Buprenorphine

Buprenorphine is an opioid used to treat opioid use disorder, acute pain, and chronic pain. It is administered under the tongue, in the cheek, by injection (intravenous or subcutaneous), or as a skin patch or implant. Maximum pain relief generally occurs within an hour and lasts up to 24 hours. In the United States, buprenorphine/naloxone (Suboxone) is usually prescribed to discourage injection misuse. Both formulations are Schedule III controlled substances. Buprenorphine acts as an agonist, partial agonist, or antagonist at different opioid receptors. It relieves opioid withdrawal and reduces the effects of other opioids. Unlike full agonists such as heroin and methadone, it has a ceiling effect for some effects, including respiratory depression, but retains misuse potential. Side effects include respiratory depression, sleepiness, adrenal insufficiency, QT prolongation, low blood pressure, allergic reactions, constipation, and opioid addiction. It may increase seizure risk in susceptible people; opioid withdrawal after discontinuation is generally less severe than with other opioids. Safety during pregnancy is unclear, but use while breastfeeding is probably safe: infants receive approximately 1–2% of the maternal weight-adjusted dose. Buprenorphine was patented in 1965, FDA approved for medical use as an analgesic in 1981, and FDA approved for treating opioid use disorder in 2002. It is on the World Health Organization's List of Essential Medicines. Despite originally being marketed as an analgesic it is far more commonly prescribed and used to treat opioid use disorders, such as addiction to heroin. In 2020, it was the 186th most commonly prescribed medication in the United States, with more than 2.8 million prescriptions.