Subutex belonged to the class of medicines known as narcotic analgesics. It was also called an opioid analgesic. Subutex was only used for the treatment of opioid (narcotic) addiction. One of the major active metabolites of buprenorphine is norbuprenorphine, which, in contrast to buprenorphine itself, is a full agonist of the MOR, DOR, and ORL-1, and a partial agonist at the KOR. [83] [84] However, relative to buprenorphine, norbuprenorphine has extremely little antinociceptive potency (1/50th that of buprenorphine), but markedly depresses respiration (10-fold more than buprenorphine). [85] This may be explained by very poor brain penetration of norbuprenorphine due to a high affinity of the compound for P-glycoprotein. [85] In contrast to norbuprenorphine, buprenorphine and its glucuronide metabolites are negligibly transported by P-glycoprotein. [85] Other types of therapies that could be used include cognitive behavioural therapy (CBT) which is used to help individuals alter negative cognitions associated with addiction and develop coping mechanisms to help them deal with addiction even after treatment. Buprenorphine Use During Pregnancy". Drugs.com. 14 October 2019. Archived from the original on 10 November 2020 . Retrieved 17 May 2020.

The glucuronides of buprenorphine and norbuprenorphine are also biologically active, and represent major active metabolites of buprenorphine. [86] Buprenorphine-3-glucuronide has affinity for the MOR (K i = 4.9 pM), DOR (K i = 270 nM) and ORL-1 (K i = 36 μM), and no affinity for the KOR. It has a small antinociceptive effect and no effect on respiration. Norbuprenorphine-3-glucuronide has no affinity for the MOR or DOR, but does bind to the KOR (K i = 300 nM) and ORL-1 (K i = 18 μM). It has a sedative effect but no effect on respiration. a b c Coller JK, Christrup LL, Somogyi AA (February 2009). "Role of active metabolites in the use of opioids". European Journal of Clinical Pharmacology. 65 (2): 121–139. doi: 10.1007/s00228-008-0570-y. PMID 18958460. S2CID 9977741. Uncommon (0.1% to 1%): Affect lability, depersonalization, libido decreased, nightmare, euphoric mood, psychosis, hallucination, euphoria a b c d Gudin J, Fudin J (June 2020). "A Narrative Pharmacological Review of Buprenorphine: A Unique Opioid for the Treatment of Chronic Pain". Pain and Therapy. 9 (1): 41–54. doi: 10.1007/s40122-019-00143-6. PMC 7203271. PMID 31994020.Opioid Conversion Guide" (PDF). Department of Health, Government of Western Australia. February 2016. Archived (PDF) from the original on 18 April 2020 . Retrieved 10 February 2020. Subutex was the first opioid to be developed to replace methadone as the primary treatment of opioid addictions.

In simplified terms, buprenorphine can essentially be thought of as a nonselective, mixed agonist–antagonist opioid receptor modulator, [66] acting as an unusually high affinity, weak partial agonist of the MOR, a high affinity antagonist of the KOR and DOR, and a relatively low affinity, very weak partial agonist of the ORL-1/NOP. [54] [67] [60] [68] [69] [70] any medication that may cause drowsiness, such as amphetamines, benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, methadone, or morphine)

6.3 Shelf Life

As mentioned previously, and with all addiction treatments, they are very effective when followed correctly and when adjusted where needed.