Opiates, drugs derived directly from opium, and opioids, synthetic drugs which mirror some or all of the effects of opiates, are available in various forms and are used for a range of medicinal purposes. Butrans patches contain the opioid buprenorphine and have been shown to have various benefits in pain management treatment and for helping to wean people off other drugs. While considered relatively lower risk than most opioids, Butrans patches still carry some potential for dependency and addiction, particularly if used other than intended, so distribution and use need careful monitoring.
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What are Butrans patches?
Butrans patches are opiate patches that contain buprenorphine, a synthetic opioid used for pain management. The original Butrans patent has now expired, so these patches are now produced and sold under a variety of brand names worldwide, including:
- Butrans
- Subutex
- Cizdol
- Suboxone
- Zubsolv
- Bunavail
- Sublocade
- Probuphine
- Temgesic
- Buprenex
- Butec
- Norspan
Butrans patches are dermal patches that, once applied to the skin, release a controlled dose of buprenorphine over a longer period rather than suddenly and all at once. This mechanism is designed to reduce the potential for abuse with long-term treatment as the comparatively slow-release means they do not produce the same “high” as other methods of opioid consumption.
Opiate patches can vary from one brand to another in terms of their duration of action, with patches now available that deliver the drug over periods ranging from three to seven days. Both Butrans and Butec patches, available via the NHS, come in seven-day formats with different dosages available: 5, 10, 15 and 20 micrograms per hour.
What are Butrans patches used for?
Opiate patches are used to relieve both acute and chronic pain, but buprenorphine is the preferred option in the treatment of chronic pain where individuals require pain medication for a prolonged period and who are unable to be treated with other medication. This can be for various reasons, such as an inability to swallow tablets or keep them down without vomiting.
Alongside their use in pain management, opiate patches, including Butrans patches, are most commonly used in the UK to treat individuals who have an opioid addiction as they can release small amounts of the drug slowly, allowing for gradual tapering.
How do Butrans patches work for pain management?
Butrans patches work for pain management by delivering a controlled and steady dose of buprenorphine through the skin and into the bloodstream. This is how the process works:
- Transdermal system: Butrans patches are applied to the skin with buprenorphine slowly released through the skin into the bloodstream.
- Steady medication release: The patch provides a continuous release of medication over a set period, usually seven days. This ensures a constant level of medication in the body, providing consistent pain relief.
- Individualised dosage: The dosage of Butrans patches can be adjusted based on the patient’s level of opioid tolerance and the severity of their pain, but they are typically used in patients who are already opioid-tolerant.
- Partial opioid agonist properties: Buprenorphine, the active ingredient, is a partial agonist at mu-opioid receptors in the brain and spinal cord. These receptors are part of the body’s natural pain-relief system. When buprenorphine binds to them, it activates the receptor but to a lesser degree than full agonists like morphine. This activation helps to reduce the perception of pain.
- Ceiling effect: Unlike full opioid agonists, buprenorphine has a “ceiling effect”, so beyond a certain dose, increasing the amount of buprenorphine does not increase its pain-relieving effects. This reduces the risk of respiratory depression, a common and serious side effect of stronger opioids.
- Consistent pain control: The steady release of medication helps maintain a consistent level of pain relief, which can be beneficial for chronic pain management.
- Reduced abuse potential: The ceiling effect of buprenorphine and the controlled release from the patch reduce the potential for abuse compared to other opioids.
- Convenience: The patch only needs to be changed once a week, which is more convenient than taking pills multiple times a day.
How do Butrans patches work in opioid addiction treatment?
Opiate patches are considered to be very effective in the treatment of opioid addiction. In the UK, this usually means a heroin addiction, but it can also be an addiction to other illegal opioids or legally prescribed opioid painkillers. Butrans patches are particularly useful because buprenorphine produces significantly less intense effects than other opiates. Here is how they work in opioid addiction treatment:
Opioid replacement therapy
Butrans patches can be used as part of opioid replacement therapy, where they replace the abused opioid with a controlled, less addictive alternative. This approach helps to stabilise the individual’s condition and reduce harmful behaviours associated with opioid addiction.
Step-down approach
In some treatment protocols, Butrans patches may be used in a step-down approach where the dose of buprenorphine is gradually reduced over time, helping the individual to wean off opioids eventually.
Precautions and warnings
Opiate patches have been associated with an increased risk of:
- Neonatal opioid withdrawal syndrome
- Life-threatening respiratory depression (especially in patients with chronic pulmonary disease and elderly, cachectic or debilitated patients)
- Adrenal insufficiency
- Severe hypotension
- Hepatotoxicity
Buprenorphine may be dangerous for patients with increased intracranial pressure, brain tumours, head injuries or impaired consciousness. It can also be potentially dangerous if used alongside benzodiazepines and/or other CNS depressants.
An allergic reaction to buprenorphine can be very dangerous, and you should contact emergency services immediately if you take buprenorphine via any means and experience any of the following:
- Hives
- Difficulty breathing
- Swelling of the face, throat, lips or tongue
The risk of Butrans patch addiction
While Butrans patches are generally considered to carry less potential for addiction than other drugs, they are not completely without risk.
Using Butrans patches in accordance with a doctor’s instructions is unlikely to create the euphoric high which drives most initial opioid abuse. However, if consumed in other ways (for example, chewing the patches – which can be extremely dangerous) or in higher quantities than prescribed, it is possible to achieve a certain high.
