Common use of Buprenorphine Sublingual Tablets (Buprenorphine e.g Clause in Contracts

Buprenorphine Sublingual Tablets (Buprenorphine e.g. Subutex®) If this is the client’s first dose of buprenorphine the pharmacist should explain they must have waited at least 8 hours since their last heroin use or at least 24 hours since their last dose of methadone. Ideally clients should be in the early stages of withdrawal before taking their first dose. This is to minimise the risk of precipitated withdrawal. This is what happens when buprenorphine displaces the opioid before the opioid is out of their system. It is the client’s responsibility to assess his or her own withdrawal state and readiness for the first dose. A drink of water should be supplied to the client prior to dose to moisten the mouth (this aids dissolution of the tablet). It should be explained that the tablet(s) must be dissolved under the tongue to absorb the active ingredient and the client should avoid swallowing (both the tablet(s) and saliva whilst dissolving). The accredited Pharmacist or Authorised Pharmacy Technician will place the tablet(s) into a pot and hand to the client. The accredited Pharmacist or Authorised Pharmacy Technician will then observe the client placing the tablet(s) under the tongue to dissolve. The accredited Pharmacist or Authorised Pharmacy Technician can ask to observe the tablets in situ under the tongue before they begin to dissolve (to ensure tablets have been placed under the tongue). The client should be observed until the tablet(s) have dissolved; the client should then open his/her mouth to confirm the tablet(s) has dissolved. Supervision is most important in the first three minutes during which time the majority of the tablet will have dissolved and the risk of diversion greatly reduces. It should be noted that different brands of Buprenorphine have different dissolution rates. Patients should be advised that excessive saliva production may reduce the effectiveness of the drug and is not desirable. Saliva should be ideally kept in the mouth and not swallowed. Crushing of Buprenorphine prior to administration is not recommended but it may be required in exceptional circumstances. It should be noted though that this is an off label use.