UMEM Educational Pearls

Category: Toxicology

Title: Buprenorphine - The New Methadone

Keywords: methadone, buprenorphine (PubMed Search)

Posted: 8/28/2008 by Fermin Barrueto, MD (Updated: 12/7/2019)
Click here to contact Fermin Barrueto, MD

Buprenorphine (Suboxone)

  • Use in opioid maintenance therapy programs, doesn't have QT prolongation and less respiratory depression than methandone
  • Patients must been maintained on <40mg of methadone for successful conversion to buprenorphine to take place
  • Primary caregivers can prescribe after taking a course
  • Partial agonist can actual precipitate withdrawal if patient takes a full opioid (say sneaking a little heroin before appointment)
  • Suboxone is buprenorphine+naloxone, since naloxone has poor bioavailability when taken appropriately there is no effect but if the tablet is crushed and injected the patient will go into florid withdrawal.
  • Use and abuse has been steadily increasing and death can still occur from overdose.
  • Pain is difficult to manage in patient on buprenorphine since opioid effect will be blunted, buprenorphine is potent partial agonist.