What is buprenorphine?

Buprenorphine is an opioid medicine that is only available on prescription from your doctor.

Buprenorphine comes in several forms and can be used to help manage opioid dependence or pain. Buprenorphine works slightly differently from other opioid medicines, so it has a lower chance of overdose and life-threatening breathing problems.

How does buprenorphine work?

Buprenorphine works to reduce feelings of pain by interrupting the way nerves signal pain between the brain and the body.

When buprenorphine replaces other opioids, it helps reduce the negative effects of withdrawal, and reduces the dependence on other opioid drugs. In this way, buprenorphine makes it easier for people to stop harmful drug use.

What is buprenorphine used for?

Buprenorphine is prescribed for the medical treatment of people with an opioid drug dependence. This could include a dependency on heroin or other opioid drugs.

Buprenorphine can help people safely withdraw from the opioid medicine they are dependent on.

Buprenorphine can also be prescribed for the short-term treatment of severe pain.

What forms of buprenorphine are available?

Buprenorphine comes in several forms, each of which has different uses:

• sublingual tablets or film — placed under the tongue for quick absorption and rapid action, for opioid dependence, opioid withdrawal or acute pain
• transdermal patches — placed on the skin for slow, steady release and a continuous effect for 7 days for the management of chronic pain
• injection — quick-release injection into muscle or vein every 6 to 8 hours for acute pain or modified-release injection under the skin given weekly or monthly for opioid dependence

What are the possible side effects of taking buprenorphine?

Like all opioid medicines, buprenorphine can cause life-threatening breathing problems. The chance of these is higher:

• when first taking buprenorphine
• after a dosage increase
• if you are older
• if you have an existing lung problem
• if you are on more than one type of opioid medicine

Other common side effects of buprenorphine include:

• skin reactions, if you are using a buprenorphine patch
• constipation
• headache or dizziness
• fatigue or drowsiness (especially soon after a dose)
• loss of appetite, nausea and vomiting

Buprenorphine affects everyone differently. Your chances of experiencing side effects may depend on:

• if you regularly use buprenorphine
• if you take buprenorphine with other drugs or medicines
• your dosage
• how much you weigh
• your general health

If you notice side effects while taking buprenorphine, or are concerned about your drug use, speak with your doctor. Your doctor can advise you on other options to manage your pain or opioid dependence, or if you need a dosage adjustment.

Always take medicines exactly as your doctor prescribes.

What are the risks associated with buprenorphine?

Buprenorphine is an opioid medicine and can cause life-threatening breathing problems.

It's also important that you do not stop taking it suddenly, as this can lead to withdrawal symptoms. If you decide you want to stop taking buprenorphine, speak with your doctor about how to gradually reduce your dosage.

Withdrawal symptoms usually peak in the first few days after stopping buprenorphine, but symptoms may continue for several weeks. Possible symptoms include:

• nausea and vomiting or diarrhoea
• muscle aches or cramps
• sweating
• anxiety or agitation

Buprenorphine may make it difficult for you to drive or operate heavy machinery. If you have recently started taking an opioid medicine, or changed the dosage, you may be more likely to have an accident. Ask your doctor whether it is legal for you to drive while taking buprenorphine. Also contact your car insurer, as you may not be covered for accidents that occur while you are taking buprenorphine.

Buprenorphine is not suitable for everyone. Using it with alcohol or other medicines that cause drowsiness, such as benzodiazepines, can increase the chance of serious side effects, including overdose.

Your doctor is the best person to advise you on whether buprenorphine is the right medicine for you, how much you need, how long to take it for and any interactions it may have with your pre-existing medications.

Opioid tolerance and dependence

If you use opioid medicines, you may also develop tolerance. This means that you may need to take larger amounts of the opioid to get the same effect. The chance of side effects also increases with a higher dose.

It's also possible to become dependent on buprenorphine, even if you take it exactly as prescribed and only for a short time. Your doctor will monitor how you use buprenorphine to reduce your chance of harm, including through misuse, abuse and addiction.

If you are worried that you are becoming addicted to or dependent on buprenorphine let your doctor know, so that you can get help. You can also call the National Alcohol and Other Drug Hotline (1800 250 015) for 24/7 support and treatment information.

