Buprenorphine is a semisynthetic narcotic medication that is derived from thebaine, which is itself an alkaloid of the opium poppy. Buprenorphine is a Schedule III drug under the Controlled Substances Act. The drug is used to help individuals with detoxification from narcotics.

It was first synthesized as an analgesic (painkiller) in England in 1969. The National Institute of Drug Abuse (NIDA) in the United States researched its possible efficacy as a treatment for opiate addiction in the 1970s. It was ultimately found to be effective in treating heroin addiction, and it was also found to produce a lower level of physical tolerance than methadone, another treatment for opiate addiction. Thus, patients who stop taking buprenorphine will experience fewer withdrawal symptoms than patients who stop taking methadone.

In 2002, two new brand names of buprenorphine, Subutex and Suboxone, were approved by the Food and Drug Administration (FDA) as a treatment for narcotic addiction. (Suboxone also includes another treatment drug, naloxone.) These drugs are sublingual (under the tongue) medications. A transdermal (skin patch) delivery system has been approved for use in Europe but has not been approved as of this writing in the United States.

According to the Substance Abuse and Mental Health Services Administration, about 5 percent of treatment facilities in the United States use buprenorphine.

Physicians who wish to treat addicted patients with buprenorphine must obtain a special waiver from the federal government, and as of 2004, there were about 4,000 physicians in the United States who had been approved to use buprenorphine for treating addiction. These physicians must meet specific criteria; for example, they must have a board certification in addiction psychiatry, and they must also be certified in addiction medicine, among other criteria.

According to Welsh and Valadez-Meltzer in their article on buprenorphine in Psychiatry, it has three primary medical uses: detoxification from narcotics, opioid maintenance, and pain management.

The goal of detoxification is to help patients rid themselves of the addiction; in opioid maintenance buprenorphine is given instead of the narcotic to which the patient is addicted, in a similar manner to the way methadone is often used. In pain management the drug is used as an analgesic for chronic severe pain.

Some patients taking buprenorphine have experienced elevated levels of liver enzymes, and such patients should be monitored carefully.

References:

Welsh, Christopher, M.D., and Adela Valadez-Meltzer, M.D. "Buprenorphine: A (Relatively) New Treatment for Opioid Dependence." Psychiatry 2, no. 12 (December 2005): 29-39.

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