Buprenorphine Treatment Overview

Understanding Buprenorphine Treatment

Buprenorphine stands as one of the most effective medications for treating opioid use disorder (OUD). Importantly, this medication helps reduce cravings, eases withdrawal symptoms, and lowers the risk of overdose. In fact, research shows that buprenorphine reduces all-cause mortality by about 60% compared to no treatment.

Moreover, buprenorphine comes in several forms. These include a daily film or tablet taken at home, or an injection given weekly or monthly at the office. As a result, treatment can fit into almost any lifestyle.

Overcoming opioid addiction can be an incredibly challenging journey, especially when attempted alone. Fortunately, with the right support and medication, recovery is possible. At Solstice Health & Wellness, we understand the difficulties and offer professional guidance on buprenorphine treatment.

Many people who try to quit opioids without help often return to use. In contrast, buprenorphine gives the brain time to heal while keeping cravings under control.

What is Buprenorphine?

Buprenorphine is a prescription medication that treats moderate to severe opioid use disorder. Specifically, it belongs to a class of medications called partial opioid agonists. The DEA classifies it as a Schedule III controlled substance.

Initially, the FDA first approved buprenorphine for OUD in 2002 as a sublingual (under-the-tongue) tablet. Since that time, manufacturers have developed additional forms:

• Generic buprenorphine/naloxone sublingual tablets and films

• Generic buprenorphine sublingual tablets (previously Subutex)

• Suboxone: buprenorphine/naloxone sublingual films (brand name)

• Zubsolv: buprenorphine/naloxone sublingual tablets (brand name)

• Sublocade: buprenorphine monthly injection given in the office (FDA approved 2017)

• Brixadi: buprenorphine weekly or monthly injection given in the office (FDA approved 2023)

NOTE: Manufacturers add Naloxone to buprenorphine formulations to discourage misuse because it causes withdrawal symptoms if someone injects the medication rather than taking it under the tongue.

What Does Buprenorphine Treat?

Buprenorphine is one of the most versatile medications in medicine today. Although the FDA has approved it for pain and opioid use disorder, growing evidence supports its use in other situations.

FDA-Approved Uses

Opioid Use Disorder (OUD): Buprenorphine is a first-line treatment for moderate to severe OUD. It reduces the risk of death by about 60% compared to no treatment. Furthermore, buprenorphine also reduces opioid use, HIV spread, and hepatitis C spread. It is available as daily sublingual tablets or films, as well as weekly or monthly injections.

Chronic Pain: Also, two buprenorphine forms are FDA-approved for severe, lasting pain:

• Butrans (transdermal patch): a 7-day patch that delivers 5–20 mcg/hour
• Belbuca (buccal film): taken every 12 hours at doses of 75–900 mcg

Importantly, buprenorphine provides pain relief similar to stronger opioids but with a better safety profile. This is largely because of its ceiling effect on breathing problems. Consequently, the VA/DoD 2022 guidelines suggest buprenorphine instead of full opioids for patients on daily opioid therapy.

Opioid Withdrawal: Buprenorphine is also FDA-approved for treating opioid withdrawal. It reduces withdrawal symptoms better than clonidine or lofexidine and works about as well as methadone for this purpose.

Evidence-Based Uses (Off-Label)

Kratom Dependence and Withdrawal

Kratom’s main active ingredients (mitragynine and 7-hydroxymitragynine) act on the same brain receptors as opioids. Because of this, kratom can cause dependence and withdrawal similar to opioids. Multiple case reports show that buprenorphine-naloxone works well for both kratom withdrawal and ongoing treatment. Furthermore, the American Psychiatric Association also identifies buprenorphine-naloxone as a promising option for kratom use disorder.

Learn more about Kratom Addiction.

