Over a year ago I wrote about the transdermal formulation of buprenorphine available in Europe called ‘Butrans.’ One problem with the treatment of opioid dependence using buprenorphine has been the limited dose options available; while 2 and 8 mg sublingual tablets are fine for maintenance, they are wholly inadequate when it comes to tapering off buprenorphine.
The ‘wall’ of withdrawal symptoms that people discover as they taper past 2 mg is a product of the ceiling effect of buprenorphine– so useful on the way up, but so challenging on the way down! At 2 mg, the level part of the dose/response curve ends, and each decrease in dose causes a drop in opiate effect and a drop in tolerance… and so an increase in (albeit temporary) misery. Smaller doses of buprenorphine would be very useful at that point, say 2 mg of buprenorphine in a scored bar about a cm long, so that people could measure consistently-sized doses like 2 mg, 1.8 mg, 1.6 mg, and so on. I have described a ‘liquefied taper method’ that some people have used with success, as described on the Forum, to consistently measure smaller and smaller doses for an effective taper.
Of course the remaining problem with any opiate taper is that the person must suffer through some degree of discomfort and craving, while at the same time holding a vial filled with the doses that would make things whole. Most opioid addicts really struggle at 3 AM under those conditions.
I’ve been excited about the newer products coming down the pipeline, including the transdermal product Butrans and also an injectable form of buprenorphine called Probuphine. The latter in particular would be useful for tapering, as the addict could get a slowly-dissolving shot of buprenorphine and then go about life as it wears off, without having a vial of more buprenorphine on the nightstand. I don’t know if Butrans will have any usefulness for tapering buprenorphine– if it did, such use would be ‘off-label’ as the medication is approved for treatment of pain, NOT for addiction treatment.