are taken once per day.

With buprenorphine, you’ll typically start by taking the medication in your doctor’s office or clinic. But with maintenance (long-term) treatment, your doctor may prescribe a short-term supply (for example, a week or a month at a time). This allows you to take your daily dose at home, but still have regular check-ins with your doctor.

With methadone, you’ll typically start treatment as an inpatient and then move on to take your daily dose under supervision in a clinic. With time, it may also be possible to take your dose unsupervised at home, if your doctor thinks this is appropriate and safe for you.

If you’re interested in taking buprenorphine or methadone for OUD, talk with your doctor about which drug may be best for you. This will likely depend on various factors, including your personal situation, where you want to have treatment, and if you’ve tried treatment for OUD in the past.

Will I have withdrawal symptoms if I stop taking buprenorphine?

Yes, if you suddenly stop taking buprenorphine completely, you may have withdrawal symptoms. But if you have induction (starting) treatment with buprenorphine and then move to maintenance (long-term) treatment, such as with buprenorphine and naloxone, you shouldn’t have withdrawal symptoms.

Withdrawal symptoms from stopping buprenorphine tend to be milder than withdrawal symptoms that occur after stopping other opioids.

If and when you’re ready to stop maintenance treatment with buprenorphine (or buprenorphine and naloxone), this should be done gradually. You’ll work with your doctor to create a plan that will allow you to slowly wean off buprenorphine without withdrawal symptoms.

Is there a risk of overdose with buprenorphine?

Yes, as with any opioid, there is a risk of overdose with buprenorphine. An overdose can happen if a person who isn’t dependent on opioids, especially a child, takes one dose of buprenorphine.

Overdose can also happen if you misuse buprenorphine (take a higher dose or take it more often than prescribed). There’s also a risk of overdose if you drink alcohol or take medications called central nervous system (CNS) depressants with buprenorphine. CNS depressants include anxiety drugs, sleeping pills, muscle relaxants, and certain illegal drugs.

Symptoms of buprenorphine overdose can include:

  • respiratory depression (slow, shallow, weak breathing)
  • extreme sleepiness or sedation
  • slurred speech
  • confusion
  • lack of coordination and slow reflexes
  • blurred vision

Call 911 if you or another person have symptoms of buprenorphine overdose. Buprenorphine overdose can be fatal if not treated.

To help avoid overdose, keep buprenorphine in a safe place, out of the sight and reach of children. Don’t take CNS depressants with buprenorphine unless your doctor tells you it’s safe to do so. And you shouldn’t drink alcohol while using buprenorphine. If you’re concerned about avoiding alcohol or CNS depressants during buprenorphine treatment, talk with your doctor.

Buprenorphine overdose can be treated with naloxone (Narcan). Narcan is a nasal (nose) spray that’s available without a prescription from pharmacies. If you take buprenorphine, your doctor may recommend keeping Narcan on hand or in your home in case of overdose. Talk with your doctor to learn more.

How much does buprenorphine cost?

The price of buprenorphine can depend on several factors. These may include your insurance plan, your treatment plan, your location, and the pharmacy you use. For estimates of how much buprenorphine costs, visit GoodRx.com.

Financial assistance may be available to help you pay for buprenorphine. Medicine Assistance Tool and NeedyMeds both provide resources that may help lower the cost of buprenorphine. These websites also offer tools to help you find educational resources and low-cost healthcare. To learn more, visit their websites.

What should my next steps be?

Talk with your doctor if you’re interested in using buprenorphine for opioid use disorder (OUD). They can help determine if buprenorphine might be a good fit for you.

Here are some examples of questions you may want to ask your doctor:

  • What happens if I use other opioids while I’m taking buprenorphine?
  • How long can I take buprenorphine?
  • Will buprenorphine show up on a drug screen at work?
  • Does buprenorphine interact with any other medications I’m taking?

Ask a pharmacist

Q:

Is it legal to drive while taking buprenorphine?

Anonymous patient

A:

Whether it’s legal to drive while taking buprenorphine can depend on where you live. For example, in some states, it’s illegal to drive with any amount of buprenorphine in your body.

Even if it’s legal in your area, you should avoid driving when you first start taking buprenorphine. This gives you some time to see how the drug affects you. Buprenorphine can affect your mental or physical abilities, including your ability to operate a car or other heavy machinery.

If you have questions about how buprenorphine will affect you and whether you can drive during your treatment, talk with your doctor or pharmacist.

Alex Brewer, PharmD, MBAAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Healthline

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.


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