7-Hydroxymitragynine (7-OH) Dependence and Withdrawal

Concentrated 7-OH products are different from kratom leaf. In particular, they are stronger and increase the risk of overdose and death. Evidence describes the successful treatment of 7-OH withdrawal with buprenorphine-naloxone along with supportive medications like clonidine and ondansetron.

Tianeptine Dependence and Withdrawal

Tianeptine is a substance with opioid-like effects that is not FDA-approved. Nevertheless, it is sold online and in some gas stations. It can cause addiction with withdrawal symptoms that look like opioid withdrawal. Research shows that buprenorphine-naloxone can manage tianeptine withdrawal, with improvement usually seen within three days.

Learn more about Tianeptine Addiction.

Chronic Pain in Patients on Long-Term Opioids

Sublingual buprenorphine (approved for OUD) is often used off-label for chronic pain. This is especially true when helping patients switch off high-dose opioids. A 2025 clinical trial found that offering the option to switch to buprenorphine led to greater opioid dose reduction.

Treatment-Resistant Depression (Research Stage)

Buprenorphine’s effects on kappa-opioid receptors may help with depression. A review of 11 studies found a small but real effect on depressive symptoms. Low-dose buprenorphine (0.2–1.6 mg/day) showed rapid improvement in older adults with hard-to-treat depression. However, this remains a research use and is not standard practice.

Learn more about Depression.

NOTE: At Solstice Health Wellness, each patient receives an individual evaluation. Many of these uses require careful clinical judgment and shared decision-making.

Choosing the Right Option

Because buprenorphine comes in several forms, the right option depends on your goals and lifestyle. Therefore, selecting the appropriate formulation should be individualized.​

Daily sublingual (Suboxone, Subutex, Zubsolv, generics): Most people start here because same-day start is available. Learn more about sublingual buprenorphine.

Sublocade (monthly injection): Sublocade works well for people who are already stabilized on sublingual buprenorphine and want to stop daily dosing. Learn more about Sublocade monthly injection

Brixadi (weekly or monthly injection): This option allows you to start with weekly doses and transition to monthly injections when you become stable. Learn more about Brixadi injections.

Who is a Good Candidate for Buprenorphine?

Buprenorphine may work well for people who:

• Have moderate to severe opioid use disorder
• Feel ready to begin or continue treatment
• Have tried treatment before (whether it worked or not)
• Have mental health conditions like depression or anxiety
• Want to reduce cravings and avoid withdrawal

Who should not take buprenorphine?

Certain people should avoid buprenorphine. These include those with:

• Severe liver disease
• A known allergy to buprenorphine or naloxone
• Current opioid use. Starting buprenorphine while concurrently using opioids can cause sudden, severe withdrawal
• Severe breathing problems (in some cases)

How Effective is Buprenorphine?

Buprenorphine serves as a first-line treatment for OUD, and research strongly supports its effectiveness. For instance, a 2021 review of 8 large studies (126,595 people) found that buprenorphine cuts the risk of death by about 60%.

At 12 months, about 43% of patients stay in treatment with sublingual buprenorphine. Even patients who do not stop opioid use completely show big reductions. They typically go from using nearly every day (6.2 days per week) to less than 2 days per week.

Injectable buprenorphine (Sublocade and Brixadi) shows similar or better results compared to daily sublingual forms. Higher daily doses (24 mg or more) are linked to better treatment retention, especially for people who use fentanyl.

Comparing Buprenorphine with Other Treatments

Three FDA-approved medications treat opioid use disorder. Each works differently. The best choice depends on individual needs, goals, and access to care.

Benefits of Buprenorphine Treatment

Buprenorphine offers many advantages for people with opioid use disorder. For example, it:

• Reduces cravings and withdrawal symptoms effectively
• Lowers the risk of overdose and death by approximately 50% or more
• Allows prescribing in an office setting (unlike methadone, which requires frequent clinic visits)
• Improves stability, employment, and quality of life
• Offers multiple formulation options to fit your lifestyle
• Combines well with counseling and other support services

Buprenorphine Risks and Side Effects

Common Side Effects

• Headache (11%)
• Pain other than headache (7.2%)
• Nausea (6.9%)
• Drowsiness (5.6%)
• Constipation (5.4%)
• Sweating (4.8%)
• Itching (3.4%)

Additionally, injectable forms may cause injection site pain (18%), nodules (17%), or bruising (7%).

