Buprenorphine

• Buprenorphine ('bup', 'B') is available by prescription, under the name of Subutex, as a treatment for heroin dependence.
• Buprenorphine has been found to be effective in reducing the need to continue using heroin (buprenorphine maintenance) and also in helping people to withdraw from heroin and methadone .
• Buprenorphine is also prescribed to treat severe pain.

Buprenorphine (pronounced bew-pre-nor-feen) has been found to be effective in treating heroin 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.

The information provided here discusses buprenorphine maintenance treatment.

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.

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:

• buprenorphine maintenance
• counselling
• alternative or holistic therapies (massage and naturopathic treatment)
• developing a positive support network including peers, family and friends and support groups.

As with any type of treatment or approach to heroin dependency, buprenorphine maintenance may be effective for some people but will not suit everyone. A doctor or drug counsellor who spends time assessing the person’s specific situation and explaining different options will recommend an approach that is appropriate for that individual.

Buprenorphine is one in a number of maintenance treatments for heroin dependence. Others include:

• Methadone (if using buprenorphine, the transfer to methadone can occur rapidly).
• Naltrexone (if using buprenorphine, the transfer to naltrexone can take place within 3–5 days).

Advantages of buprenorphine maintenance treatment

There are many benefits of being on buprenorphine maintenance, when compared with continuing the use of heroin:

• 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.

What are the side effects?

Buprenorphine is generally well tolerated; however, some side effects have been reported. Most of these symptoms occur very early in treatment—in the first week or so. Side effects may be due to the combined experience of withdrawal from opioids and taking buprenorphine. It is important to report any side effects to a health professional.

The most common side effects are similar to those listed under the section ‘Buprenorphine withdrawal’.

Starting on buprenorphine maintenance

People who use heroin and those on a methadone program can use buprenorphine. After beginning on daily doses of buprenorphine, the dose is adjusted until the person is stabilised (free from withdrawal symptoms such as cravings). The dose may then be reduced to every second day or three times a week.

For people who use heroin, the first dose of buprenorphine is taken at least 6 hours after last using heroin; ideally, just as withdrawal symptoms begin.

People on a methadone program with a daily dose of 30 milligrams or less can transfer straight onto buprenorphine, and are unlikely to experience withdrawal symptoms. Those on methadone doses above 30 milligrams may need to have their methadone dose reduced before transferring to buprenorphine. If transferring to buprenorphine from methadone doses above 30 milligrams, withdrawal symptoms may be experienced similar to those listed under ‘Buprenorphine withdrawal’. It is not recommended that anyone on a daily methadone dose of more than 60 milligrams transfer to buprenorphine.

In general, people on methadone programs have a slightly higher risk of experiencing withdrawal symptoms than those taking heroin when transferring to buprenorphine. This means that some people may feel slightly uncomfortable for a short period of time before the buprenorphine stabilises them.

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.

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.

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 to get help

If a person is interested in entering a buprenorphine treatment program, they should contact their local Aboriginal Health Service, their doctor or a drug and alcohol service.

• Direct Line. Phone; 1800 888 236
• Family Drug Help; Phone: 1300 660 068
• Youth Substance Abuse Service (YSAS); Phone: 1800 014 446; Website: www.ysas.org.au
  Drug and alcohol services for people aged between 12 and 21 who are experiencing significant problems related to their drug use.
• Alcoholism and Drug Treatment Centre Moreland Hall; Phone: 9386 2876.

 This fact sheet has been adapted from more detailed information provided by the DrugInfo Clearinghouse.