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The meaning of «buprenorphine»

Buprenorphine is an opioid used to treat opioid use disorder, acute pain, and chronic pain.[8] It can be used under the tongue (sublingual), in the cheek (buccal), by injection (intravenous and subcutaneous), as a skin patch (transdermal), or as an implant.[8][9] For opioid use disorder, it is typically started when withdrawal symptoms have begun and for the first two days of treatment under direct observation of a health-care provider.[8] The combination formulation of buprenorphine/naloxone (Suboxone) is recommended to discourage misuse by injection.[8] Maximum pain relief is generally within an hour with effects up to 24 hours.[8]

Side effects may include respiratory depression (decreased breathing), sleepiness, adrenal insufficiency, QT prolongation, low blood pressure, allergic reactions, constipation, and opioid addiction.[8][10] Among those with a history of seizures, a risk exists of further seizures.[8] Opioid withdrawal following stopping buprenorphine is generally less severe than with other opioids.[8] Whether use during pregnancy is safe is unclear, but use while breastfeeding is probably safe, since the dose the infant receives is 1-2% that of the maternal dose, on a weight basis.[11][8] Buprenorphine affects different types of opioid receptors in different ways.[8] Depending on the type of receptor, it may be an agonist, partial agonist, or antagonist.[8]

Buprenorphine was patented in 1965, and approved for medical use in the United States in 1981.[8][12] In 2017, 14.6 million prescriptions for the medication were written in the United States.[13] It is also a common medication used to treat opioid use disorders, such as addiction to heroin.[13] Buprenorphine may also be used recreationally by injection or in the nose for the high it produces.[13] In the United States, it is a schedule III controlled substance.[13]

Buprenorphine is used to treat people with opioid use disorder.[8][14]: 84–7  The combination formulation of buprenorphine/naloxone is generally preferred, as naloxone, an opioid antagonist, has a higher bioavailability intravenously, and results in acute withdrawal if the formulation is crushed and injected.[8][15]: 99  Before starting buprenorphine, individuals should wait long enough after their last dose of opioid until they have some withdrawal symptoms to allow for the medication to bind the receptors, but if taken too soon, buprenorphine can displace other opioids bound to the receptors and precipitate an acute withdrawal. The dose of buprenorphine is then adjusted until symptoms improve, and individuals remain on a maintenance dose through treatment.[15]: 99–100 [16]

Both buprenorphine and methadone are medications used for detoxification and opioid replacement therapy, and appear to have similar effectiveness based on limited data,[17] and are safe for pregnant women with opioid use disorder,[15]: 101 [16] although preliminary evidence suggests that methadone is more likely to cause neonatal abstinence syndrome.[18] In the US and European Union, only designated clinics can prescribe methadone for opioid use disorder in which people starting treatment must follow up daily, which may be appropriate for those requiring a more structured environment. If patients are drug free for a few weeks they can then reduce their visits to 5 days and so on until only visiting once a week. Alternatively, buprenorphine can be prescribed by any clinician in the US or assigned doctor within the EU with a waiver/licence allowing people to receive treatment as a part of their routine care.[14]: 84–5 

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