Long-term Effects

Long-term effects can develop with ongoing buprenorphine use. These include:

• Dental problems such as cavities, tooth decay, and tooth loss can occur even in people with no prior dental issues. This risk applies only to sublingual and buccal forms (not patches or injections).
• Hormone changes can also occur, including low sex drive, erectile problems, and changes in menstrual periods (reported in 39% of women). Low testosterone occurs in 11–23% of men on buprenorphine.
• Adrenal insufficiency, a rare condition in which buprenorphine may lower cortisol levels over time, causing fatigue, weakness, nausea, dizziness, low blood pressure, and weight loss.

Serious Risks

Serious risks include:

• Respiratory depression, especially when combined with benzodiazepines, alcohol, or other sedatives
• Liver problems, including elevated liver enzymes
• Precipitated withdrawal, a sudden and severe onset of withdrawal symptoms that can occur if the medication is started too soon after opioid use

Boxed Warnings

Boxed warnings highlight the risk of:

• Respiratory depression
• Neonatal opioid withdrawal syndrome in pregnancy
• Dangerous interactions with benzodiazepines and other CNS depressants.

Other Reported Reactions

Post-marketing reports show that buprenorphine is associated with:

• Serotonin syndrome (with certain antidepressants)
• Severe allergic reactions
• Low blood sugar (mainly in people with diabetes)

Managing Side Effects

Most side effects are mild and go away within 1–2 weeks. For constipation, increasing water and fiber intake often works. For nausea, taking the medication with food may help. Contact a provider right away if drowsiness is severe or breathing feels slow.

Precautions and Safety

Several important safety points apply to buprenorphine:

• Avoid benzodiazepines, alcohol, and other sedatives while taking buprenorphine. Specifically, these combinations increase overdose risk significantly.
• Monitor liver function before and during treatment.
• Pregnancy: Buprenorphine remains the preferred medication for OUD during pregnancy.
• Driving may be affected initially. Therefore, use caution until you know how the medication affects you.
• Naloxone access: All patients should keep naloxone (Narcan) available for overdose reversal.

Dental care (FDA Safety Warning)

Because sublingual and buccal buprenorphine can cause dental problems over time, the following steps help protect teeth:

• Gently rinse teeth and gums with water and swallow after the medication fully dissolves
• Wait at least one hour before brushing teeth
• Have regular dental checkups; more frequent visits may be needed
• A provider may prescribe a fluoride supplement

Important: Do not stop buprenorphine because of dental concerns; the benefits of treatment far outweigh the dental risks

Heart rhythm (QTc prolongation)

Buprenorphine can cause a small change in heart rhythm (up to 15 msec). This is unlikely to cause dangerous heart rhythms when used alone. However, caution is needed when combining with other medications that affect heart rhythm.

Serotonin Syndrome

Serotonin syndrome is a serious drug reaction that can happen when buprenorphine is taken with certain other medications. For example, these include common antidepressants (SSRIs like sertraline or fluoxetine, SNRIs like duloxetine), some migraine medications (triptans), tramadol, and certain muscle relaxants. Essentially, the reaction happens because too much serotonin builds up in the brain.

Typically, symptoms appear within hours of starting or increasing a medication. These include:

• Muscle twitching, tremor, or stiffness
• Fast heart rate, sweating, or fever
• Agitation, confusion, or restlessness

In most cases, symptoms are mild and get better within 24 hours after stopping the problem medication. However, severe cases with high fever can be life-threatening and therefore need emergency care.

