Subutex
Subutex is known by the street names 'subbies', 'temmies' and 'bupe'.
Subutex is the trade name for Buprenorphine Hydrochloride. It is a complex drug, with a number of important considerations to be taken into account by anyone prescribing or using it. Buprenorphine was licensed for the treatment of opioid addiction in the UK in 1999. Essentially, it is a long acting opioid (heroin or methadone) substitute, though it has some unusual properties.
It is available in sub-lingual tablets; these are small white or yellow tablets, 400 microgrammes (mcg), 2 milligrammes or 8 milligrammes (mg). The usual dose is around 12 mg taken once daily, though dose can vary between 2 and 32mg per day. There is a ‘blocking’ effect at around 16mgs daily that reduces the potency of other opiates/opioids when used concurrently, thus reducing the desirability of ‘using on top’. Using Subutex on top of heroin can precipitate symptoms of full withdrawal. Buprenorphine, the active ingredient of Subutex, is a partial opiate antagonist. This means that as well as preventing withdrawal and producing morphine-like effects, it can block the effects of heroin and thereby induce withdrawal symptoms.
It is very important to understand what this means in practice. When beginning Subutex, the first dose should not be taken until at least 12 hours after the last dose of street heroin. The more regular and the heavier heroin use has been, the longer one should leave between the last dose of heroin and the first dose of Subutex- ideally in cases of long term opiate use, one should leave a gap of 24 to 36 hours. This is especially true of methadone, which has a long half life, remaining in the body for 24 or 36 hours. People are not usually transferred from methadone to Subutex until they are on a methadone dose of 30mg or lower. Whereas some people use methadone and occasionally use street heroin on top, with Subutex this is a very bad idea, and is likely to send the user into immediate withdrawal.
These matters should be fully discussed by the user and their prescribing doctor before embarking on the use of Subutex. Generally this medication is of most use in cases where individuals are either relatively new to opiate addiction, and/or on a fairly low dose.
Note: Buprenorphine is also available as Temgesic, small, white round tablets of 0.2 or 0.4 mg; again they are designed to dissolve under the tongue, but not licensed for use in drug dependence. Temgesic has a history of ‘misuse’ (that is, in this context, being taken in a manner that it is not intended to be, i.e. injecting tablet formulations).
Subutex users should carry a card identifying themselves as patients on this substance in case of accident; it is necessary for physicians to know their status in order to correctly prescribe pain medications etc.
Free, confidential information and advice is available by calling the Release Drugs Helpline on