Buprenorphine for Opioid Use Disorder

Medically Reviewed by Jennifer Casarella, MD on April 22, 2022
4 min read

Most treatment plans for opioid use disorder (OUD) include the use of medications to help ease withdrawal symptoms and stop cravings. You take them in combination with counseling and therapy as part of a program called medication-assisted treatment (MAT). This type of therapy is designed to help you to avoid an overdose, prevent a relapse, and maintain recovery. The FDA allows doctors to prescribe buprenorphine and give it in their offices, so it’s available to a wider range of people seeking help for their opioid use. Here’s what you need to know about the drug.

Buprenorphine is an opioid partial agonist. It activates the same receptors in your body that opioid drugs such as heroin, fentanyl, and oxycodone do. But it doesn’t activate them as strongly as those drugs do. It works more slowly and doesn’t give you a euphoric high. Instead, it helps ease withdrawal symptoms and cravings.

Buprenorphine doesn’t work if you swallow it as it is absorbed by the mucosa, or lining of your mouth. It comes as a tablet or film that you place under your tongue (sublingual). Don’t try to cut or chew the tablet or film. Take a sip of water to moisten your mouth before you take it. Put it under your tongue and wait for it to dissolve completely with your mouth closed. This will take about 5 minutes. If you speak, eat, or drink it will affect how well your body absorbs the medication.

You’ll take this drug daily. Your provider may write your prescription as an observed dose, which means you must go to the pharmacy, clinic, or doctor’s office in person and take it there. This helps make sure that you take the correct dose and that you’ve taken it correctly. Some people also find that it helps them stay committed to treatment. As you continue with treatment, you may be able to start taking doses at home.

Your doctor will work with you to determine the dosage that works best for your needs. Most people take buprenorphine for at least 2 months. From there, some people taper off within a few months, while others continue to take buprenorphine for years. For people who are in the maintenance phase of their treatment, buprenorphine can be taken as a once-monthly injection (called Sublocade). This can be more convenient than taking a daily dose.

If you only use buprenorphine to detox, you may not fare that well. Research has shown that this drug isn’t very effective when used only for medically-supervised withdrawal. One study found that more than 90% of people relapsed within 2 months, despite getting drug counseling during this time. But longer-term buprenorphine use, especially at higher doses, can be as effective as methadone at keeping people from relapsing. One small Swedish study found that 75% of people who took daily buprenorphine were not using illicit opioids 1 year later.

Like most medications, this drug can cause side effects. Some of the most common side effects include:

Talk to your doctor if you have any side effects that make you uncomfortable.

Methadone is a medication commonly used for MAT, but it’s not the best choice for everyone. Some people don’t respond well to it, or they may not live close to an opioid treatment program where methadone is available. And because it’s an opioid, it doesn’t end your body’s dependence on opioids. Buprenorphine is a partial opioid agonist and usually has milder side effects, although as with full agonists, your body is still dependent.

Let your doctor know if you have a history of seizures, since buprenorphine can make you more susceptible to them. If you have liver problems, your doctor may want to track your liver function while you’re on buprenorphine. You should avoid alcohol and sedating medications such as benzodiazepines while taking it; the combination can increase your risk of overdose.

If you are pregnant, you and your doctor will map out a treatment plan that carefully balances the risks and benefits to both you and your baby.

It’s important that you don’t stop taking buprenorphine on your own. If you do, you may have withdrawal symptoms. Your doctor will track your recovery progress and will let you know when it’s safe to stop your treatment.

Tell your doctor about any other medications, vitamins, or supplements you’re taking. Buprenorphine may interact with them and cause side effects or affect how other medicines work.

Buprenorphine may be combined with another drug called naloxone, which blocks the effects of opioids (opioid antagonist). Naloxone causes opioid withdrawal symptoms if injected, so combining the two drugs -- taken under the tongue -- protects someone who is dependent on IV opioids from injecting the buprenorphine.

Buprenorphine for opioid use disorder costs an estimated $6,000 per year. The treatment is covered by Medicare, Medicaid, and other forms of health insurance as part of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. It is available at doctors’ offices and through many opioid treatment programs.

The Substance Abuse and Mental Health Services Administration has a website where you can locate buprenorphine providers: https://www.samhsa.gov/medication-assisted-treatment/find-treatment/treatment-practitioner-locator