1. What is Buprenex?
   Buprenex (Buprenorphine, Suboxone, Subutrex) is a narcotic drug that was first introduced as an injectable painkiller. For whatever reason, Buprenex was not popular in the United States as a pain medication.
2. Buprenex is a partial agonist and a partial antagonist. What does this mean?
   Buprenex both stimulates the opiate receptors of the brain producing pain relief, and at the same time, blocks the receptors, decreasing addiction. Although no one quite understands how it does this, having agonist and antagonist properties allows for a more comfortable opiate withdrawal.
3. What are the properties of Buprenex that make it useful?
   Buprenex has partial agonist and partial antagonist actions and also a very long duration. These properties make it a useful drug in some circumstances. First, it is hard to overdose on it because the antagonist quality kicks in at higher doses. Second, Buprenex does not produce as much of a high as heroin making it less addictive. Third, because of these properties, it seems to taper itself fairly well meaning it is easier to taper off than a drug like methadone. Due to these properties, the FDA has approved Buprenorphine under the trade names Subutex and Suboxone, to be prescribed by specially trained MDs as both a detoxification drug and a maintenance drug.

Buprenex (Buprenorphine) Protocol

You have found that you are unable to just stop using opiates. We can  convert you painlessly from a opiate habit to a Buprenorphine habit and you will be able to just stop using Buprenorphine without too much difficulty. The way this is done involves taking Buprenorphine FOR THREE DAYS. Buprenorphine is administered by a sublingual tablet or injection. If you use the Buprenorphine intravenously it may cause or worsen withdrawal symptoms. It is important that you start the Buprenorphine only after you are feeling uncomfortable. The preferred method is not to use any opiates after midnight, and use the Buprenorphine as your "wake-up" in the morning when you are feeling ill.

Prescription medications are provided for use with the Buprenorphine, and after the Buprenorphine is finished, if needed. These pills can lessen the severity of withdrawal symptoms. For additional medication, you MUST return to the office. Other medications are available but you must return to the office for another visit. DO NOT CALL FOR PRESCRIPTIONS.

After a three to four day taper of Buprenorphine  80% of opiate withdrawal symptoms is complete.  It is a good idea to continue smaller doses of Clonidine for the next week or two to help with very mild withdrawal symptoms and/or sleep.  Many people are able to taper off of their opiate habit with Suboxone and then are able to maintain their sobriety with behavioral guidance and counseling.  Oftentimes a significant change to one's habits, lifestyle, and friends is necessary.

Suboxone Maintenance

Hopefully after opiate withdrawal, a person can remain opiate free.  Sometimes, even with the best medical care and behavioral guidance, a person does not remain opiate free.  Possibly secondary to mental addiction, pain, and fatigue a person finds himself repeatedly relapsing on opiates.  For this person Suboxone maintenance is available.  Suboxone maintenance involves taking a small dose of Suboxone and a daily basis.  The daily dose of Suboxone  helps curb the craving for opiates.  Suboxone causes much less dependence and tolerance towards the opiate.  We have had patients take Suboxone for over two years now without increasing the dose and without feeling poorly.  Only monthly visits are required to the doctors office.  Unlike methadone, it is very difficult to use other opiates with Suboxone.  Also unlike methadone it is easier to taper off of Suboxone than off of methadone.  The cost of this treatment averages $300-$500 per month depending upon the dose of Suboxone  required.  If only taking Suboxone, most urine drug screens will be negative which is good for work-related situations as well as legal situations