Understanding Buprenorphine: A Dual-Purpose Medication
Buprenorphine is a semi-synthetic opioid medication primarily used to treat opioid use disorder (OUD) [1.3.5]. It is also prescribed for managing severe pain under brand names like Butrans and Belbuca [1.8.2]. As a cornerstone of Medication-Assisted Treatment (MAT), buprenorphine helps reduce opioid cravings and withdrawal symptoms, diminishing the effects of physical dependency [1.7.1]. Its use in MAT has been shown to reduce the risk of fatal opioid overdose by 38% to 59% compared to not receiving medication [1.4.2].
Unlike full opioid agonists such as heroin or methadone, buprenorphine is a partial opioid agonist [1.7.2]. This means it binds to and activates the same opioid receptors in the brain but to a lesser degree [1.7.4]. This creates a "ceiling effect," where the opioid effects plateau even with increased doses, lowering the risk of respiratory depression and overdose compared to full agonists [1.7.2, 1.6.4]. Due to its high affinity for these receptors, it can displace other opioids, effectively blocking their effects [1.3.5].
What is the Street Name for Buprenorphine?
Despite its critical role in treatment, buprenorphine is often diverted and sold illegally. On the street, it is known by various names, often derived from its brand names (like Suboxone® or Subutex®) or appearance [1.2.2, 1.8.1]. Common street names include:
- Subs / Subbies [1.2.1]
- Strips (referring to the sublingual film formulation) [1.2.2]
- Bupe [1.2.1, 1.2.3]
- Oranges or Orange Guys (often referring to the color of the tablets/films) [1.2.1, 1.2.2]
- Sobos [1.2.2]
- Big Whites or Small Whites [1.2.2]
- Stops [1.2.2]
This diversion happens for several reasons. Some individuals use illicit buprenorphine to manage withdrawal symptoms when they cannot access formal treatment, while others misuse it for its euphoric effects, though these are weaker than those of full agonists [1.7.2, 1.7.4].
Pharmacology and How It Works
Buprenorphine's effectiveness stems from its unique pharmacological profile. It acts as a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor [1.5.2].
- Partial Mu-Agonist Activity: It provides enough opioid effect to prevent withdrawal and reduce cravings but has a ceiling, making overdose on buprenorphine alone rare [1.6.3, 1.7.2].
- High Receptor Affinity: It binds very tightly to mu-opioid receptors, displacing other opioids like heroin or fentanyl and blocking them from producing a high [1.3.5].
- Long Half-Life: Buprenorphine has a long duration of action, with a half-life of 28 to 37 hours after sublingual administration, allowing for stable, once-daily or even alternate-day dosing in stabilized patients [1.3.5, 1.3.1].
To prevent misuse via injection, many buprenorphine products, like Suboxone, are combined with naloxone, an opioid antagonist [1.7.2]. When taken sublingually as directed, the naloxone has minimal effect. However, if the product is crushed and injected, the naloxone becomes active and can trigger immediate, unpleasant withdrawal symptoms [1.5.2].
Comparison: Buprenorphine vs. Methadone
Buprenorphine and methadone are both effective MAT options, but they have key differences.
| Feature | Buprenorphine | Methadone |
|---|---|---|
| Mechanism | Partial opioid agonist with a 'ceiling effect' [1.7.2] | Full opioid agonist; effects increase with dose [1.5.4] |
| Overdose Risk | Lower risk of respiratory depression and overdose [1.5.2] | Higher risk, especially when combined with other sedatives [1.6.3] |
| Administration | Can be prescribed by qualified practitioners in an office setting for take-home use [1.5.4, 1.11.4] | Highly regulated (Schedule II); typically dispensed daily at specialized clinics [1.5.4] |
| Treatment Retention | Studies show lower retention rates compared to methadone [1.5.5, 1.5.3] | Generally higher treatment retention rates [1.5.5, 1.5.3] |
| Side Effects | Common effects include headache, nausea, constipation, and insomnia [1.9.1]. | Similar opioid side effects; can also prolong the cardiac QT interval [1.5.2]. |
| Use in Pregnancy | Associated with lower risk of neonatal abstinence syndrome (NAS) compared to methadone [1.5.1]. | Effective, but associated with a higher incidence of NAS [1.5.1]. |
Risks of Illicit Use
The non-prescribed use of buprenorphine carries significant risks. When abused, particularly through snorting or injection, the risk of harm increases [1.2.1]. The most severe danger comes from combining it with other central nervous system depressants like benzodiazepines or alcohol, which can lead to respiratory distress, loss of consciousness, and death [1.6.2, 1.6.4]. Other risks of illicit use include:
- Infectious Complications: Injecting dissolved tablets can lead to serious infections like abscesses, endocarditis, and the transmission of HIV or Hepatitis C [1.6.3].
- Precipitated Withdrawal: If taken while a person still has a full opioid agonist in their system, buprenorphine's high affinity can violently displace the other opioid from receptors, causing severe and sudden withdrawal symptoms [1.6.5, 1.7.3].
- Dependence and Withdrawal: Physical dependence will develop with regular use. Abruptly stopping can lead to withdrawal symptoms like anxiety, muscle aches, insomnia, and sweating [1.6.1, 1.10.1].
Conclusion
Buprenorphine is a vital pharmacological tool in the fight against the opioid crisis, known on the street by names like "Subs" and "Strips." Its properties as a partial opioid agonist make it a safer and more accessible alternative to methadone for many patients with OUD [1.5.2, 1.5.4]. However, its potential for diversion and misuse underscores the importance of comprehensive treatment plans, patient education, and harm reduction strategies. Understanding both its therapeutic benefits and the dangers of its illicit use is crucial for healthcare providers, patients, and the public.
Authoritative Link: For more information on medications for opioid use disorder, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) [1.3.1].
