The National Alliance of Advocates
for Buprenorphine Treatment

Buprenorphine (Suboxone®, Subutex®3, Zubsolv®4, Bunavail™5, Probuphine®6) is an opioid medication used to treat opioid addiction in the privacy of a physician's office.1 Buprenorphine can be dispensed for take-home use, by prescription.1 This, in addition to the pharmacological and safety profile of buprenorphine, makes it an attractive treatment for patients addicted to opioids.2

Important Buprenorphine Information

Buprenorphine is a partial opioid agonist. It can cause a diminished response to opioid pain medications.

This patient is taking a combination drug of buprenorphine, a partial opiate agonist, and naloxone, an opioid antagonist (naloxone is only clinically active when abused parenterally). Patients taking buprenorphine may have a diminished response to opiate medications (including those for the management of cough or pain).

Opiate-containing preparations should be avoided when non-opiate therapy is available as an alternative. In an emergency situation requiring pain relief in patients taking buprenorphine, a suggested plan of management is regional anesthesia, conscious sedation with a benzodiazepine, use of non-opioid analgesics or general anesthesia. In a situation requiring opiate analgesia, the dose of opiate required may be greater than usual. A rapidly acting opiate analgesic, which minimizes the duration of respiratory depression, should be used. The dose of opioid medication should be titrated against the patient's analgesic and physiological response, with close monitoring by trained staff.

Overdose with buprenorphine alone is uncommon. In a situation that a patient taking buprenorphine has overdosed and is unconscious, the primary management should be the re-establishment of adequate ventilation with mechanical assistance of respiration, if required. Overdose in combination with other CNS depressants should be considered because of the increased potential for life-threatening events. Naloxone may not be effective in reversing any respiratory depression produced by buprenorphine. High doses of naloxone hydrochloride, 10-35 mg/70 kg, may be of limited value in the management of buprenorphine overdose. Doxapram (a respiratory stimulant) has also been used.

Important documentation and resources:

The basics on buprenorphine:
Buprenorphine pamphlet

Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction  SAMHSA- TIP-40:

Physician Clinical Support System (PCSS):
The SAMHSA-funded PCSS service is available, at no cost, to interested physicians and staff, to assist in implementing office-based treatment of opioid dependence with buprenorphine: 1-888-572-7724: Contact

The buprenorphine MOA illustration, for a quick understanding:

List of certified physicians near you (some may be available to give advice): - Locator

How do I manage acute pain in a patient receiving buprenorphine/naloxone (bup/nx) for the treatment of addiction?

PCSS Clinical Guidelines – Treating acute pain in buprenorphine maintained patients:

Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders:

Can a physician dispense buprenorphine for opioid dependence without a waiver?

Yes. Dispensing of buprenorphine in emergencies, to treat acute withdrawal symptoms, by non-DATA-2000 certified physicians is allowed.(the 72 hour rule, DEA-1306.07):

Other resources:

This article explains practical treatment issues:

SAMHSA/CSAT Government buprenorphine website:

General patient educational information – National Alliance of Advocates for Buprenorphine Treatment:


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Information contained on or made available through the Site is not intended to and does not constitute medical advice, recommendations or counseling under any circumstance and no doctor-patient relationship is formed. We do not warranty or guarantee the accurateness, completeness, adequacy or currency of the information contained in or linked to the Site. Your use of information on the Site or materials linked to the Site is entirely at your own risk. See all terms
This page was last modified on : 09/12/2016

The Purpose of Buprenorphine Treatment:

To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -

The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization charged with the mission to:

  1. U.S. Food and Drug Administration, FDA Talk Paper, T0238, October 8, 2002, Subutex and Suboxone approved to treat opiate dependence.
  2. Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004.
  3. Subutex Discontinued in the US market in late 2011.
  4. Zubsolv (bup/nx sublingual tablet) FDA approved 7/3/2013 see buprenorphine pipeline graphic -in pharmacies now.
  5. Bunavail (bup/nx bucal film) FDA approved 6/6/2014 see buprenorphine pipeline graphic -in pharmacies now.
  6. Probuphine FDA approved 5/26/2016 - FDA Probuphine press release