Important: This does not mean antidepressants cannot be taken with buprenorphine. In fact, the combination is common and usually safe. Instead, the risk is highest when multiple serotonin-raising medications are combined or when doses are increased quickly. Additionally, MAO inhibitor antidepressants should not be used within 14 days of buprenorphine. Before starting treatment, a provider will review all medications for interactions.

Dosing and How it is Given

Starting buprenorphine (initiation): Treatment typically begins after at least 12 hours without opioids. The first dose is usually 2-4 mg, taken under the tongue when in moderate to severe withdrawal. Then, additional doses are taken every 1–8 hours on day 1, up to a total of 8–16 mg. After that, on days 2–3, the dose increases to 12–24 mg daily.

For people who use fentanyl or other synthetic opioids, it may require more than 72 hours without opioids. Alternatively, a low-dose approach allows starting buprenorphine while still using other opioids. As a result, this avoids the need to stop opioids first.

Maintenance dosing: Most patients do well on 12–24 mg per day. In some cases, higher doses may be necessary.

Injectable options: Sublocade is given as a monthly injection. Meanwhile, Brixadi offers weekly or monthly options. Both are given at the office.

What to Expect After Starting Buprenorphine

During the first week, some mild withdrawal symptoms may occur during the first 1-3 days as the dose is adjusted. However, most people feel noticeably better within 24-48 hours.

During the first month, cravings decrease. At the same time, energy and sleep improve.

Over time, visits may decrease. Meanwhile, the provider monitors progress.

Treatment Duration

Most guidelines recommend at least 12 months of treatment, and often longer. Importantly, no maximum recommended duration exists. Opioid use disorder is a chronic medical condition. Therefore, long-term treatment reduces the risk of returning to opioid use.

In fact, research shows that patients who stay in treatment longer have better outcomes. Specifically, they have fewer hospital visits and emergency room trips. Conversely, stopping too early is one of the most common reasons for relapse.

Stopping or Transitioning

The decision to stop buprenorphine should be planned. Gradually, tapering of sublingual buprenorphine may occur over several months. The final 2 mg may take the longest to taper.

Alternatively, switching to Sublocade or Brixadi before discontinuing or to Vivitrol 7-10 days after the last sublingual dose of buprenorphine are other options. Your provider can guide this transition safely. Regardless of how treatment is stopped, always keep naloxone available and stay connected with their provider.

For Clinicians: Key Prescribing Considerations

Buprenorphine is a Schedule III controlled substance. Following the elimination of the X-waiver requirement in 2023, any DEA-registered practitioner with a current Schedule III authority may prescribe buprenorphine for OUD.

Pharmacokinetics

Notably, sublingual bioavailability is approximately 30%. Mean elimination half-life is 31-35 hours. Buprenorphine is metabolized primarily via CYP3A4 to norbuprenorphine (active metabolite). It is 96% protein-bound with a large volume of distribution. Most elimination occurs via feces (70%), with 10-30% in urine.

Drug interactions

CYP3A4 inhibitors (e.g., azole antifungals, macrolide antibiotics, HIV protease inhibitors) may increase buprenorphine levels. In contrast, CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin) may decrease levels.

Concomitant benzodiazepines, other CNS depressants, and alcohol increase respiratory depression risk (boxed warning).

Additionally, serotonin syndrome risk exists with concurrent serotonergic agents (SSRIs, SNRIs, TCAs, triptans, tramadol, and MAOIs which is contraindicated within 14 days). Cyclobenzaprine and metaxalone also carry serotonergic risk.

