Key Points

1. Buprenorphine is different from other opioids. It is effective in treating opioid use disorder (OUD) and reducing withdrawal and cravings. It requires a prescription from a specially-trained clinician.
2. Buprenorphine is safe in pregnancy and breastfeeding.
3. Your buprenorphine will work best if you dissolve it completely under your tongue.

What is Buprenorphine?

Buprenorphine is the active ingredient in medications called Suboxone, Bunavail, Zubsolv, and Subutex. Buprenorphine is an opioid medicine that stops withdrawal from other opioids. It also acts as an opioid “blocker,” binding tightly so that other opioids like heroin and fentanyl do not usually give a high, though too much of them can still cause an overdose.

Because it is strong and blocks other opioids, the first dose of buprenorphine cannot be taken close to a dose of other opioids, or you will experience sudden withdrawal. That is why we wait for enough withdrawal symptoms to start before taking the first dose of buprenorphine (see How to Start Taking Buprenorphine).

Boulder Care uses a medication that combines buprenorphine and naloxone. The naloxone does not do anything to your body when taken under the tongue.

Why Buprenorphine?

Buprenorphine is one of three medications approved by the United States Food and Drug Administration (FDA) for the treatment of opioid use disorder (OUD). Broadly, we know that any kind of medication treatment is better than no medication treatment. However, buprenorphine/naloxone is the treatment of choice at Boulder Care because there is a lot of scientific evidence about how helpful it is compared to other treatments. Buprenorphine also has fewer side effects compared to methadone [1, 2, 3].

Buprenorphine and buprenorphine/naloxone taken at appropriate (high enough) doses have been shown to:

• Help people stick to their treatment plan [4] and stay in treatment longer [1, 5]
• Result in less uncontrolled opioid use [2] — in one study, for every 3 months someone took buprenorphine/naloxone, their use of opioids and other substances got significantly lower [6]
• Reduce the risk of death from any causes, including overdose [7]
• Reduce psychological distress, perceived stress, improve physical functioning and improve quality of life [8, 9, 10, 11]
• Improve physical health, including better Human Immunodeficiency Virus (HIV) viral suppression [12]
• Fewer symptoms of withdrawal [13] and reduced cravings for opioids [10]

Science also shows buprenorphine can help people function better in their day-to-day life. Some examples could include doing better at work or having less relationship trouble. For many people, legal trouble and custody issues because of substance use can get fixed, too. [10, 11, 14, 15]

In addition, people who take buprenorphine during pregnancy have healthier babies (better birth outcomes) than if they didn’t have medication; if the babies develop neonatal abstinence syndrome, it is less severe when their birth parent took buprenorphine [2].

There are a lot of common myths about buprenorphine. We investigate some of these misconceptions in Common Myths about Buprenorphine.

How to Get Buprenorphine

Buprenorphine requires a prescription. The clinicians (doctors, nurse practitioners, and physicians assistants) who prescribe buprenorphine are required to have special training and a certificate in order to prescribe. All Boulder Care Clinicians are able to prescribe buprenorphine.

If you know someone not enrolled with Boulder who is looking for buprenorphine treatment, you can recommend that they reach out to Boulder or that they speak with their primary care clinician about treatment options.

Taking Buprenorphine

Buprenorphine is taken daily to prevent opioid withdrawal, opioid cravings and return to opioid use. You may need to take your buprenorphine more than once a day, but for many, a single dose once a day can give 24 hours of relief and treatment.

To take buprenorphine medicines, you will dissolve the tablet or film under your tongue. The small blood vessels under the tongue absorb the medicine directly. If the buprenorphine tablet or film is swallowed it will not work.

In order to absorb the most medicine possible, allow the film or tablet to completely dissolve under your tongue. This may take up to 15 minutes. A dry mouth can make this take longer. Drinking plenty of water beforehand can help. Because nicotine makes mouth small blood vessels shrink, avoid smoking a cigarette or using other nicotine products in the 30 minutes before and 30 minutes after taking buprenorphine.

