Many patients buy bupe, administering their own medication-assisted treatment. When patients speak of treating their symptoms or self-medicating with “strips,” they are usually speaking of 8 mg/2 mg bupe/naloxone film strips. Clearly, bupe does have street value. However, the street value of bupe is far less than that of other prescription opioids.
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ACEP Now: Vol 37 – No 10 – October 2018Injectable Buprenorphine
Buprenex, the common brand of injectable bupe, comes in 0.3 mg/1 mL vials. Bupe is a potent analgesic, and as an analgesic, bupe 0.3 mg IV is equivalent to about 7.5 mg of IV morphine. However, it has a much longer half-life. Of note, although the half-life of bupe as an analgesic is only about eight hours, its half-life when treating OUD is much longer (about 36 hours) but is dose-dependent.
The IV form of bupe is not commonly used in the United States but has been used as an IV analgesic in other parts of the world since the 1980s. The use of injectable bupe is growing in American veterinary medicine. Due to its much higher affinity for the mu receptor, IV bupe has also been used in some emergency departments to reverse acute opioid overdoses.3
Transdermal Buprenorphine Patches
Butrans is the brand name of the transdermal bupe patches used to treat chronic pain. While Butrans may be effective in treating OUD, it is not usually prescribed for OUD, and it has a U.S. Food and Drug Administration (FDA) indication only for chronic pain in the “opioid-experienced” patient. Generally, patients are switched to Butrans patches after developing a tolerance to traditional opioids.
The patches come in dosing strengths of 5, 7.5, 10, 15, and 20 mcg/hour and are changed every seven days. The 10 mcg/hour patch is approximately equianalgesic to 80 mg/day of oral morphine. Note that bupe patches, intended for the opioid-dependent patient, release much fewer mcg/hour of buprenorphine than fentanyl patches do of fentanyl.
Implantable Buprenorphine
Probuphine is a long-term implantable form of buprenorphine that delivers a continuous, stable blood level of bupe for the treatment of OUD. Four implants inserted subdermally in the upper arm (in an office procedure) release a total dose of bupe similar to a daily sublingual 8 mg dose for six months. The dose equivalent of only 8 mg/day SL is lower than the effective dose for most patients treated for OUD with bupe SL. This low equivalent dose along with the cost and the need to obtain insurance approval are factors that prevent more widespread use.
Depot Subcutaneous Buprenorphine
Sublocade is the newest long-acting form of bupe on the market, FDA-approved in late 2017 for treating OUD. This depot form of bupe is injected monthly in 100 mg and 300 mg doses into the abdominal subcutaneous tissue to continuously release a dosage equivalent to 8–24 mg/day of SL bupe. Although more patients with OUD could more easily remain compliant in bupe medication-assisted treatment, the number of patients receiving Sublocade remains low. The cost and the need to obtain insurance approval are factors that prevent more widespread use.
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10 Responses to “A Quick Guide to Buprenorphine Products”
November 7, 2019
Linda TrpletteAll I want to know is which is stronger soboxin 8 mg or belbuca 75 mcg
August 24, 2020
AmandaMcg is micrograms and mg is milligrams, mg is more!
October 25, 2020
Cody LehnerWhile that is true, it doesn’t make one medication in milligrams strings than a different medication doses in micrograms. They don’t have the exact same conversion.
January 11, 2020
TDavisIs there a such thing as buprenorphine strips
September 22, 2020
AlexiThere is a form of this medication that comes in a dark orange what feels like plastic. Its not the film. How is this form used? Is it like the films?
September 22, 2020
ALEXII meant to ask my own question. Not reaspond to yours.
July 12, 2020
KevinYes the strips come in 2mg,4mg,8mg and 12mg. The max dose allowed per day is 24mg so depending on your need the doctor will prescribe all the way up to that amount and divide it up such as an 8mg three times a day or a 12mg twice a day.
August 6, 2020
KenWho manufactures the best sublingual buprenorphine tablet product? Meaning one that dissolves and has the best bioavailability. The ones we are using don’t completely dissolve in an hour.
August 28, 2020
Deborah MooreKen is it for pain or addiction. It’s beyond me why the fda seperates it buprenorphine is buprenorphine but anyway look into belbuca.
October 10, 2020
JodyI’m currently on 8mg buprenorphine sl tablets 3x a day but just stumbled onto the knowledge of there being transdermal patches of buprenorphine as well.. im not very good at taking my meds on time, basically remembering only when the sickness creeps over my body that I’m late on my does. ive read there is 5mcg all the way too 20mcg for the transdermal patches.. would this be an option I could potentially ask about? what is the equivalence from an X amount mcg per hr, 7 day transdermal patch to my current 8mg sl tablet, 3x a day does? all I can find is equivalence charts on everything else “opioid” but nothing on the same drug just different in the way its prescribed to be taken.