Once abuse has begun, the route to addiction follows the same pattern as with other opioid drugs and medication:
1. Tolerance
This is the first stage in the addiction cycle. Over time, with regular use of opioids like those delivered by Butrans patches, the body becomes accustomed to the drug, and the brain’s receptors become less responsive to its effects. This means that the user will need to take larger doses to achieve the same pain-relieving effects or, if the drug is being misused recreationally, to experience the same level of euphoria.
2. Physical dependence
After prolonged use, the body becomes dependent on the drug. Dependence is characterised by the necessity of the drug for normal functioning. Ironically, as Butrens patches are often used to reduce the severity of opioid withdrawal, once a person becomes dependent on buprenorphine, they can also experience withdrawal symptoms if they stop taking the drug. These can include:
- Nausea
- diarrhoea
- Vomiting,
- Fever
- Muscle aches
- Depression
- Irritability
- Anxiety
- Sleep disturbances.
- Intense buprenorphine cravings
At this stage, the use of the drug is no longer about seeking pleasure but rather about avoiding the discomfort of withdrawal.
Compulsive use and addiction
Addiction is a chronic, relapsing disorder characterised by compulsive drug seeking and continued use despite harmful consequences and long-lasting changes in the brain. At this full addiction stage, obtaining and using the drug becomes the primary focus of the individual’s life. This compulsive behaviour often leads to neglect of personal responsibilities, relationships and health.
As well as the potential for dependence and addiction, abusing opiate patches also gives rise to the risk of overdose, various other health risks and all the social, financial and legal risks associated with addiction. This is why it is so important only to use Butrans patches as prescribed by a doctor and to voice any concerns immediately if dependency or addiction is suspected.
Factors contributing to Butrans patch addiction
There are a number of factors which can increase the risk of developing a Butrans patch addiction. It is essential to consider these risk factors in both prescribing and monitoring the use of Butrans patches and that proactive measures are taken to help mitigate these risks. Common contributing factors include:
Method of administration
As mentioned, altering the method of administration to achieve a high increases the risk of addiction. Common methods of misuse include:
- Chewing the patch
- Wearing someone else’s patch
- Wearing more than one patch
- Wearing a patch at a higher dose than what you were prescribed
- Opening the patch to extract the liquid gel
- Dissolving the gel so you can snort or inject it directly into your bloodstream
Dosage and duration
Higher doses and prolonged use increase the risk of developing tolerance and dependence, leading to buprenorphine addiction.
Genetic predisposition
Genetics can also play a role in an individual’s susceptibility to addiction. This means that people with a family history of substance abuse are often at a higher risk of developing addiction themselves.
Dual diagnosis
Individuals with mental health disorders, such as depression, anxiety or bipolar disorder, may be more susceptible to addiction as they might use substances like opioids for self-medication.
Previous addictions
A history of substance abuse, including alcohol, prescription drugs or illegal drugs, can increase the risk of developing an addiction to Butrans patches as it can indicate a pattern of addictive behaviour.
Unresolved trauma
Individuals who have experienced trauma such as physical or emotional abuse and have not resolved these issues through therapy or other means may turn to substances like opioids to cope with their emotional pain.
Environmental factors
Environment plays a crucial role in addiction. This includes factors like peer pressure, family dynamics, socio-economic status and exposure to high-stress environments. Accessibility to buprenorphine and the normalisation of substance use in an individual’s home environment or social circle can also contribute.
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How is buprenorphine addiction treated?
Buprenorphine addiction treatment requires a multi-avenue approach to address the physical, psychological and long-term aspects of the condition. This usually includes:
Buprenorphine detox
Although Butrans patches are commonly used to assist with detoxification and withdrawal, dependence on them will also require detox to clear the system of buprenorphine and begin healing. Due to the unpleasant and potentially dangerous nature of opioid withdrawal, detox must be done with medical assistance in a hospital or at a specialist rehab or detox clinic.
Buprenorphine rehab therapy
After the initial detox phase, the next critical step in treating buprenorphine addiction is rehab therapy. This stage involves a combination of therapeutic approaches that may include:
Individual therapy: One-on-one sessions with a therapist can help individuals understand the root causes of their buprenorphine addiction, develop coping strategies and work through personal issues contributing to their substance use.
- Group therapy: Group sessions provide a support network of peers who are also working through addiction. These sessions allow individuals to share experiences, learn from others and practise social skills.
- Cognitive-behavioural therapy (CBT): CBT helps individuals identify and change negative thought patterns and behaviours associated with buprenorphine addiction.
- Family therapy: Involving family members in therapy can help repair and strengthen family relationships and provide additional support.
- Holistic therapies: Activities like yoga, meditation, art and sound therapy can promote overall well-being and stress management.
Aftercare and relapse prevention
The final stage is focused on aftercare and relapse prevention, which are essential for maintaining long-term sobriety after leaving rehab. This may include:
- Continued counselling: Regular counselling sessions post-rehab can help individuals stay on track and address new challenges.
- Support groups: Participating in groups like Narcotics Anonymous (NA) provides ongoing encouragement and accountability.
- Lifestyle changes: Adopting a healthy lifestyle, including regular exercise, a balanced diet, and engaging in hobbies, can improve mental health and reduce the risk of relapse.
- Relapse prevention strategies: Developing a plan with a therapist can help individuals recognise warning signs and implement coping strategies.
- Building a supportive environment: Creating a supportive environment, both at home and socially, is crucial for recovery.
Get help for Butrans patch addiction today
If you have developed an addiction to Butrans patches, there are effective treatment options available. Get in touch with your GP and/or an addiction specialist as soon as possible to discuss your situation and find out how best to tackle your addiction. While it may seem daunting, picking up that phone can be the first and most important step on the road back to a happy, healthy life.
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