If you stop taking heroin, buprenorphine can prevent or reduce the unpleasant withdrawal symptoms. Many people stay on buprenorphine long-term, but some people gradually reduce the dose and come off drugs altogether. You should not take any street drugs or much alcohol when you are taking buprenorphine.
If you are addicted to heroin it means that you develop withdrawal symptoms within a day or so of the last dose. So, if you are addicted to heroin you need a regular dose to feel 'normal'.
Withdrawal symptoms can include: sweating, feeling hot and cold, runny eyes and nose, yawning, being off food, stomach cramps, feeling sick or vomiting, diarrhoea, tremor, poor sleep, restlessness, general aches and pains, and just feeling awful. Withdrawal symptoms tend to ease and go within five days. However, you may then have a persistent craving for heroin, remain tired, and have poor sleep for quite some time afterwards.
Buprenorphine (brand name Subutex®) is an opioid drug that is similar to heroin. It can be prescribed. If you take buprenorphine, you are unlikely to get withdrawal symptoms if you stop heroin (or the withdrawal symptoms are much less severe). It also helps to reduce cravings for heroin. The drug most commonly prescribed as a substitute for heroin is methadone. On average, methadone tends to work better than buprenorphine in helping people to keep off heroin. However, buprenorphine is still a good treatment and some people prefer it because:
If you take buprenorphine (or methadone) under supervision from a doctor instead of street heroin, you are:
Many GPs will refer you to a community drug team to be assessed. Following assessment, the community drug team may prescribe buprenorphine. Some GPs work in a 'shared care' arrangement and will prescribe whatever is recommended for you by a community drug team. Some GPs who are specially trained may assess and prescribe buprenorphine without the need for referral.
Assessment usually includes:
If you have been injecting drugs such as heroin, it is also common to advise:
Buprenorphine is usually started some time after assessment when the results of the urine test are back. An initial dose is chosen, depending on current usage of heroin (or methadone).
Buprenorphine is a tablet which you put under your tongue. The tablet dissolves over 3-7 minutes and is absorbed straight into the bloodstream from your mouth. (The tablets do not work if you swallow them into the stomach.) It is usually prescribed as a once-daily dose. You will usually be asked to take it under the supervision of the pharmacist who dispenses the buprenorphine to you. This means there can be no doubt about how much you take at each dose. This supervision may be relaxed after a few months if you are taking a regular maintenance dose. The taste of buprenorphine can be quite bitter.
The timing of the first dose is important.
The reason for these timings is because, for buprenorphine to work well, you need to take it when your body has low levels of heroin or methadone. So, the aim is to take the first dose only when you feel some withdrawal symptoms starting. This tends to be about eight hours after the last dose of heroin, and longer after the last dose of methadone. If you take buprenorphine sooner, it can actually cause withdrawal symptoms suddenly to develop.
The initial dose will usually need to be increased. You will usually be given a higher dose on the second and third days, by which time you should not be feeling any withdrawal symptoms. It is very important that you do not take any heroin or methadone during this time, as this will cause you to feel ill - as though you are withdrawing. Your dose may need to be increased again to prevent symptoms of craving but most people feel they have the correct dose within the first week.
Once established on a regular dose, most people stay on buprenorphine for a long period of time or even long-term. This is called maintenance and helps you to keep off street drugs. Some people gradually reduce the dose and come off it. This is called detoxification, or 'detox'. However, it usually takes several months, and sometimes years, before most people are ready to consider 'detox'. It is often safer to stay on buprenorphine then to 'detox' before you are ready.
Buprenorphine has been combined with another medicine called naloxone (brand name Suboxone®) and it has been produced in the form of a tablet which is dissolved under the tongue. Naloxone blocks the action of buprenorphine and the effect of the combination is that, if a person is tempted to take more than the recommended dose (particularly if they crush the tablet and try to inject it), they will start to get withdrawal effects.
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The Alliance is a user-led organisation which provides advocacy, training and helpline services to those currently in drug treatment, those who have accessed drug treatment in the past and those who may access drug treatment in the future.
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