BuTrans– Transdermal Buprenorphine

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.

2014 Update:  Butrans is available in 4 strengths in the US, indicated for pain treatment.  Butrans is not indicated for the treatment of opioid dependence.

4 thoughts on “BuTrans– Transdermal Buprenorphine”

  1. This patch is known in Australia as Norspan and I did manage to have it prescribed. I think you might be on to something as the reason I stopped using the patch and went for sub lingual Suboxone was the dose was not holding me. I have a friend currently an inpatient who is having a diabolical time coming of .2mgs of Subutex. I will suggest to her Doctor as he is an Addiction Medicine Specialist. Thankyou

  2. I have been on Suboxone for 5 years and 6 months. I have been at a very low dose of .5 mg for the past year. My suboxone dr recently retired, and now his replacement doctor (not a licensed suboxone dr) is prescribing me Butrans 5mcg transdermal patches. I have been slightly uncomfortable at times, but I find each time I drink plenty of water and eat a healthy meal I feel totally better. Today is day 11, so I am now on my second patch. Although this patch is not approved by the FDA to treat opiate addiction, they are prescribing it to me to taper me off my suboxone. Is this legal?

  3. No. The Harrison Act of 1916 makes it illegal to treat opioid dependence or withdrawal using opioids. There are two exceptions– one is the treatment offered by methadone clinics, where methadone is dispensed, not prescribed… the other is DATA 2000, which allows for the use of specific buprenorphine products. The law requires that only the products that are FDA indicated for opioid dependence can be used to treat addiction and withdrawal— and BuTrans is not indicated for that use.

    Any doctor, whether or not approved for buprenorphine/addiction treatment, can prescribe Butrans (or Suboxone) to treat pain. But only DATA 2000-certified docs can treat addiction using certain buprenorphine products. Butrans is not indicated for addiction treatment— and therefore cannot be used as part of DATA 2000.

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