Buprenorphine

In the past, dihydrocodeine (DF118) was sometimes prescribed for opiate detox instead of methadone. However, there are problems with it: DF118 is short-acting (and so may need to be taken several times a day) and it gives a more heroin-like sensation - which isn’t always very helpful at the end of a detox. Because of these, and other problems, many services won’t prescribe it.

Buprenorphine (which has the trade name Subutex) is now taking the place of DF118 as an alternative prescribed opiate for detoxification.

Subutex gives some opiate effects (but less ‘euphoria’ than heroin or methadone) and can significantly reduce the physical withdrawal symptoms of detox. However, it does not offer a completely pain-free detox and, as with methadone, the different feelings can take some getting used to at the start of treatment.

Subutex is taken once a day, by putting a tablet under the tongue and letting it dissolve - it has no effect if chewed or swallowed.

If people are transferring from methadone they have to be on a dose of 30 mg or less, as the changeover from higher doses can cause withdrawal symptoms.

If you are taking methadone you will have to go at least 24 hours from the last methadone dose before taking Subutex for the first time, and if you are using heroin there should be 4-6 hours between your last heroin dose and your first Subutex tablet. This is because Subutex can send you into withdrawals if you start treatment without waiting for opiates to begin to clear out of your system.

A Subutex detox can be completed in 12-14 days, or it can be done gradually over a longer period.