Monitoring

The following are recommended during buprenorphine treatment:

• Liver function tests (AST, ALT) at baseline and periodically
• Urine drug screening at initiation and periodically thereafter
• PDMP checks at initiation and periodically
• ECG if taking medications that may prolong the QT interval
• Endocrine monitoring, including testosterone levels in men with symptoms of low testosterone
• Dental evaluations for patients using sublingual or buccal formulations
• Adrenal function testing if symptoms develop after one month or more of use, including fatigue, low blood pressure, or nausea
  – Consider morning cortisol levels
  – Cosyntropin stimulation test if cortisol 5–10 µg/dL
  – Treat confirmed cases with physiologic hydrocortisone 15–25 mg/day

Special populations

• Hepatic impairment: No dose adjustment for mild impairment. Moderate impairment requires monitoring; severe impairment may require dose reduction and coordination with a hepatologist.
• Renal impairment: No significant dose adjustment required.
• Older people: Use caution; start at the lower end of the dosing range.
• Pregnancy: Buprenorphine is preferred pharmacotherapy for OUD in pregnancy (ACOG, SMFM, ASAM). Buprenorphine monoproduct has been traditionally recommended, though emerging data support safety of combination product. Dose adjustments (higher and more frequent dosing) may be needed as pregnancy progresses. Neonatal opioid withdrawal syndrome (NOWS) occurs but is typically less severe than with methadone.
• Precipitated withdrawal prevention: Standard induction requires COWS ≥8 and 12–72 hours of opioid abstinence (longer for fentanyl users). Furthermore, low-dose (micro-dosing) protocols allow initiation without opioid cessation. High-dose protocols (8-32 mg on day 1) are emerging for patients presenting in withdrawal or post-naloxone reversal.
• Naloxone prescribing: Recommended for all patients. Higher doses of naloxone may be needed to reverse respiratory depression in patients on depot formulations due to sustained buprenorphine release.
• Long-acting formulations: Sublocade depot remains detectable for months after the last injection. Steady-state plasma levels of approximately 2-5 ng/mL persist for extended periods. Consequently, this provides ongoing opioid blockade even after discontinuation, which may be clinically advantageous but should be considered in perioperative planning.

Referral Process

New patient appointments are typically available within 1 week. Care coordination includes direct communication with referring providers. The practice offers integrated primary care, mental health, and addiction medicine in one setting.

For referrals, please contact us at 941-330-9797 or submit a request through our contact form.

Is Buprenorphine Right for Me?

Choosing the right treatment depends on several factors:

• Personal goals (daily dosing at home vs. weekly or monthly injections)
• Medical history and current medications
• Prior treatment experience
• Readiness for change

A provider can help make this decision through shared decision-making. Treatment can begin even before achieving full abstinence, especially with low-dose induction approaches.

Seeking help takes courage. Above all, substance use disorder is a treatable medical condition, not a moral failing. Recovery is possible, and it can start today.

If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline at any time.

Buprenorphine Treatment at Solstice Health Wellness

Buprenorphine is part of a complete outpatient treatment program. Specifically, each patient receives a plan that combines medication management with behavioral health support and ongoing medical care.

Program Features

• Medication management and on-site dosing
• Counseling and behavioral support (CBT, motivational interviewing)
• Treatment for co-occurring medical and mental health conditions
• Preventive care, lab work, and wellness services under one roof
• Telehealth visits available throughout Florida
• Respectful, stigma-free environment focused on long-term recovery

Cost and Insurance

Solstice Health Wellness operates on a direct primary care (DPC) model. For an affordable monthly fee, services include primary care, mental health treatment, addiction medicine, preventive care, lifestyle and wellness services, and telehealth access.

In addition, insurance can be used for lab testing, preventive screening, imaging, prescription medications, and other off-site services. Generic sublingual buprenorphine remains widely available and affordable. Furthermore, insurance often covers injectable medications (Sublocade, Brixadi) with prior authorization, which the team arranges.

NOTE: DPC is not health insurance and does not replace health insurance.