Opioid overdose

If you take too much buprenorphine (known as an overdose), it's important to get immediate medical attention. Overdose of opioid medicines can cause you to stop breathing.

Symptoms of overdose include:

• feeling sleepy
• difficulty breathing
• loss of consciousness
• pinpoint (very small) pupils

Access to overdose-reversing medication

Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose. The Australian Government is offering this medication free of charge and without a prescription to people who may experience, or witness, an opioid overdose.

Learn more about the Take Home Naloxone program.

How do I take buprenorphine?

There are several ways to take buprenorphine, since it comes in a few different forms.

Sublingual tablets or film

Sublingual tablets or film are placed under the tongue and must be left there until they dissolve. Here are some tips:

• Do not chew, swallow, or cut the tablets.
• You may experience dry mouth from taking this medicine.

Transdermal patches

Transdermal patches are placed on dry, non-irritated, hairless skin on the upper torso. Here are some tips:

• Make sure to write the date and time on the patch in permanent marker before applying it.
• Do not cut or divide patches.
• Remove the patch after 7 days and place the new patch on a different area of skin.
• Avoid reusing the same area for at least 3 weeks.
• Between patch changes, check that the patch is still attached.
• When wearing the patch, do not let it come into contact with direct heat sources such as electric blankets, heat pads, saunas, or hot baths.
• Dispose of a used buprenorphine patch by folding it over on itself (bringing the sticky sides together).

Injection

Buprenorphine injections must be given by registered healthcare professionals in healthcare settings. Buprenorphine injections will not be directly supplied to you or your carer.

Make sure you or your carer have read and understand the Consumer Medicines Information (CMI) leaflet for the brand you have been prescribed so you know how to dispose of your medicine safely.

How do I dispose of medicines safely?

It's important to dispose of unwanted opioid medicines safely. Unused medicines can be returned to any pharmacy. Don't keep unused buprenorphine 'just in case' — this can lead to dangerous or inappropriate use.

Keep buprenorphine out of reach of children and pets. Never throw medicines into a garbage bin or flush them down the toilet — this is dangerous to others and harmful to the environment.

When should I see my doctor?

If your pain is not well controlled with buprenorphine, or you have any unexpected or unwanted side effects, see your doctor. There are different options for pain management, and your doctor can suggest other approaches.

Always check with your doctor before adjusting your dosage either up or down, unless otherwise directed.

Are there alternatives to buprenorphine?

Both buprenorphine and methadone are used to help treat opioid dependence or misuse. Your doctor will help you decide which option is best for you.

Everyone's pain is different, and different pain-relief medicines are used in different situations. If your doctor has prescribed buprenorphine for you, and you have concerns or are experiencing side effects, speak with them about other ways you can manage your pain.

If you have chronic (long-term) pain, your doctor might suggest lifestyle changes to help manage the effects of pain. This may include:

• improving your physical fitness
• activity pacing
• social activities
• relaxation techniques
• overall health management

Resources and support

Asking about your treatment or medicines is important to help you understand your options. Here's a guide to questions to ask your pharmacist or doctor before taking a medicine.

You can also see this list of medicines that contain buprenorphine.

Read the Consumer Medicines Information (CMI) leaflet for the brand you have been prescribed, or:

• If you are struggling with addiction to alcohol or other drugs, call the National Alcohol and Other Drug Hotline (1800 250 015) for 24/7 support and treatment information.
• Call 1300 MEDICINE (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link helpline (1300 340 357) which is staffed by volunteers with personal experience of chronic pain.
• Go to PainAustralia to find pain services and programs in your area.
• Learn more about prescription opioids on Choosing Wisely.

Information for Aboriginal and/or Torres Strait Islander peoples

• Visit Positive Choices for an overview of drug services and resources for Aboriginal and Torres Strait Islander people and communities.
• Your Room is a website with resources about drugs, with information for Aboriginal and/or Torres Strait Islander people.
• Learn more about pain management on Pain Management Network.

Languages other than languages

The Alcohol and Drug Foundation has a guide to using medicines safely, translated into many community languages.