drugs_thumb_buprenorphine

What is Buprenorphine?

Buprenorphine (pronounce bew-pre-no-fee) is a prescription drug. It is taken as a replacement for heroin in the treatment of heroin dependence. Replacing a prescribed drug as to treat a drug of dependence in this way is known as pharmacotherapy.  As well as improving wellbeing and preventing physical withdrawal, pharmacotherapy helps to stabilise the lives of people who are dependent on heroin and opioid, to reduce the harm that related to drug use.

Buprenorphine pharmacotherapy can be used to

  • Help people to withdraw from methadone and heroin.
  • Reduce the need to use heroin – this is known as ‘buprenorphine maintenance’.
  • Treat severe pain.

Pharmaceutical Name

There are two formulations of buprenorphine available for people who are on pharmacotherapy treatment in Victoria.

  • Suboxone Sublingual Film® – A combination of buprenorphine and naloxone (also known as Narcan®). This is the most widely used form
  • Subutex Sublingual Tablets® – Contains the only buprenorphine 

Also known in local terms as 

  • Subutex, tec or SU SU
  • Slang names- Bup, B

How is it used and what are the ingredients?

Suboxone Sublingual Film® is a lime-flavoured, rectangular, orange film, which is placed under the tongue to dissolve. The film will not work properly if it is chewed or swallowed. Subutex Sublingual Tablets® are also placed under the tongue to dissolve and will not work properly if chewed or swallowed.

Subutex comes in 2 mg and 8 mg pills. Its active ingredients are Buprenorphine Hydrochloride which is semi-synthetic opioid derivatives closely related to Morphine.

How effective is it?

Buprenorphine treatment is more likely to be successful if it is a part of a comprehensive treatment program, which addresses the body, mind and environment in which heroin has been used.  For example, may include combination of buprenorphine, counselling, alternatives therapies, and the development of a positive support network of peers, friends and support group.5

Buprenorphine maintenance

Buprenorphine maintenance may not work for everyone, so it is important to work with a doctor and drug counsellor for the best approach.

Advantages of buprenorphine maintenance over heroin use.

  • Using the buprenorphine on it is unlikely for an overdose use.
  • Buprenorphine maintenance keeps the person stable while they make positive changes in their lives.
  • Health problems are reduced or avoided, especially those related to injecting, such has HIV, hepatitis B and hepatitis c viruses,  skin infections and vein problems.
  • Doses are required only once a day, sometimes even less often, buprenorphine’ effects are long-lasting.
  • Buprenorphine is much cheaper than heroin

Effects of buprenorphine 

There is no safe level of drug use.  Use of any drugs always carries a risk. Even medications can produce unwanted side effects. It’s important to be careful when taking any type of drug.

Buprenorphine affects everyone differently, based on;

  • Size, weight and health
  • Whether the person is used to taking it
  • Whether other drugs are taken around the same time
  • The amount was taken

Side effects 

The most common side effects;

  • Constipation
  • Headaches
  • Increased sweating
  • Tiredness or drowsiness ( especially after dose)
  • Loss of appetite, nausea and vomiting
  • Abdominal pain
  • Skin rashes, itching and hives
  • Tooth decay
  • Change to period (menstruation)
  • Lowered sex drive ( male & female)
  • Weight gain (particularly for female)

Withdrawal 

Withdrawal from long-term use of buprenorphine may produce some symptoms similar to those experienced from heroin withdrawal. However, symptoms tend to be milder than for heroin or other opioids such as methadone withdrawal. Withdrawal symptoms may vary from person to person, but may include,

  • Cold or flu-like symptoms
  • Headaches
  • Sweating
  • Aches and pains
  • Difficulties in sleeping
  • Nausea, Mood swings and Loss of appetite

These effects usually peak in the first 2 to 5 days. Some mild effects may last a number of weeks. Medical complications arising from intravenous abuse of Subutex especially when mixed with other prescription drugs:

  • Clogging of veins leading to gangrene.
  • Breathing problems (respiratory depression) which can lead to death.

The sharing of needles can also cause the spread of Hepatitis B and C and the HIV virus if the needles are contaminated.

Singapore views on Buprenorphine

Penalties-Possession or consumption of Buprenorphine:

  • Up to 10 years of imprisonment or S$20,000 fine or BOTH

Illegal traffic of Buprenorphine:

  • Up to 20 years of imprisonment and 15 strokes of the cane

Illegal import or export of Buprenorphine:

  • Up to 30 years of imprisonment or imprisonment for life and 15 strokes of the cane for the unauthorised manufacture of Buprenorphine

References

  1. Lintzeris. N, Clark. N, Winstock. A, Dunlop. A, Muhleisen. P, Gowing. L, Ali. R, Ritter. A, Bell. J, Quigley. A, Mattick. RP, Monheit. B., & White. J. (2006). National clinical guidelines and procedures for the use of buprenorphine in the treatment of opioid dependence [PDF:3MB].
  2. Harm Reduction Victoria. (n.d.) Buprenorphine (Subutex).
  3. NPS MedicineWise (n.d.) Suboxone Sublingual Film.
  4.  Lintzeris, N., & Bath, N. (n.d.) Subutex: A guide to treatment [PDF:1MB].
  5. Wodak, A., (2001). Drug treatment for opioid dependence

Click to see more on buprenorphine

Click to see more on Singapore Misuse of Drug Act

 

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