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.