Talk to your Boulder Clinician if you are having a hard time taking your buprenorphine or have questions about how best to take it.

Additional Resources

• Suboxone®: Important Safety Information
• Common Myths about Buprenorphine
• How to Start Taking Buprenorphine
• Safe Storage of Buprenorphine/Naloxone
• Managing Buprenorphine Side Effects

References

1. Barnett PG (2009) Comparison of costs and utilization among buprenorphine and methadone patients. Addiction 104:982–992
2. Thomas CP, Fullerton CA, Kim M, Montejano L, Lyman DR, Dougherty RH, Daniels AS, Ghose SS, Delphin-Rittmon ME (2014) Medication-assisted treatment with buprenorphine: Assessing the evidence. Psychiatr Serv 65:158–170
3. Kao DP, Haigney MCP, Mehler PS, Krantz MJ (2015) Arrhythmia associated with buprenorphine and methadone reported to the food and drug administration. Addiction 110:1468–1475
4. Crits-Christoph P, Lundy C, Stringer M, Gallop R, Gastfriend DR (2015) Extended-release naltrexone for alcohol and opioid problems in Missouri parolees and probationers. J Subst Abuse Treat 56:54–60
5. Timko C, Schultz NR, Cucciare MA, Vittorio L, Garrison-Diehn C (2016) Retention in medication-assisted treatment for opiate dependence: A systematic review. J Addict Dis 35:22–35
6. Korthuis PT, Fiellin DA, Fu R, et al (2011) Improving adherence to HIV quality of care indicators in persons with opioid dependence: The role of buprenorphine. JAIDS J Acquir Immune Defic Syndr 56:S83–S90
7. Hickman M, Steer C, Tilling K, Lim A, Marsden J, Millar J, Strang T, Telfer J, Vickerman O, Macleod J (2018) The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom. Addiction 113:1461–1476
8. Dunlop AJ, Brown AL, Oldmeadow C, et al (2017) Effectiveness and cost-effectiveness of unsupervised buprenorphine-naloxone for the treatment of heroin dependence in a randomized waitlist controlled trial. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2017.01.016
9. Maremmani I, Pani PP, Pacini M, Perugi G (2007) Substance use and quality of life over 12 months among buprenorphine maintenance-treated and methadone maintenance-treated heroin-addicted patients. J Subst Abuse Treat 33:91–98
10. Bolek S, Yargic I, Ekinci O (2016) The effects of Buprenorphine/Naloxane maintenance treatment on the quality of life, substance use and functionality in opiate dependence: A follow-up study. Klin Psikofarmakol Bülteni / Bull Clin Psychopharmacol 26:141–151
11. Shion LD, a/l Sambamoorthy VR, Ying DLS, Aznal SSS (2014) Assessment effects of maintenance therapy on quality of life of opiate abusers. ASEAN J Psychiatry 15:131–139
12. Springer SA, Qiu J, Saber-Tehrani AS, Altice FL (2012) Retention on Buprenorphine Is Associated with High Levels of Maximal Viral Suppression among HIV-Infected Opioid Dependent Released Prisoners. PLoS One 7:e38335
13. Giacomuzzi SM, Riemer Y, Ertl M, Kemmler G, Rössler H, Hinterhuber H, Kurz M (2005) Gender Differences in Health-Related Quality of Life on Admission to a Maintenance Treatment Program. Eur Addict Res 11:69–75
14. Öhlin L, Fridell M, Nyhlén A (2015) Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years. BMC Psychiatry 15:56
15. Larney S, Toson B, Burns L, Dolan K (2012) Effect of prison-based opioid substitution treatment and post-release retention in treatment on risk of re-incarceration. Addiction 107:372–380

Questions, concerns, or feedback?

You can send a message to your Care Team in the app with non-urgent questions or feedback, or you can always call Boulder's 24/7 Support at 888-316-0451.

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