Because Buprenorphine is safer and easier to prescribe than methadone, patients can take more than one dose home at a time. The convenience of this kind of prescription carries a risk of abuse.
Patients may try to take more than one dose at a time. Overdose by buprenorphine is less common than overdose with heroin or methadone because buprenorphine is only a “partial agonist” at opioid receptors in the brain, and does not cause a strong enough effect to suppress breathing to the point of death. However, buprenorphine can still be dangerous when mixed with other drugs, and life-threatening overdose and death have occurred when it is not taken as recommended by a physician. Formulations of buprenorphine like Suboxone contain built-in safety measures to prevent abuse by injection.
Patients may sell or give their doses to other people who have not been prescribed buprenorphine and do not use it safely. Patients interested in buprenorphine should be aware of how to use this medication safely. Overdoses can occur when street drugs or excess alcohol are taken with buprenorphine.
Buprenorphine should also be kept away from children, as life-threatening overdoses have occurred when children take this medicine.
Reducing these risks
Studies have found that buprenorphine has a lower potential for abuse than other prescription opioid drugs. Buprenorphine abuse has decreased over time since its release as a treatment for opioid use disorder. Buprenorphine’s lack of euphorogenic properties makes it an unpopular drug of abuse. Individuals who are physically dependent on opioids very rarely report buprenorphine as their primary drug of abuse.[1]
Film vs Tablet. Buprenorphine doses in the form of a thin film instead of a tablet have less risk of diversion.[2]
Patients may try to use buprenorphine to self-treat symptoms of opioid use disorder, pain, or depression. Recent studies suggest that the demand for illicit buprenorphine is not driven by users attempting to “get high,” but instead often represents attempts to self-treat symptoms of opioid use disorder, pain, or depression. Clinical concerns may be best directed toward increasing access to professional buprenorphine treatment, as a lack of easy access to legal buprenorphine treatment may promote, rather than discourage, illicit buprenorphine use. Buprenorphine treatment plans may also benefit from recognizing the more complex needs of opioid-dependent patients with chronic pain and depression.[3]
[1] Cicero, T. J., Surratt, H. L., & Inciardi, J. (2007). Use and misuse of buprenorphine in the management of opioid addiction. J Opioid Manag. Nov-Dec 3(6),302-8.
[2] PCSS-MAT
[3] Schuman-Olivier, Z., et al. (2010). “Self-treatment: illicit buprenorphine use by opioid-dependent treatment seekers.” J Subst Abuse Treat 39(1): 41-50.
