|
|
|
|
Buprenorphine (Subutex / Suboxone)
In the UK it comes under the brand name Subutex in sublingual tablets of 0.4mg, 2mg or 8mg strength. Sublingual tablets have to be placed under the tongue and allowed to dissolve, which usually takes around 5 - 10 minutes. This is the only way that the tablets can be taken and is more effective as the medication goes directly into the blood stream and starts working quicker. Do not chew or swallow them as this will make them ineffective. Every morning your tablets should be taken at the same time, as each dose lasts 24 hours.
Using Buprenorphine as a substitute for opiates means that you will be given an initial dose of 4mg on the first day, gradually increasing the dose each day until you feel no withdrawal symptoms. During your treatment your Doctor may increase your dose to a maximum daily dose of 32mg, depending on your response. You would then remain on this dose for an agreed length of time (usually around 3-6 months) before gradually reducing the dose until you stop taking it altogether. Do not suddenly stop taking the tablets, as this will cause withdrawal symptoms. You must reduce carefully under your Doctors orders, otherwise you will be very ill and probably end up using again.
Once you have arranged to start your detox you must finish your heroin 12 hours before starting the treatment. So that you can have a good nights sleep and not have to wait too long to take your tablet in the morning, aim to finish your gear by 9 - 10 pm. Then you will be able to wake up and start your medication rather than having to wait hours because you used until late in the night.
Although it is new to the UK (but is more widely available now), it has been tried and tested in scientific studies for the past 10 years. In France it has been used to help people since early 1996 and it is estimated that it has helped over 60,000 people. At present research is also being undertaken into whether or not it is safe for pregnant women to use. The brand name for it in the UK is Subutex (high dose buprenorphine). You must be careful to get the right thing, as tablets such as Temgesic contain Buprenorphine but at a low dose which is inappropriate for treating addiction.
The week long Buprenorphine detox usually starts on a Monday morning, lasting until Sunday. To help you cope until you start Naltrexone on the Wednesday, a course of tranquillizers (Chlordiazepoxide) and sleeping tablets (Nitrazepam) are normally prescribed for the two day gap between medications.
Medical Notes Like all drugs, Buprenorphine may cause side effects: constipation, headaches, difficulty in sleeping, lack of energy or weakness, drowsiness, nausea and vomiting, fainting and dizziness, drop in blood pressure on changing position from sitting or lying down to standing, sweating.
Rarely the following have occurred: severe difficulty in breathing, liver problems, hallucinations.
Do not take Buprenorphine if: you have serious breathing problems; have problems with your liver; are intoxicated due to alcohol or have delirium tremens; are breast-feeding your baby; if you are or think you are pregnant (speak to your Doctor first); have asthma or other breathing difficulties; have kidney disease.
Do not mix Buprenorphine with any other drugs not prescribed to you. Check with your pharmacist if you get a prescription for something else or you are buying over-the-counter medicines. If you go to the dentist or a doctor who is not your prescribing doctor tell them you are using Buprenorphine. Because of the way that it works there is no point in trying to 'top up' with heroin or other opiate drugs - it will stop them from working and you won't get a 'hit'. Taking other drugs such as benzos (sedatives) on top should be avoided. Mixing any opiates with drugs such as Diazepam and Temazepam is extremely dangerous as this can make you very drowsy and increase the chance of overdose. Strong pain killers, cough medicines and anti-diarrhea medicines containing opiate drugs like codeine should also be avoided.
Don't drink too much alcohol. Mixing opiates with alcohol can be very dangerous. So if you do have a drink, make sure that you don't overdo it as it could make you very drowsy and this could make you more likely to overdose. If you feel Buprenorphine is not enough for you, don't be tempted to 'top up' with alcohol. Be sure to talk to your Doctor or counselor if you feel that you need more help.
Click here to read the handbook 'Treatment Choices: Buprenorphine' by HIT. |
|
Last updated: 31 August 2004 |
Buprenorphine
is a strong pain reliever which when used for the treatment of patients addicted
to opiate drugs such as morphine and heroin, acts as a substitute for these
drugs and therefore aids the patient in withdrawing from them over a period of
time. It is also used to detox from opiates over a week by helping to
relieve the withdrawal symptoms.
Doing
a detox using Buprenorphine will take place over seven days with the dose
increasing over the first three days and then being reduced. If you
haven't managed to get your heroin or methadone use to a low level, the drug
won't be able to work properly and you will more than likely not be able to cope
with the withdrawal symptoms which are similar to those with heroin and
methadone, only not as severe. Unless you have a responsible non-user to
administer your medication each day, most clinics will require you to attend
daily to collect your medication. It will take most people 4 - 5 days to
get over the mild withdrawal symptoms that are felt when reducing the dose and
it can take up to 2 weeks to feel physically okay. Whilst the withdrawal
symptoms are not as severe you will still get all of them and will probably get
little or no sleep. Sleeping tablets can not be taken with Buprenorphine
as they increase the sedative effects of the drug and can increase the risk of
overdose. Some people have been known to have died from respiratory
failure (inability to breath) because of using benzodiazepines (sleeping
tablets) whilst on Buprenorphine. After the seven day detox you need to
have three days free of any opiates before you can start on Naltrexone.