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Buprenorphine is a medication used for the treatment of opioid addiction and dependence in a practice known as buprenorphine maintenance treatment or more broadly, medication-assisted treatment (MAT). A buprenorphine treatment program that includes both medication and counseling is more effective than buprenorphine or therapy alone.1
What Is Buprenorphine?
Buprenorphine is a medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid addiction, also known as an opioid use disorder. In addition to opioid treatment programs, it is available with a doctor’s prescription, which has greatly increased treatment access.2
Buprenorphine maintenance treatment is typically combined with therapy to provide patients with a comprehensive recovery plan that focuses on healing the whole person—this is known as medication-assisted treatment.2 While buprenorphine treatment can reduce cravings and opioid withdrawal symptoms, counseling helps address the underlying issues that influenced opioid misuse in the first place and teaches recovering individuals effective coping strategies.
Buprenorphine has different formulations and methods of administration. It exists in tablets or small, thin films, both of which you place under the tongue (sublingual) or inside of your cheek (buccal) until they dissolve; you would take them once every 1-2 days. You never chew the tablets or swallow them whole.2
If you have already been treated with the oral formulations of buprenorphine and are medically stable on them, it is possible to get buprenorphine implants.3 With these, you don’t have to worry about losing tablets or films, forgetting to take them, or misusing them. The implants are four one-inch-long rods that are surgically placed under the skin on the inside of the upper arm. These implants provide treatment for six months then have to be surgically removed. New implants are inserted in the opposite arm for one additional course of treatment if needed. An implant can come out or protrude from the skin. Therefore, you should visit your provider during the first week after getting the implants and at least once per month for counseling.4
Buprenorphine is often combined with naloxone, an opioid antagonist that is used to reverse the effects of an opioid overdose. Adding naloxone decreases the likelihood of misuse of the medication.2 If someone injects buprenorphine/naloxone, they will go into immediate opioid withdrawal.
Brand names for the different formulations of the medication include:2
- Bunavail: buprenorphine/naloxone buccal film (placed between gums and inside of the cheek)
- Probuphine: buprenorphine implants
- Sublocade: buprenorphine extended-release injection
- Suboxone: buprenorphine/naloxone sublingual films (placed beneath the tongue)
- Subutex: buprenorphine sublingual tablets
- Zubsolv: buprenorphine/naloxone sublingual tablets
How Does Buprenorphine Work?
It is a partial opioid agonist, which means it binds to opioid receptors in the brain but to a much lesser degree than full opioid agonists, such as methadone, another common opioid addiction medication. Because buprenorphine is a partial opioid agonist, it helps to:2
- Alleviate opioid withdrawal symptoms
- Ease opioid cravings
- Increase safety in case of overdose
- Reduce the risk of misuse
Unlike potent opioids like heroin and prescription painkillers, buprenorphine doesn’t produce a euphoric high.2
Is Buprenorphine Safe and Effective?
When taken as prescribed by a doctor or treatment professional, buprenorphine is a safe and effective opioid addiction treatment medication. However, there are some potential risks and precautions patients should be aware of before beginning buprenorphine treatment.
There is a risk of surgical complications with the Probuphine implants. There are also risks of misuse and accidental overdose if a Probuphine implant comes out or protrudes from the skin. In addition, the safety and efficacy of these implants have not been established for people younger than 16 years of age or older than 65 years of age.4
However, generally, buprenorphine has a “ceiling effect,” which means that once you reach a certain dose, the opioid effects like respiratory depression level off and don’t increase. This reduces the risk of overdose, misuse, and severe side effects. Conversely, methadone does not have a ceiling effect and, therefore, has a higher risk of misuse and overdose. Though the effects of buprenorphine are not as strong as those of methadone, they last longer, which means you might be able to take the medication less often than you would methadone.8
Take buprenorphine only as prescribed by your doctor. Any changes to medication frequency or dosage should only happen with direction from your doctor. Some possible side effects of the medication, which usually go away with time, include:2
- Body aches, headaches, and cold– or flu-like symptoms
- Tiredness and sleep problems
- Upset stomach
- Mood swings
Make sure you tell your doctor if these side effects do not go away. Also, notify your physician immediately if you experience these rare, more severe, side effects:2
- Dark–or tea-colored urine
- Bad stomach ache
- Light-colored bowel movements
- Yellowing in the whites of eyes
- Yellow skin
Is It Possible to Misuse Buprenorphine?
