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Buprenorphine (Suboxone)
- Use in opioid maintenance therapy programs, doesn't have QT prolongation and less respiratory depression than methandone
- Patients must been maintained on <40mg of methadone for successful conversion to buprenorphine to take place
- Primary caregivers can prescribe after taking a course
- Partial agonist can actual precipitate withdrawal if patient takes a full opioid (say sneaking a little heroin before appointment)
- Suboxone is buprenorphine+naloxone, since naloxone has poor bioavailability when taken appropriately there is no effect but if the tablet is crushed and injected the patient will go into florid withdrawal.
- Use and abuse has been steadily increasing and death can still occur from overdose.
- Pain is difficult to manage in patient on buprenorphine since opioid effect will be blunted, buprenorphine is potent partial agonist.