Medication Reference Card — Opioid Use Disorder
Suboxone® & generic · S100 (MATOD) · Induction: COWS ≥8–12 · Maintenance: 8–24 mg/day
Buprenorphine is a medication that partially activates opioid receptors, reducing cravings and withdrawal symptoms without producing the high of stronger opioids. The naloxone component discourages misuse by injection. It is taken as a film or tablet under the tongue and can be prescribed by authorised GPs and specialists.
Buprenorphine: Partial mu-opioid agonist with very high receptor affinity, slow dissociation (long half-life 24–60 hrs), and ceiling effect for respiratory depression. Displaces full agonists — precipitates withdrawal if initiated before patient is in moderate withdrawal (COWS ≥8–12). Naloxone: short-acting antagonist; minimally absorbed sublingually but active if injected (abuse deterrent). Combination produces stable opioid receptor occupancy, eliminates cravings, and blocks the reinforcing effects of additional opioids.
Standard induction: 2–4 mg SL when COWS ≥8–12 (moderate withdrawal) — observe 1 hour, re-dose if tolerated. Titrate to 8–16 mg on day 1. Maintenance: 8–24 mg/day (most patients 12–16 mg/day). Low-dose induction (Bernese method): begin 0.5–1 mg while patient still on full agonist, increase gradually over days — avoids precipitated withdrawal entirely. S100 in Australia — requires MATOD enrolment and prescriber authority.
Strong evidence. Fudala et al. NEJM 2003: buprenorphine/naloxone significantly superior to placebo for opioid use disorder. NIDA CTN 0003: comparable to methadone for prescription opioid dependence. Lee et al. Lancet 2018 (X:BOT trial): extended-release naltrexone vs buprenorphine — both effective; buprenorphine easier to initiate (lower induction failure rate).