Given that it’s an opioid medication, buprenorphine does have some potential for diversion, misuse, and addiction. There is also a likelihood of misuse of Probuphine if an implant comes out or protrudes from the skin.3
However, the overall misuse potential of buprenorphine is lower than that of methadone because the opioid effects are not as strong, and the ceiling effect prevents individuals from taking higher doses to experience a relaxing or euphoric high. Buprenorphine is a Schedule III Controlled Substance, which means it has a moderate to low risk of dependence and misuse, whereas methadone is classified as a Schedule II drug, which has a higher risk.9,10
Additionally, due to the addition of naloxone, Suboxone has a particularly low likelihood of misuse since injecting this medication causes the person to go into immediate opioid withdrawal, which involves unpleasant symptoms.
How Long Do I Have to Take Buprenorphine?
How long you would be on buprenorphine depends on your situation; for some, buprenorphine treatment can be for a predetermined period of time before slowly tapering you off of it, and for others it can be indefinite.8 It is important to work closely with your medical professionals in the treatment of opioid use disorder.
What Do MAT Programs Involve?
Medication-assisted treatment programs approach addiction treatment from a comprehensive perspective. This means they provide a combination of FDA-approved medications, such as buprenorphine, and counseling as well as other behavioral therapies. Buprenorphine addresses the physical dependence of an opioid addiction and cognitive and behavioral therapies address the use of healthy coping skills, trigger management, and emotional and interpersonal factors that contribute to addiction. Therapies often include individual and group counseling and some include family counseling as well.11
Research has found that opioid treatment programs (OTPs) with both medication and behavioral treatment are more effective in treating OUD than short-term detox programs aimed at abstinence.4 OTPs are governed by federal regulations. They are required to provide counseling and behavioral therapies along with FDA-approved medications and education on the prevention of HIV and other infectious diseases.11
How Can I Find a Buprenorphine Treatment Program or Provider?
You can search for OTPs in your state using the program directory.
Outside of OTPs, not all medical providers are approved to prescribe buprenorphine. They are usually required to complete specialized training before they can dispense buprenorphine in settings other than OUD residential or intensive outpatient treatment programs.2 To find a practitioner near you who prescribes buprenorphine, you can use this locator.
For help finding an opioid addiction treatment program, call our confidential helpline at 800-405-1685 (Who Answers?) . Our knowledgeable and compassionate rehab support specialists can help you find the right program for you.
- Substance Abuse and Mental Health Administration. (2015, August). The facts about buprenorphine for treatment of opioid addiction.
- Substance Abuse and Mental Health Services Administration. (2021, May 14). Buprenorphine.
- National Institute on Drug Abuse. (2016, May 26). Probuphine: A game-changer in fighting opioid dependence.
- U.S. Food and Drug Administration. (2016, May 26). FDA approves first buprenorphine implant for treatment of opioid dependence.
- Canadian Agency for Drugs and Technologies in Health. (2019, July). Clinical review report: Buprenorphine extended-release injection (Sublocade).
- National Institute on Drug Abuse. (2021, June). Prescription opioids drugfacts.
- Nunes, E.V., Gordon, M., Friedmann, P.D., Fishman, M.J., Lee, J.D., Chen, D.T., Hu, M.C., Boney, T.Y., Wilson, D., & O’Brien, C.P. (2018). Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone. Journal of Substance Abuse Treatment, 85, 49-55. https://doi.org/10.1016/j.jsat.2017.04.016
- Gov. (n.d.). Buprenorphine maintenance treatment.
- Drug Enforcement Administration. (2019). Buprenorphine.
- Drug Enforcement Administration. (2020). Methadone.
- Substance Abuse and Mental Health Administration. (2020, October 7). Certification of Opioid Treatment Programs (OTPs).