Buprenorphine

Buprenorphine is a medication approved by the Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD).

  • What is Buprenorphine?

    Buprenorphine is a medication approved by the Food and Drug Administration (FDA) to treat Opioid Use Disorder (OUD) as a medication-assisted treatment (MAT). As with all medications used in MAT, buprenorphine should be prescribed as part of a comprehensive treatment plan that includes counseling and other behavioral therapies to provide patients with a whole-person approach.

    Buprenorphine is the first medication to treat OUD that can be prescribed or dispensed in physician offices, significantly increasing access to treatment.

  • Buprenorphine Waiver Certification

    To receive buprenorphine waiver certification to administer, dispense, and prescribe buprenorphine:

    • Office-based practitioners must notify SAMHSA’s Center for Substance Abuse Treatment (CSAT), Division of Pharmacologic Therapies (DPT) of their intent to practice this form of medication-assisted treatment (MAT).
    • The NOI must be submitted to SAMHSA before the initial dispensing or prescribing of OUD treatment medication.
    • Recently published Practice Guidelines have created a training flexibility for the Notifications of Intent (NOI) to prescribe Buprenorphine.
    • Find buprenorphine waivered practitioners in your local area.

    In order to apply for subsequent increases in the number of clients eligible for treatment with buprenorphine:

    • Office-based providers are obliged to undertake required training activities. Completion of required training accompanies the NOI.
    • This pathway recognizes the importance of specialized training in managing a larger panel of patients who might require treatment with buprenorphine.
    • An eligible provider may choose to undertake training, or forego it prior to prescribing buprenorphine. Those who forego training are limited to treating no more than 30 patients at any one time.

    To expand access to buprenorphine, the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder exempts eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives from the certification requirements related to training, counseling and other ancillary services (i.e., psychosocial services) under 21 U.S.C. § 823(g)(2)(B)(i)-(ii) of the Controlled Substances Act (CSA). Practitioners utilizing this exemption are limited to treating no more than 30 patients at any one time (time spent practicing under this exemption will not qualify the practitioner for a higher patient limit). This exemption applies only to the prescription of Schedule III, IV, and V drugs or combinations of such drugs, covered under the CSA, such as buprenorphine.

    Payment Program for Rural Health Clinics Buprenorphine-Trained Providers. In June 2021, the Health Resources & Services Administration (HRSA) launched an effort to improve access to medications for opioid use disorder treatment by paying for providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019. Approximately $1.2 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Information and registration for free waiver training is available. Please contact DATA2000WaiverPayments@hrsa.gov with any questions.

    Several federal laws and regulations permit physicians and other medical personnel to administer medications approved by the Food and Drug Administration (FDA) for the treatment of opioid use disorders (OUD) under special circumstances without a buprenorphine waiver. Learn about these special circumstances.

    In addition, buprenorphine is also administered at SAMHSA-certified opioid treatment programs (OTPs). Find a SAMHSA-certified OTP in your local area.

    How Buprenorphine Works

    Buprenorphine is an opioid partial agonist. It produces effects such as euphoria or respiratory depression at low to moderate doses. With buprenorphine, however, these effects are weaker than full opioid agonists such as methadone and heroin.

    When taken as prescribed, buprenorphine is safe and effective. Buprenorphine has unique pharmacological properties that help:

    • Diminish the effects of physical dependency to opioids, such as withdrawal symptoms and cravings
    • Increase safety in cases of overdose
    • Lower the potential for misuse

    Buprenorphine for Opioid Use Disorder

    • To begin treatment, an OUD patient must abstain from using opioids for at least 12 to 24 hours and be in the early stages of opioid withdrawal. Patents with opioids in their bloodstream or who are not in the early stages of withdrawal, may experience acute withdrawal.
    • After a patient has discontinued or greatly reduced their opioid use, no longer has cravings, and is experiencing few, if any, side effects, if needed, the dose of buprenorphine may be adjusted. Due to the long-acting agent of buprenorphine, once patients are stabilized, it may be possible to switch from every day to alternate-day dosing.
    • The length of time a patient receives buprenorphine is tailored to meet the needs of each patient, and in some cases, treatment can be indefinite. To prevent possible relapse, individuals can engage in on-going treatment—with or without MAT.

    Before Starting Buprenorphine

    Patients diagnosed with an OUD should talk to their health care practitioner before starting treatment with buprenorphine to fully understand the medication and other available treatment options.

    Common and Serious Side Effects of Buprenorphine

    These are not all the side effects of buprenorphine. For more information patients should talk to their health care practitioner or pharmacist. Patients should tell their health care practitioner about any side effects that are bothersome, or do not go away.

    Patients and practitioners are encouraged to report all side effects online to MEDWatch, FDA’s medical product safety reporting program for health care professionals, patients, and consumers or by calling 1-800-FDA-1088.

  • Common side effects of buprenorphine include:
    • Constipation, headache, nausea, and vomiting
    • Dizziness
    • Drowsiness and fatigue
    • Sweating
    • Dry mouth
    • Tooth decay
    • Muscle aches and cramps
    • Inability to sleep
    • Fever
    • Blurred vision or dilated pupils
    • Tremors
    • Palpitations
    • Disturbance in attention

  • Serious side effects of buprenorphine include:
    • Respiratory distress
    • Overdose
    • Adrenal insufficiency
    • Dependence
    • Withdrawal
    • Itching, pain, swelling, and nerve damage (implant)
    • Pain at injection site (injection)
    • Neonatal abstinence syndrome (in newborns)

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  • Safety Precautions

    People should use the following precautions when taking buprenorphine:

    • Do not take other medications without first consulting your doctor.
    • Do not use illegal drugs, drink alcohol, or take sedatives, tranquilizers, or other drugs that slow breathing. Mixing large amounts of other medications with buprenorphine can lead to overdose or death.
    • Ensure that a physician monitors any liver-related health issues that you may have.
    • Tell your doctor if you are pregnant or plan to become pregnant.
    • Prevent children and pets from accidental Ingestion by storing it out of reach. For more information, visit CDC’s Up and Away educational campaign.
    • Dispose of unused methadone safely. Talk to your MAT practitioner for guidance, or for more information on the safe disposal of unused medications, visit FDA's disposal of unused medicines or DEA's drug disposal webpages
    • Do not shared your buprenorphine with anyone even if they have similar symptoms or suffer from the same condition.

    Buprenorphine Misuse Potential

    Because of buprenorphine’s opioid effects, it can be misused, particularly by people who do not have an opioid dependency. Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product. Learn about other MAT medications.

  • Tip 63 Cover

    Tip 63: Medications for Opioid Use Disorder (2021)

    This Treatment Improvement Protocol reviews the use of the three FDA-approved medications used to treat OUD.

  • Advisory cover

    Sublingual and Transmucosal Buprenorphine for Opioid Use Disorder (2016)

    This advisory summarizes data on the use of sublingual and transmucosal buprenorphine for the medication-assisted treatment of opioid use disorder.

Last Updated: 09/27/2022