What to Expect: Getting Started

• Schedule a private evaluation by phone or online
• Complete a full health history and physical exam
• Obtain baseline lab testing to assess overall health
• For sublingual buprenorphine (daily tablets or films): Begin buprenorphine per the personal plan developed by the treatment team. Same-day start is available.
• For injectable buprenorphine (Sublocade or Brixadi): Begin or continue sublingual buprenorphine per the personal plan while the team coordinates the injectable
• A team member coordinates with the patient and their insurance to determine eligibility, obtain approval, and arrange delivery of the injectable to the office
• Once the injectable arrives, the provider gives the first injection at the office

What to Bring

• Valid ID
• Insurance card (for labs, prescriptions, and injectable coordination)
• List of current medications
• Medical records if available

Frequently Asked Questions

1. Is buprenorphine addictive?

Buprenorphine can cause physical dependence. However, when you use it as prescribed for OUD, it stabilizes brain chemistry rather than producing a high. Consequently, it is much safer than continued opioid use.

2. Can I work while taking buprenorphine?

Yes, absolutely. Most people work, drive, and live normal lives while taking buprenorphine. Once you reach a stable dose, it should not impair your ability to function.

3. Can I drive on buprenorphine?

Yes, once you stabilize on your dose. However, use caution during the first few days because drowsiness can occur initially.

4. What happens if I relapse?

Relapse does not mean failure. Instead, contact your provider right away so we can adjust your treatment plan. Additionally, keeping naloxone available remains important for safety.

5. Does insurance cover buprenorphine?

Yes, you can use insurance for prescriptions if needed. Generic buprenorphine remains affordable, and insurance often covers injectable forms with prior authorization.

6. Can I take buprenorphine with antidepressants?

In most cases, yes. Your provider will review all your medications for interactions. Although rare, serotonin syndrome is a possible risk with certain combinations.

7. What’s the difference between Suboxone, Sublocade, and Brixadi?

Suboxone is a daily film or tablet you take at home. In contrast, Sublocade is a monthly injection. Meanwhile, Brixadi offers weekly or monthly injection options with more dosing flexibility. All three contain buprenorphine as the active ingredient.

8. How do I choose between daily and injectable buprenorphine?

The best choice depends on your goals, lifestyle, and treatment stage. Your provider will help you decide. Typically, many patients start with daily sublingual and then transition to injections when they become stable.

9. Is buprenorphine safe during pregnancy?

Yes, it is. Buprenorphine remains the preferred medication for OUD during pregnancy. It is safer for both mother and baby than continued opioid use.

10. How long will I need to take buprenorphine?

Guidelines recommend at least 12 months, and often longer. No maximum duration exists. Your provider will work with you to determine the right timeline based on your individual progress.

11. Can buprenorphine help with kratom or tianeptine withdrawal?

Yes. Growing evidence supports using buprenorphine for kratom, 7-OH, and tianeptine dependence and withdrawal. Although these are off-label uses, case reports and expert guidance support their effectiveness.

12. Does buprenorphine cause dental problems?

The FDA has warned about dental issues with sublingual and buccal forms. However, these risks can be managed with proper dental care. Do not stop buprenorphine because of dental concerns — the benefits of treatment far outweigh the risks.

13. What is serotonin syndrome?

Serotonin syndrome is a rare but serious reaction that can happen when buprenorphine is combined with certain other medications, especially antidepressants. Symptoms include muscle twitching, fast heart rate, sweating, and confusion. In most cases, symptoms are mild and resolve quickly. A provider will check for drug interactions before starting treatment.

14. Can buprenorphine affect my hormones or adrenal glands?

Yes. Long-term use can lower testosterone in men and affect menstrual periods in women. In rare cases, it can also lower cortisol levels (adrenal insufficiency), causing tiredness, dizziness, and low blood pressure. However, a provider can check hormone and cortisol levels if these symptoms develop.

Medically Reviewed By
Frank Melo, MD
Board Certified Addiction Medicine and Family Medicine
Medical Director, Solstice Health & Wellness
Last Updated: April 2026

Medical Disclaimer: The information provided on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition.