Here is some info I got from the NAABT (National Alliance of Advocates for Buprenorphine Treatment) websight.
Buprenorphine ('bu-pre-'nôr-fen) (C29H41NO4) is a semi-synthetic opioid derived from thebaine, an alkaloid of the poppy Papaver somniferum. Buprenorphine is an opioid partial agonist. This means that, although Buprenorphine is an opioid, and thus can produce typical opioid effects and side effects such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone. At low doses Buprenorphine produces sufficient agonist effect to enable opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symptoms. The agonist effects of Buprenorphine increase linearly with increasing doses of the drug until it reaches a plateau and no longer continues to increase with further increases in dosage. This is called the "ceiling effect." Thus, Buprenorphine carries a lower risk of abuse, addiction, and side effects compared to full opioid agonists. In fact, Buprenorphine can actually block the effects of full opioid agonists and can precipitate withdrawal symptoms if administered to an opioid-addicted individual while a full agonist is in the bloodstream. This is the result of the high affinity Buprenorphine has to the opioid receptors. The affinity refers to the strength of attraction and likelihood of a substance to bind with the opioid receptors. Buprenorphine has a higher affinity than other opioids and as such will compete for the receptor and win. It will "knock off" other opioids and occupy that receptor blocking other opioids from attaching to it. If there is enough Buprenorphine to knock the opioids off the receptors but not enough to occupy and satisfy the receptors, withdrawal symptoms can occur; in which case the treatment is more Buprenorphine until withdrawal symptoms disappear.
In October 2002, the Food and Drug Administration (FDA) approved Subutex® (buprenorphine hydrochloride) and Suboxone® tablets (buprenorphine hydrochloride and naloxone hydrochloride) for the treatment of opiate dependence. These are the only buprenorphine based products approved to treat opioid dependence (addiction).
Suboxone, contains both buprenorphine and the opiate antagonist naloxone. Naloxone has been added to Suboxone to guard against intravenous abuse of buprenorphine by individuals physically dependent on opiates. If misused by injection, the naloxone will cause immediate withdrawal in opioid dependent people, however when taken sublingually, as indicated, the naloxone is clinically insignificant.
Are there other uses for Buprenorphine?
The Food and Drug Administration (FDA) has approved Buprenex® ( an injectable formulation of buprenorphine) (Buprenex PI) to treat pain. However, by law, Buprenex cannot be used to treat opioid dependence(addiction), even by DATA-2000 wavered physicians. Buprenorphine: Considerations for Pain Management (study)
Buprenorphine has also been found to relieve refractory depression, but this particular use has never been approved by FDA. Refractory depression is depression that has not responded to other treatments. Some patients, who suffered from depression in the past, have experienced relief of symptoms on buprenorphine. (Bodkin,1995)
FDA has approved Subutex®( buprenorphine) and Suboxone® (buprenorphine/naloxone) to treat opioid dependence (addiction). However, neither Suboxone nor Subutex has been approved by the FDA for the treatment of depression or pain. Thus any use of Suboxone® and Subutex® for pain or depression is considered an off-label, unapproved use of these medications.
The D.E.A. articulates policy on the use of buprenorphine for pain and other off-label uses of buprenorphine products under DATA2000. Letter to Doctor Heit
Clarification: Buprenorphine is intended for the treatment of pain (as, Buprenex®) and opioid dependence (addiction) (as, Suboxone® and Subutex®). In 2001, 2005,and 2006 the Narcotic Addict Treatment Act was amended to allow qualified physicians, under certification of the DHHS, to prescribe Schedule III-V narcotic drugs (FDA approved for the indication of narcotic treatment) for narcotic addiction (up to 30 patients/physician at any time, 100 for those who meet certain criteria) outside the context of clinic-based narcotic treatment programs (Pub. L. 106-310). Suboxone® and Subutex® are the only treatment drugs that meet the requirement of this exemption (not Buprenex®). Source: DEA
Can someone switch from methadone to buprenorphine?
It is best to SLOWLY reduce your therapeutic dose of Methadone to 30 mg a day or less for at least a week, before discontinuing it completely for at least 36 hours before starting Buprenorphine. You MUST be in mild to moderate withdrawal before you take your first dose of Buprenorphine. If you are doing well in Methadone treatment it may not be advisable to change treatments at all unless you and your doctor determine it is in your best interest.
It is VERY important to follow these guidelines and prevent precipitated withdrawal.
What the experts say (PCSS mentors)
NAABT Precipitated Withdrawal sheet (including COWS)
What if I need pain medication for surgery, or acute pain?
You will still be able to be treated for pain with elective dental or surgical procedures. Your doctors should speak with each other about the plan. They will likely stop your Buprenorphine medication, at least 36 hours before the procedure, and then when you are ready to go back on Buprenorphine you will need to be re-induced, which means stopping your pain medicine, experiencing mild withdrawal (for a very short time) and restarting your Buprenorphine.
And here are some links to information on buprenorphine and pregnancy/birth-
I hope this information helps. I'm not taking credit for any of this stuff cause I didnt write it. But I only posted some of the importnt stuff like for pain pregnancy.
26 years old, single mother of 2 children, 7 year old girl and 9 year old boy
DX-Lower back pain, Arthiritis, Migraines, Raynald's Phenomenon, Depression, Anxiety/Panic Disorder, Bipolar Disorder, Pancreatic Divisum, Chronic Pancreatitas, Fibromyalgia
Meds- Suboxone 16-24mg daily, Cymbalta 60mg, 100mg Lyrica, Ventolin Albuterol Inhaler, Advair, Imitrex 100mg, Ibprofen 800mg, Phenergan 25mg, Hydroxizine 25mg, Biofreeze
Surgeries- Gallbladder removed 1998, Stent in Pancreas 2003, marsupilized bartholin gland cyst, countless upper GI scopes and ERCPs
Pets- 3 degus named Pricilla, Aster, and Shorty, one female rat named Sassy, one male rat named Squeeky who's brother died on 4/18/09 and was replaced by a baby female Guinea pig name Rosalina, a baby black emperor scorpian, and a corn snake named Precious
"Never go to a doctor's office whose plants has died."