Things You Need To Know

What is buprenorphine?

Buprenorphine (‘bup’, ‘B’) is available by prescription, under the name of Subutex, as a treatment for Opioid dependence. It has been found to be effective in reducing the need to continue using Opioids (buprenorphine maintenance) and also in helping people to withdraw.
Buprenorphine (pronounced bew-pre-nor-feen) has been found to be effective in treating opiod dependence by:
· Preventing withdrawal symptoms, such as cravings for heroin
· Blocking the effects of heroin. Using heroin will not provide the ‘high’ that would normally be expected, therefore it takes away one of the main reasons to use heroin.

How effective is buprenorphine?

The effectiveness of any treatment, including for heroin or other Opioid dependency (addiction), is more likely to be successful if it is part of a comprehensive treatment program. Often, a range of factors contributes to an individual’s use of drugs. Thus, it is strongly recommended that those wanting to remain free of heroin engage in a treatment program that addresses the physical (the body), psychological (the mind) and environmental issues relating to the person’s drug use. This may involve combining several treatment approaches, such as buprenorphine maintenance, counseling, alternative or holistic therapies such as massage and naturopathic treatment; and developing a positive support network including peers, family and friends and support groups.
As with any type of treatment or approach to addiction, buprenorphine maintenance may be effective for some people but will not suit everyone. A doctor or drug counselor who spends time assessing the person’s specific situation and explaining different options will recommend an approach that is appropriate for that individual.

Advantages of buprenorphine maintenance treatment

There are many benefits of being on buprenorphine maintenance, when compared with continuing the use of opiates:
· Maintenance treatment holds the person stable while they readjust their lives. The person may decide later to work towards reducing their dose of buprenorphine until they no longer require medical treatment.
· Using buprenorphine on its own is unlikely to result in an overdose.
· Health problems are reduced or avoided, especially those related to injecting, such as HIV, hepatitis B and hepatitis C viruses, skin infections and vein problems.
· Doses are required only once a day, sometimes even less often, because buprenorphine’s effects are long lasting.
· Buprenorphine is much cheaper than heroin.
· Staying off heroin can provide the opportunity to experience more ‘life opportunities’, such as. Greater personal happiness, more close and stable relationships with others, employment and more money to buy goods for personal enjoyment.
What are the side effects?

Buprenorphine is generally well tolerated; however, some side effects have been
Reported. The most common side effects are similar to those listed under the section ‘Buprenorphine withdrawal’.

Related issues

Before a person commences any drug treatment program, it is important that all the relevant information has been explained to them by a qualified health professional and, where appropriate, to carergivers such as family, friends etc. This includes the length of the program, how much it costs, what other supports are included or recommended, all the risks and side effects, and any other health issues to consider. When deciding on the suitability of buprenorphine maintenance, the following issues should also be discussed with a health professional:
· Existing liver conditions, such as acute hepatitis
· Respiratory illnesses
· If a woman is pregnant, wanting to become pregnant or breastfeeding (it has not been established that using buprenorphine during pregnancy is safe)
· Buprenorphine may impair the ability to drive and operate machinery safely, so it may not be appropriate for people in certain occupations.

How is buprenorphine taken?

A Subutex tablet must be placed under the tongue and allowed to dissolve. Chewing or swallowing the tablet will make it ineffective. Injecting Subutex is dangerous, and can lead to severe vein damage, blood clots and other health complications.
Subutex dissolves within 2–8 minutes after placing it under the tongue. The effects begin within 30–60 minutes of taking the dose and peak within 2–4 hours, lasting between 4 hours to three days, depending on the dosage.

What is the right dosage?

The dosage of buprenorphine often varies for each person. As a guide, doses range from 4 milligrams to 32 milligrams per day for people with heroin dependence. A health practitioner should be informed of any side effects that are experienced, so that the dosage can be adjusted where appropriate. When first starting on buprenorphine maintenance, it may take a number of days (typically from three to seven days) for the effects of buprenorphine to become stable in the body. Continuing heroin use can make it difficult for the person to stabilize.

Missed doses

If a person misses their buprenorphine doses for more than five days in a row, they will need to undergo a review by the prescribing health professional. If this occurs, it is recommended that the person start again on a lower dose of buprenorphine.

Using buprenorphine with other drugs

Combining the use of any drugs can increase or alter the effects that are usually experienced from using the individual drug. It is often difficult to predict the consequences of combining the use of different drugs.
It is particularly important to avoid using other depressant drugs, such as benzodiazepines (‘benzos’), e.g. Valium, with buprenorphine. Using benzodiazepines with buprenorphine may lead to breathing difficulties, coma or death.
Using buprenorphine with heroin or other opiates, such as methadone, increases the chances of experiencing ongoing withdrawal symptoms.
Always check with your doctor or pharmacist before using buprenorphine with alcohol, medicines or other drugs.

Phases of treatment
The induction phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opioid-addicted individual has abstained from using opioids for 12–24 hours and is in the early stages of opioid withdrawal. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could precipitate acute withdrawal. Induction is typically initiated as observed therapy in the physician’s office and may be carried out using either Suboxone® or Subutex®, dependent upon the physician’s judgment. As noted above, Buprenex®, the parenteral analgesic form of buprenorphine, is not FDA-approved for use in opioid addiction treatment.

The stabilization phase has begun when a patient has discontinued or greatly reduced the use of his or her drug of abuse, no longer has cravings, and is experiencing few or no side effects. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved.

The maintenance phase is reached when the patient is doing well on a steady dose of buprenorphine (or buprenorphine/naloxone). The length of time of the maintenance phase is individualized for each patient and may be indefinite. The alternative to going into (or continuing) a maintenance phase, once stabilization has been achieved, is medically supervised withdrawal. This takes the place of what was formerly called “detoxification.”

Buprenorphine withdrawal

Withdrawal from long-term use of buprenorphine may produce symptoms similar to those experienced from heroin withdrawal. However, withdrawal symptoms tend to be milder with buprenorphine than those from methadone and other opioids.
Withdrawal symptoms vary from person to person, but may include:
· Cold- or flu-like symptoms
· Headaches
· Sweating
· Aches and pains
· Sleeping difficulties
· Nausea
· Mood swings
· Loss of appetite.
These effects usually peak in the first two to five days. Some mild effects may last a number of weeks.

Where can I get buprenorphine and what does it cost?

Buprenorphine may only be prescribed by a doctor who has a permit from the Department of Human Services (DHS). Like methadone, buprenorphine is subject to a dispensing fee, currently about $5.00 per dose.