Is Suboxone available in a patch?

No, not to treat addiction. At least, not yet.

 

However, buprenorphine, the active ingredient in Suboxone, is now available in the U.S. in a transdermal patch for use in patients with pain. It’s being marketed under the brand name Butrans by Purdue Pharma, the fine folks who also make OxyContin.  Transdermal buprenorphine has been available in Europe since 2001, under the trade name Transtec.

 

The patches are meant for patients with nearly constant moderate to severe pain. Each patch is meant to be worn for seven days, making it one of the longest-acting opioid patches on the market. Butrans comes in three strengths: 5mcg/hour, 10 mcg/hr, and 20 mcg/ hour. This means that at the highest dose, the patient gets nearly half a milligram over twenty four hours.

 

The patches have been inadequately studied  for use in patients with addiction, and they aren’t approved for this purpose.  I did find one open label study of nine patients, all physically addicted to opioids. In an inpatient setting, they were allowed to go into opioid withdrawal,  then they were given a patch containing buprenorphine that lasted for three days. During that time, their withdrawal symptoms were improved. The symptoms decreased by about 50%, and did return somewhat after the patch was removed. The patch used in this study was said to have released 1.9 mg per day of buprenorphine, about four times more than the highest strength of the brand Butrans.

  

I hope more clinical trials are done with this delivery system of buprenorphine. I’m curious to see if a patch of some strength can be used successfully to treat addiction. I have patients who can get down to 1 or 2 milligrams of Suboxone per day, and still have a difficult time stopping completely, due in part to physical withdrawal symptoms. These Butrans patches deliver much less medication than that each day, and I wonder if it would be just enough medication…

  

1.      Lanier RK, Umbricht A, Harrison JA, Nuwayser ES, Bigelow GE, Evaluation of a transdermal buprenorphine formulation in opioid detoxification., Addiction, 2007 Oct; 102(10): 1648-56.

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19 responses to this post.

  1. Posted by swim on March 24, 2011 at 9:47 pm

    I was given Butrans by my addiction doctor for the terminal step of my bupe taper – I’d failed once before to jump off from tablets.

    I was started from roughly 3-4mg sublingual subutex a day directly onto the 20 mcg/hr patch and experienced no withdrawal symptoms. I encountered mild, tolerable symptoms for a few days when stepping down to the 10mcg/hr patch.

    As of Tuesday I have removed the final 5mcg/hr patch (the total schedule was 20,10,5,5 for a four-month taper) and while experiencing the familiar symptoms of anxiety and sleeplessness, clonidine and exercise make them manageable. Will report in a few weeks. So far I’m quite happy with the lower doses available in patch form. There are also untold benefits of the “fire and forget” nature of the patch, which helps break the addict’s mindset of “feel bad, take pill.”

    Reply

  2. Posted by Elycia on April 2, 2011 at 9:06 am

    Hello everyone, I have a couple questions as I just heard about this patch. I am on suboxone and I have been for about 4 years. I was originally stuck on pain meds because my headaches was and are so extreme. My dr is wonderful and knows everything about me but I wanted to look a little more into this before talking with him about it. Is what your saying that it probably wouldn’t give me as good as effect as the pill form? I currently take 12-16 mg of suboxone a day depending on my head. Please give me any feed back, it would really be helpful since I don’t know much, just what I’m reading online. Thanks so much!

    Reply

    • Thanks for writing.
      The buprenorphine patches are only approved – at present – for use in pain control, not for treating addiction. Doctors can, and do, use medications “off label,” which means for uses other than those approved by the FDA. This is OK as long as we can document why we’re doing it and inform the patient that the use is off label.

      Buprenorphine has more oversight, so it’s possible that questions may be raised if doctors use the patch to treat addiction.

      But in your case, I doubt patches would be an option now, since your dose is 12-16mg per day. The very highest dose of the 7-day patch is about half a milligram per day, so I think it’s unlikely to be of any help.

      I think it may be an option for patients who have tapered down to one milligram of sublingual buprenorphine, but just feel bad when they stop completely. I’d like to see a controlled trial involving the use of the 7-day patches to help complete a taper.

      Reply

  3. Posted by Cheddar on May 7, 2011 at 6:13 pm

    I have been addicted to Percocet for over a year taking anywhere from 80 – 100 mg twice a day. Yes… about 16 – 20 5mg pills in the morning and the same at night. This all started after my 8th knee surgery. Anyways… not only was this costly but tough having 3 baby girls and finally my baby boy on the way. I was recently prescribed Butrans patch 10mcg from my doc who is aware of my opiate addiction, he gave me 15mg perc and 4 patches (month worth)and said continue taking the perc until you feel you don’t need too. So… he also mentioned it could take up to 3 days for the patch to be effective. I took 4 of the 15mg perc and placed the patch on my arm at 6 pm. I woke about 7:30 am which is odd because I’m usually up at 5 am making coffee and taking my perc, feeling like a champ (somewhat normal). My back (herniated disc as well) began to hurt so I took some perc and I never felt the buzz or high and my back continues to hurt. My doc mentioned that it will block the receptors which I beleive is happening. Regardless, I feel like I am going to finish the day without any pill popping. Doc wants me to finish the month of Butrans then do another month of 10 mcg and after that lower the mcg to 5. Thus eliminating the severe withdraw. I will write back again within the next couple of days and let you know how I feel. Doc did mention he does prescribe Suboxone but feels this is better. We shall see….

    Reply

    • I hope this works for you.
      As enthusiastic as I might be about the possiblities for a buprenorphine patch, at the present time it’s not only off label but illegal to prescribe for the purposes of treating addiction. However, it can be prescribed for pain.
      I assume you’re no longer pregnant…

      Reply

  4. Posted by Cheddar on June 9, 2011 at 10:02 pm

    Sorry, I should have mentioned my wife and I have 3 girls and she is pregnant with our baby boy. Well… the patch didnt work at all, I had severe withdrawls and my chest hurt really bad. Doc asked me to discontinue the patch and stick to the pills. Anyways… I am getting surgery on my knee next month and after that my Doc is going to start me on Suboxone. I will let you know how it goes. Thanks, CHEDDAR

    Reply

  5. Posted by Justin on September 6, 2011 at 4:26 am

    I have been on oxycontin, morphine, hydrocodone, and other opiates for 13 years . I asked my doctor for butrans transd patches for pain only before I decided to quit this horrible nightmare . I discontinued taking all opiates for 3 weeks only taking librium at night for sleep and promethizine for the vomiting. These where one of the worst 3 weeks of my life sweating, chills, (hot and cold), vomiting, horrible dreams ect. At the end of the third week i was still feeling the same symptoms minus the vomiting. I did some research online about Buprenorphine and realized that was what was in suboxone. I remember taking suboxone years ago on the onset of withdraw and it put me into the worst w/d ever. It didn’t make me feel better at all. The reason is that the buprenorphine is a partial opioid agonist and will kick in the withdraw effects faster if you don’t give time for the opiate levels in your system to lower this is what is going to happen. Anyways after the 3 weeks i still felt the same i started out with 4 20mc of the butrans patches. They recommended that you leave on the patch for 7 days the first one i left on for 5 days and felt little progress. i researched this and they say it takes a few days for the Buprenorphine to build up in your blood.

    Reply

  6. Posted by Justin on September 6, 2011 at 4:35 am

    the second patch was put on on day 5 and I was starting to feel semi normal I finally could take walks and eat normally. This is where I am at this point. I do realize that “butrans” buprenorphine is a partial opioid agonist and is meant for pain, but looking at this post they where using double dosage almost 2mg in 24hrs for WD. I am using half the dosage and it Works. I can care less about the long term study’s and what the fda use as directed. I plan on going from 20mc per 5 days after 4 patches to 10mc every 7 till i stop all together. I’m not sure if 20mc to 5mc yet. I don’t know if the doctor will plan on even giving me these again and i cant even afford it anyways but we will see. Please comment!

    Reply

  7. Posted by sluggertimm on November 1, 2011 at 8:36 pm

    I have been on one mill of suboxone six or seven years. I have a long history of substance abuse, and have been in AA 15 years. I broke a foot seven or 8 years agon, and was perscribed oxy. Before a week was up, I called an Additionologist, and he put me on Suboxone. It turns out I have a tumor in my cuboid. It is bone pain. I knew if I stayed on pain killers, my subrity would end. was orginally on 2 mills twice a day. I spoke to my pharmacy about withdrawls, and was told to taper alittle at a time for as long as posible. I am going to begin 1/2 a mill per day, and after several months 1/4 mill a day. Then start skiping days until I get to four days out. I have late stage liver failure, but feel pretty good. Hep C

    Reply

  8. Posted by Justin on November 2, 2011 at 6:33 am

    wow no one has commented on this till now i would like to see more about the study.

    Reply

  9. Posted by revamped83 on November 30, 2011 at 1:33 pm

    I can’t wait for more developments in this area.

    I’ve had ongoing issues with rapid metabolism of sublingual buprenorphine. Using a patch over 24 hours would, in theory, solve my problem of my inconsistent bup levels.

    Nicotine patches were pivotal in me quitting smoking. I found a level that satisfied my cravings, then ever so slowly I “cut” slivers off the patch until I only had a sliver left. It was the smoothest quitting experience. And the beauty of it, was that other than 2 minutes every morning, it was out of my head completely.

    When a person tapers off sublingual buprenorphine, often the lowest doses require multiple dosing over the day. It becomes a very conscious process that can resemble active addiction. IMO these patches could really help with this issue.

    Keen to hear more. Thank you Jana.

    Tom.

    Reply

  10. well, i have fibro. My doctor has had me on 15mg percs 3 times a day for break-through pain. He recently added the Burtan Patch, 10mg as well. We have tried a couple other extended release meds but they all give me stomach promblems and headaches. Im a little confussed because i would think it would be pointless to prescribe both these meds together due to the patch being a blocker like soboxone. Will the percs help my fibro pain when i take them as prescrbed along with the patch or will it give me extreme withdraw if i take both together. The pecs do help and i do take them as prescribe. He told me to call in a few days to let him know how the patch is doing so i am wondering if i need to call before my first patch..Any advice?!?

    Reply

    • Excellent question! I had to look this one up.
      If a patient is on full opioids, the butrans patch has the potential to precipitate withdrawal; however, if the patient is on an equivalent of 30mg of morphine or less per day, it should be OK. So it sounds to me like your doctor is OK in his prescribing. It wouldn’t hurt to call and make sure, though…

      Reply

  11. Need help here with this whole Butrans patch thing. I am down to 1/8 mg of a 2 mg film strip. Put another way, it takes 15 days for me to finish one 2 mg strip. I have been taking Sub for 5 years, 3 years at 1 mg p/day dose. Tried twice to get off Sub cold turkey and it was HELL. Now at 1/8 mg, withdrawal symptoms really kicked in though they seem to have subsided so I could potentially cut down to 1/16, then jump. Or jump now? HOWEVER, my Sub doctor just prescribed the Butrans patch (super expensive I might add) to help me complete my taper more comfortably. It’s a 10/mcg/hour dose. I have to say, I am very confused as to the equivalency of this strength to what I am currently taking on the film strips. Is it about the same? Does 1/8 mg p/day = 10 mcg p/hour? Used an online converter and am still confused! More important will this patch thing work? Still not sure how it works. Help!

    Reply

    • OK…you and your doctor are blazing new territory. Actually, it’s illegal for your doc to prescribe Butrans patch to treat addiction. Only the sublingual form is covered by DATA 2000 law.
      But here’s the way I figure it. You are now taking around .13 mg per day.
      The 10 mcg/hr delivers .01mg/hr, so over a whole day I’d say that’s .24 mg per day. I’m not sure if that’s pharmacologically correct, but that’s what it looks like to me.
      Seems like you would be better to go with the lowest strength, the 5mcg/hr which – I think – would be half of that. But talk with your doctor and see what he recommends.
      No one knows if transition to the patch will work – no studies that I can find.Since it’s super long-acting, maybe the withdrawals will be more gradual. I’ve often wondered if it would work, so please write back and keep readers updated.

