Heroin Addiction - Help for Addicts

www.helpingaddicts.net

Buprenorphine Handbook

All the information on this page is from the leaflet called 'Treatment Choices: Buprenorphine' and is available from drug services in the UK. It is produced by HIT.

THE buprenorphine HANDBOOK

buprenorphine / SUBUTEX
Drugs work by stimulating receptors in the brain. These pictures show how Subutex 'sticks' to the opiate receptors stopping heroin having any effect and, at the same time, stimulating them enough to take away, or reduce, the desire to take heroin.

Long-lasting
Buprenorphine is sold in the UK under the trade name Subutex. It is a long-acting opiate that you take as a pill that dissolves under the tongue.

Subutex is more strongly attracted to the opiate receptors in the brain than heroin (and methadone), and sticks very tightly to them.

Because Subutex sticks so well to the opiate receptors, you can take it just once a day to start with. And, once you are stable in your treatment, you may be comfortable taking it once every two or three days.

Heroin blocking
Subutex binds so tightly to the opiate receptors that taking heroin on top has little or no effect. This is because it can't get to the receptors to stimulate them.

If there is heroin or methadone in your system when you first take Subutex, it will 'kick' them off the receptors. This means that if you are prescribed Subutex, it's got to be at least 12 hours since you last took heroin, and 24 to 36 hours since you last took methadone, before you can take the first dose. If not, you will go into instant, severe withdrawals.

Feeling 'normal'
The way Subutex works means that although it can still stimulate the opiate receptors enough to prevent withdrawals, most people who take it don't get a strong opiate effect.

This can be a real plus if you are fed up with the highs and lows of using heroin or if you:

• haven't been using for very long;

• have low tolerance;

• are on a low methadone dose; or

• find methadone really slows you down.

However, some people find it leaves them feeling 'too normal'. This tends to be more of a problem for people who are using a lot of heroin (particularly injectors) to get a hit (rather than just avoid withdrawals) and those using combinations of other drugs with heroin.

If you feel comfortable with the 'limited opiate effect', Subutex can work well as a long-term maintenance treatment to help you stop using heroin and get stable.

Detox
If you are ready to come off opiates and want to detox, the physical withdrawals from Subutex are usually less severe than those from heroin or methadone. Because of this, Subutex is being prescribed more and more often for detox.

Switching
You can't take methadone and Subutex at the same time. If you are on methadone and think Subutex might work better for you (see 'Feeling normal') for maintenance or detox, you usually have to reduce the methadone dose to 30 milligrams to prevent withdrawal symptoms during the changeover.

Overdose
The other major advantage Subutex has is that it is not as dangerous as methadone or heroin in overdose. However, people have died taking combinations of Subutex with alcohol or tranquillizers such as valium.

Source:  www.hit.org.uk  (HIT)