About Buprenorphine (Subutex and Suboxone)

Like methadone, buprenorphine is a drug which prescribed for addiction to heroin and opiate-based pain-killers such as OxyContin, Vicodin, Demerol, and so on. Unlike methadone, you don’t have to go to a special clinic to get it, but only authorized doctors can prescribe it. Self-Led Solutions^SM has a special relationship with some of these doctors, and you can find out more at Resources. To find an authorized doctor, check the national locator service.

What Is It, How Does It Work?

Buprenorphine is an opiate. But unlike the other opium-based drugs, it has the unusual quality of blocking the opiate receptors in your brain so that it blocks withdrawal symptoms without giving you an intense high. It also has a “ceiling effect”, so that you can only experience a mild high from it, no matter how much you take.

Buprenorphine comes in pill form which you take under the tongue. It takes two to ten minutes to dissolve. Unlike methadone, where you have to come to the clinic every week and sometimes every day, a doctor can prescribe you a month’s supply of buprenorphine. In your first week of taking buprenorphine, however, you may have to visit the doctor several times, in order to get the dose right.

There are two versions of buprenorphine, coming under the names of Subutex and Suboxone. Subutex is straight buprenorphine. Suboxone is buprenorphine mixed with Naloxone, which means that if when it is crushed up and injected, it will not get someone high, but put them straight into withdrawals. Suboxone is usually prescribed in outpatient settings, but for both versions, the timing of when you take the pill is important. If you take it when you are just starting to enter withdrawals, it will block those symptoms. If you take it when you are already high, it can send you into withdrawals.

The other important thing to know about either of these products is that if you want to switch from methadone to buprenorphine, you have to get down to 30mg-40mg of methadone. If you tried to switch from a higher dose of meth, the buprenorphine would not hold you from withdrawals.

What Are The Pluses of Buprenorphine?

You can get this through a physician in his/her office and pick it up at the pharmacy.
You can bring it with you on a trip without the hassle of “take home” bottles of methadone
Many doctors will prescribe it without subjecting you to urine tests to see if you are “clean.”
Its noticeable side effects (i.e., nodding) are much less powerful than methadone.
It’s harder to overdose on buprenorphine, because of its ceiling effect.
Buprenorphine creates much milder withdrawal symptoms than methadone. You can use it to taper off heroin or methadone, or you can use it for ongoing maintenance.
Because buprenorphine is less likely to make you noticeably high, and because you don’t get held to a schedule the way you do in a methadone clinic, it’s easier to find and hold a job, or to stay in school.

What Are The Minuses?

If you mix buprenorphine with alcohol of benzodiazepines (Atavan, Klonopin, Valium, etc.) you are at high risk for an overdose.
Buprenorphine eliminates the effects of opiate-based pain-killers. If you are taking these kinds of drugs for pain, you would need to switch to another class of pain-killers.
Like methadone and the other opiates, buprenorphine does make you drowsy, and does have other side-effects, they are just less strong.
If you are pregnant or may get pregnant, buprenorphine is not recommended, because there have not been enough studies done to figure out its level of safety. Your doctor would probably recommend methadone.

So, Is Buprenorphine For Me?

If you are pregnant or trying to get pregnant, taking opiates for pain relief, or taking high levels of methadone, the answer is a straight no. If you are on lower levels of methadone or opiate pain-killers – it’s a maybe. It all depends on your goals and how ready you are to achieve them.
If your goal is to stop using hard drugs, and if you feel confident and self-guided, buprenorphine can be a wonderful support in your endeavor. It blocks withdrawals, doesn’t get you high the way methadone does, and because you get it as a script from your doctor, gives you the chance to eliminate drug connections and associations from your life.
If you are still pretty conflicted about your drug use, and are not sure about your stability right now, buprenorphine may not be for you. It will spoil your high, and that could make you more likely to mix it with other drugs like alcohol and benzodiazepines, putting you at much greater risk for an overdose. It’s just not the right time yet.

Still Uncertain?

If you are not quite sure where you stand, do your best to make a realistic and compassionate assessment of where you are really at. If you feel you have a strong commitment to not using hard drugs, have a good support system, and feel confident that if you did relapse you wouldn’t go to extremes, buprenorphine could be well worth a try. On the other hand, if you believe there’s a good chance you will relapse, and if in the past you have been a binger, or an extremist in your drug use, your buprenorphine experiment could lead to an overdose visit to the Emergency Room. Not from the buprenorphine itself, but from the alcohol or benzos you needed to mix it with.

To be realistic, some people take buprenorphine during the week and then some week-ends let themselves go briefly into withdrawals so that they can party on other opiates. It’s not the recommended way to take this drug, and it carries all the attendant problems of illegal drugs – possible arrest, overdose, poisoning from a bad cut, HIV, not a good scene. It’s not a stable way to take buprenorphine, and most likely you will wind up back on heroin or pain-killers, or on a higher dose of methadone after a while.

So that’s the long and the short of buprenorphine. If you want to find out more, you should talk it over with your doctor. You can also reach me using the Contact Form, or you can call me. I would be happy to help you figure out your best next step, or set up a time for a more in-depth conversation in a therapy session.