      Reply

  12. Well, I was taking the Sub for chronic pain. Originally, 5 years ago I’m talking here, the doctor who put me on Sub did so for both reasons. To use Sub to replace Vicodin for pain resulting from neck and back issues. (2 back surgeries, 5 things wrong with neck for which I have had a total of 10 injections in my spine. More recently, CRPD in my left hand that also resulted from a neck injury to my weakened neck).

    So I was dependent on Vicodin, though I never escalated my dose …not once. So I was considered “dependent” vs. “addicted” though of course I exhibited the classic “drug seeking behavior” if I ran out of Vicodin because of the pain of withdrawal.

    Yet the cruel irony in all of this is that the withdrawal from Sub was far worse than anything I ever experienced with Vicodin. I know because I tried to get off of Sub twice and it was pure HELL. First time from a 2 mg dose, second from a 1 mg dose. I have been taking 3/4 to 1 mg daily of a 2 mg film strip for about 3 years. A low dose for most drugs, but not Sub which as you know is about 30 times more powerful than morphine.

    So clearly this doctor was dead wrong to put me on Sub. He knew nothing about the drug, and swallowed the lie that pharm rep gave him that “it was easy to get off of Sub.”

    Bottom line is that I DO NOT WANT TO BE ON ANY OPIATES. I would rather deal with whatever pain comes—real or “phantom” pain from withdrawal owing to the fact that my own natural pain fighting agents, i.e. serotonin, endorphins, etc. have been on vacation for five long hears.

    Now I am calling them back from lying on the white sands and drinking pina coladas in the Bahamas. (Little humor there.)

    The reason for my wanting to be off of Sub is that it has caused me to feel emotionally and spiritually detached from life, provokes vivid and crazy non-stop dreams at night and agitation and irritability during the day. In other words, I have never been my “true self” while on this drug.

    HERE IS WHERE I AM AT TODAY, JAN 2. I have not taken the patch off yet though I am seriously debating it. It is helping with withdrawal…somewhat…though I was already starting to feel the worst of the withdrawal go away.

    Related to this, I do so appreciate your doing the math for me on this. It worries me that I may be in fact escalating my dose of Sub from 1/8 mg to 1/4 mg by going on this patch. Is that what your math calculations concluded?

    RE: 5 mcg vs. 10 mcg. 10 mcg is about right for where I am at right now. I think perhaps I should wait a week before going down to 5 mcg. (My doctor said that even though drug mfg would not advocate cutting a 10 mcg half he said it’s really not harmful if I do this.)

    I say this because the withdrawal pain level I am at right now is tolerable. I don’t think it would be at 5 mcg…at least not right now.

    Prior to my putting on this first 10 mcg patch 24 hours ago, I was following a careful plan. This plan given to me by a guy who has literally helped hundreds get off Sub successfully. It was very systematic and I was following it.

    I had planned to jump off at a 1/8 or possibly even lower at at 1/16 sometime in the next two weeks.

    Now….well I don’t know. I’m confused. Part of me just wants to rip off this patch right NOW, and jump off the 1/8 mg of Sub that is probably still in my system since I have only been on this patch for 24 hours. I have all the comfort meds I need at hand to do this and am mentally ready.

    But I can’t use any of these meds (Clonidine, anxiety med, etc) while I am still on this patch. Can I?

    Because it seems to be that this transdermal patch thing may just prolong the taper/withdrawal process. But no one can tell me for sure it seems. REALLY wish someone who had done what I am doing now will read this post and tell me.

    And that, as they say is that! Any more comments/suggestions/advice would be most helpful. :)

    Reply

    • I think you need to keep talking to your doctor. Don’t do anything rash. And yes, you can take clonidine (from your doctor) to help with opioid withdrawal.

      Reply

    • And Suboxone is not approved for treatment of pain. All sublingual forms of buprenorphine were only meant for treatment of opioid addiction.

      Reply

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