From the Guidelines
Conversion from Suboxone tablets to Butrans patches should only be done under the guidance of a healthcare provider, as it requires individualized medical assessment and careful tapering to ensure safety and effectiveness of treatment. These medications contain different forms of buprenorphine and are used for different purposes - Suboxone (buprenorphine/naloxone) primarily for opioid use disorder and Butrans (buprenorphine transdermal system) for chronic pain management. The conversion is complex because Suboxone has higher bioavailability and includes naloxone, while Butrans delivers medication continuously through the skin at lower doses 1.
Key Considerations
- The patient's current Suboxone dose, reason for treatment, pain levels, and medical history must be evaluated before determining an appropriate Butrans dosage.
- The transition typically requires careful tapering and monitoring for withdrawal symptoms or inadequate pain control.
- Butrans has proven efficacy and may be safer than full opioid agonists in the treatment of chronic pain, with a systematic review showing comparable pain relief with fewer adverse events compared to transdermal fentanyl and morphine 1.
- Patients should never attempt this conversion independently, as it can lead to serious health consequences, including withdrawal symptoms, overdose, or inadequate pain control.
Clinical Evidence
- A study published in the Clinical Infectious Diseases journal in 2017 found that buprenorphine has a high binding affinity for the μ-opioid receptor, which can provide analgesia over a long period of time 1.
- Another study published in the Annals of Oncology journal in 2018 found that transdermal buprenorphine can be useful in patients with stable opioid requirements, but its use requires careful consideration and monitoring 1.
Recommendations
- Healthcare providers should carefully evaluate the patient's specific situation and medical history before determining an appropriate Butrans dosage.
- The conversion from Suboxone to Butrans should be done gradually, with close monitoring for withdrawal symptoms or inadequate pain control.
- Patients should be educated on the proper use of Butrans and the importance of following their healthcare provider's instructions to ensure safe and effective treatment.
From the Research
Conversion from Suboxone Tablets to Butrans Patch
- The provided studies do not directly address the conversion from Suboxone tablets to Butrans patch.
- However, the studies discuss the management of opioid withdrawal symptoms and the use of buprenorphine in opioid-dependent patients 2, 3, 4, 5.
- Buprenorphine is the active ingredient in both Suboxone and Butrans, but the dosage and administration route differ between the two formulations.
- Study 2 compares the effectiveness of buprenorphine and methadone in managing opioid withdrawal, suggesting that buprenorphine is more effective than clonidine or lofexidine, but equally effective as methadone.
- Study 3 discusses the primary care management of opioid use disorders, recommending methadone or buprenorphine-naloxone treatment over abstinence-based treatment, and providing guidance on patient selection for each treatment option.
- Study 4 evaluates the use of buprenorphine to reverse respiratory depression from methadone overdose, suggesting that buprenorphine is a safe and effective substitute for naloxone in overdosed opioid-dependent patients.
- Study 5 reviews the effective management of opioid withdrawal symptoms, highlighting the importance of noradrenergic hyperactivity in generating withdrawal symptoms and discussing the use of non-opioid medications to treat withdrawal symptoms.
Key Findings
- Buprenorphine is effective in managing opioid withdrawal symptoms and is a safe substitute for naloxone in overdosed opioid-dependent patients 2, 4.
- Methadone and buprenorphine-naloxone are recommended over abstinence-based treatment for opioid use disorders, with patient selection guided by individual characteristics and preferences 3.
- Non-opioid medications can facilitate opioid tapering and provide a gateway to long-term treatment with naltrexone or psychosocial therapies 5.