Buprenorphine: Indications & Contraindications

by | Last updated Jun 12, 2023 | Published on Jul 25, 2022 | Addiction Treatment | 0 comments


Buprenorphine is a synthetic opioid used to manage pain since the 1970s. It’s also sometimes used to reduce withdrawal symptoms from opioid use disorder when used as part of a treatment program involving counseling and behavioral therapy. It works by attaching to receptors in the brain and reducing symptoms of withdrawal associated with opioid use. Buprenorphine has been used successfully for over 15 years as a treatment for opioid addiction and holds several advantages over other medications commonly used for this condition. However, like most opioids, buprenorphine also comes with indications and contraindications for safe use. 

Most Common Buprenorphine Indications

Buprenorphine is an effective medication for addiction treatment when combined with other treatments, including psychotherapy. It is FDA approved for the treatment of opioid dependence and pain. A physician can prescribe it to help patients with an opioid use disorder quit abusing opioids, including heroin. 

Buprenorphine/naloxone (marketed as Suboxone) is a semi-synthetic opioid derivative that belongs to the group of medications known as partial agonists/antagonists because it binds to receptors in your brain just like other opioids but doesn’t fully activate them.

Buprenorphine tablets are also used to treat people addicted to prescription painkillers or tranquilizers such as Valium or Xanax.

Buprenorphine Contraindications and Precautions

When taken as prescribed, buprenorphine can be used safely with other medications. It’s important to let your doctor know if you are taking any other prescription medications or over-the-counter (OTC) drugs so they can assess whether there will be any drug interactions between them. Common buprenorphine contraindications include:

  • Buprenorphine is contraindicated in patients with a history of allergy to buprenorphine or other ingredients in buprenorphine.
  • Buprenorphine is contraindicated in patients with acute or severe bronchial asthma.
  • For patients with renal impairment and liver dysfunction 
  • Contraindicated for patients taking alvimopan or lefamulin.

In addition, buprenorphine should be used with caution in the following situations:

  • In opioid-dependent individuals who have been abruptly withdrawn from opioids during therapy, there have been reports of seizures and death associated with this practice.
  • In pregnant patients, breastfeeding women, and elderly patients
  • Patients with HIV that are being treated with highly active antiretroviral therapy (HAART)
  • Patients with hepatitis B and C
  • People with chronic pain who also have a history of substance abuse

Buprenorphine is often combined with other drugs to treat opioid addiction and prevent withdrawal symptoms. Your doctor may recommend combining buprenorphine with naloxone, which blocks the effects of opioids and prevents overdose; naltrexone (Vivitrol), which blocks opioid receptors in the brain; or methadone, which acts as a substitute for heroin in people addicted to it. 

If you are using buprenorphine for pain relief after surgery, ensure that your surgeon knows about all prescription medications you’re taking before surgery so they can adjust their dosages appropriately. 

Buprenorphine Side Effects to Know

Buprenorphine is a Schedule III medication with a low potential for abuse. This also means you’ll need to take special care when prescribing and monitoring buprenorphine. While the drug itself doesn’t have abuse potential, you should always be aware that patients may choose to use prescription pills in non-medical ways.

In addition to its addictive properties, buprenorphine can cause withdrawal symptoms if you stop taking it abruptly or miss your medication doses. When starting treatment with this drug, patients receiving high doses of buprenorphine may experience drowsiness, confusion, sedation, nausea, and vomiting.

What Is Buprenorphine Used For Today?

The role of buprenorphine today is as a treatment for opioid dependence and chronic pain. But it has also been beneficial in treating other conditions such as insomnia. It is a partial agonist, which means it binds to specific receptors in the brain and causes those receptors to activate (or become active). Buprenorphine helps treat both opiate dependence and alcohol dependence.

While buprenorphine is not addictive, it can cause euphoria or other pleasurable feelings when taken at high doses by people addicted to other substances such as heroin or OxyContin (oxycodone). As a result of these pleasant effects, some people may choose not to take their buprenorphine as prescribed but instead abuse it to achieve a “high.” This is extremely dangerous because it can lead them back down the path toward addiction even though they have been treated with this medication.

Because of this, it’s crucial to follow buprenorphine indications. Openly discuss with your doctor if you find yourself or a loved one misusing buprenorphine to adjust your dosage or find an alternative medication. This small step can help prevent a substance abuse problem down the line. 

Written by: Nick B.

Nicholas B. is the Corporate Director of Admissions for our substance abuse and behavioral health company. Nick’s mission is to provide quality care to every person that reaches out regarding substance abuse or behavioral health questions. Knowledge of an ever-changing industry, compassion when dealing with people, and compliance in every decision are the forces that drive his personal and professional growth.

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