Subutex/Suboxone

Harm Reduction

Some of the advantages of Subutex can be seen as disadvantages, depending on the perspective adopted; it has little euphoric action and is a very effective antagonist if used in conjunction with heroin, therefore transitions from heroin to Subutex/Suboxone need to be handled carefully with at around 18 hours between the last heroin dose and first tablet. If this seems too long, it is safe to initiate when opiate withdrawal symptoms are observed. Using heroin on top of Subutex will not cause withdrawal; it will block the sought-after effects. It is important to note, that for reasons we do not fully understand, with some individuals the drug will act atypically. For example, while rare, some heroin dependent people seem to be able to use heroin ‘on top’ of sub-lingual Suboxone with no negative effects and little or no diminished euphoria. Be aware of the potential loss of partial tolerance to opiates effects on cessation of Subutex/Suboxone.

Subutex users should carry a card identifying themselves as patients on this substance in case of accident; it is necessary for physicians to know their status in order to correctly prescribe pain medications etc.

Pregnancy

It is known that buprenorphine passes through the placenta to the developing foetus. Thus, chronic use of buprenorphine during pregnancy is theoretically problematic, but there is not a rich body of evidence on the consequences although they can be assumed to be similar to other opioids (although buprenorphine is atypical), it may cause the baby to become dependent on the drug, but the symptoms can be managed and it is preferable to injecting street drugs. It is suggested that even if the mother breastfeeds, it could be traumatic, as the baby would receive less of the drug through breast milk than it received during pregnancy, although to further compound matters, the drug may inhibit lactation.