I am the ‘expert’ on a couple forums at MedHelp.org, including the forum for chronic pain; tonight I was answering a couple posts and came across the name of a medication I was not familiar with: Butrans, by Napp Pharmaceuticals. After looking up the medication I learned that BuTrans is a 7-day buprenorphine patch manufactured in the U.K. that comes in doses ranging from 5 to 20 micrograms per hour. I have mentioned in other posts that what is really needed to taper off Suboxone is a lower-strength form of the medication; buprenorphine is just so potent that when people taper down to a quarter of a tablet they are still taking 2000 micrograms of buprenorphine– which is a significant dose. The potency of buprenorphine is clear when one realizes that BuTrans is considered a potent analgesic, even though the low-potency patch releases only 5 micrograms– MICROgrams– per hour. That comes to about 100 micrograms per day, and if we assume similar absorption for skin and mucous membranes that would equal a dose of buprenorphine less than 1/10th of the smallest ‘chip’ of Suboxone a person could reasonably use.
In other words, BuTrans would offer a much-needed low-dose application of buprenorphine; it comes in several doses and would be an excellent way to taper down in the lower dose range of the medication. For people who have not read my earlier posts on the potency of buprenorphine, one reason people become so frustrated when trying to discontinue Suboxone is because of the high potency and ceiling effect; tapering down to 2 mg of Suboxone is relatively easy, and then people tend to simply stop taking it– but they are still taking a dose of buprenorphine that has a high opiate potency– virtually as high as the dose they originally started with before the taper began! So they are expecting the very last bit of going off Suboxone but instead they are hit with significant withdrawal, equal to the withdrawal from stopping 30 mg of methadone. That is why I have recommended that people think in terms of MICROgrams instead of MILLIgrams– a quarter tab of Suboxone being 2000 micrograms. The 5 microgram/hr BuTrans patch is a good illustrator of the medication’s potency.
Unfortunately, to my knowledge there is no way to prescribe BuTrans in the United States– for now, anyway. My hope is that eventually options such as, or similar to, BuTrans, Temgesic, and other buprenorphine formulations will eventually be available.