Resource Center: Patient education materials

This book presents an historical overview of heroin use in the USA, as well as articles by experts in the field which focus on current developments and emerging trends in prevention, treatment, distribution and consumption. Filling a void in the literature on what is known about the `new' heroin users, this volume also updates the reader on the status of aging heroin-addicted populations who initiated use of the drug prior to the `age of cocaine'.
SAGE Publications
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides this website so that physicians can improve the deliver and financing of prevention, treatment and recovery support services to patients.
Substance Abuse and Mental Health Services Administration (SAMHSA)

How Opioids and Buprenorphine Work

How opioids and buprenorphine affect the brain.

This illustrated patient handout outlines how opioids and buprenorphine affect the brain.

Keys to Successful Addiction Treatment

This patient handout sheet offers a list of suggestions and reminders for successful addiction treatment.

Keys to Successful Addiction Treatment

Overcoming an addiction is not easy --it takes courage and commitment. However, as many people have discovered, the rewards of going clean and staying sober are worth the effort. Starting treatment is an important first step toward overcoming drug use. If you follow the guidelines listed below, your treatment will be much more effective, and you will have a better chance of staying drug-free. These keys to successful treatment are based on medical research and the experiences of thousands of patients who successfully stopped using drugs during treatment and remained drug-free afterward.

  • Above all else, stay in treatment! Patients who stay in treatment have a much better chance of staying drug-free than those who drop out.
  • Especially for the first month of treatment, you may feel very unmotivated to continue. This is normal -- most patients who drop out of treatment do so in the first 30 days. You need to be prepared for this feeling so you can better resist the urge to drop out.
  • Obey the program's rules -- they're in place to help you become drug-free. Also, many programs will stop your treatment if you don't follow the rules.
  • Develop a good relationship with your provider or counselor. Many people who have gone on to become drug-free have found that trusting relationships with their counselors were important in helping them complete treatment.
  • Make a commitment to your treatment and to changing your life. Don't just go to all your treatment sessions --take part in them, too.
  • Follow your treatment plan and use the services that your provider or counselor recommends.
  • Don't let a lapse become a relapse. Many people lapse and use drugs once, twice, or even more times during treatment. If this happens to you, it doesn't mean that your treatment has failed --but it does mean that you're having trouble. Talk to your provider or counselor about the lapse, and let them help you stop it from becoming a relapse --a return to drug abuse.
  • Ask for help if you need it! That's what your provider or counselor is there for.
  • Be prepared to make some major life changes. It's very hard to stay sober when the people around you are still using drugs. You will need to stay away from friends who use drugs and, if possible, get out of houses or even neighborhoods where drug use is going on. Follow these keys to treatment and you will be on your way to a drug-free life!

© 2010 Clinical Tools, Inc.

Common Side Effects of Buprenorphine

Patient Handout

These Are The Common Side Effects of buprenorphine

Buprenorphine is safe to use for most patients. Some people do experience side effects, but most of buprenorphine's side effects are not dangerous --they're just unpleasant.

Common minor side effects include:
Nausea Sweating
Constipation Headache
Drowsiness Depression
Disturbed sleep

If you experience any of the above, talk to your provider. Your provider may give you medicine to treat the side effects, or your provider may lower your dose of buprenorphine slightly. Regardless, most minor side effects will either go away as you become used to the drug or can be treated with minor lifestyle changes.

Some people with certain medical conditions are at risk for more serious side effects:

Drug Interactions: Some people who take both sedatives and buprenorphine have overdosed on one or both drugs. If you have been prescribed medications, make certain your provider knows. He or she may change how much of each drug you take. Also, while on buprenorphine, never take sedatives or other drugs except those prescribed by your provider!

Allergic reaction: If you develop hives or a rash while taking buprenorphine, you may be allergic to it. If this happens, call your provider or go to the emergency room immediately. Also, tell your provider if you know that you are allergic to drugs called buprenorphine or naloxone.

Respiratory depression: Like prescription narcotics and heroin, buprenorphine affects the reflexes that keep you breathing. In most patients, this effect is minimal, but it can be serious in patients who already have damaged or diseased lungs. If you have a condition that impairs your breathing, tell your provider before beginning buprenorphine.

Liver problems (hepatitis):
A few people have developed problems with their livers while taking buprenorphine. Most of these people already had liver problems like hepatitis B or C or cirrhosis due to alcohol abuse. If you have had liver problems in the past, make sure that your provider knows. He or she will monitor your liver closely during your treatment. If you develop severe stomach pain, severe nausea, or jaundice (skin and/or whites of the eyes look yellow), get to the hospital as quickly as possible. Your chances of full recovery are very good if you get treatment quickly.

Head injury: If you have suffered a severe head injury or have been told by a provider that you have an intracranial lesion, tell your provider before beginning buprenorphine. Buprenorphine causes a increase in pressure in the skull, and this can make your injury worse.

Talking to Your Provider

This patient handout sheet discusses the importance of honesty from both the patient and the provider when talking about drug use and treatment.

Be Honest With Your Provider

Your provider wants to provide the best possible treatment for you with a treatment plan that meets
your unique needs and circumstances. This can be achieved through a relationship based on
honesty and good communication. Be sure to tell your provider if you:
    Start taking a new prescription or over-the-counter medication
    Use an opioid, such as heroin, methadone, or a prescription narcotic
    Use other illicit drugs
    Crave opioids or think you might be experiencing withdrawal.

These are things that could alter your treatment plan, so be sure to bring them to your provider 's
attention right away. Your provider cares about you and is there to listen, so don't be afraid to speak
up if you have a problem or a concern.

Expect Your Provider to Be Honest With You

Just as your provider expects honesty and communication from you, you should expect the same
from him or her. Your provider should discuss several issues with you before starting a treatment
plan, including:

    Treatment philosophy --What is your provider's approach to treatment?
    Confidentiality --Who will have access to your information?
    Office policy --What is the policy for missed or canceled appointments?
    Prescription procedures --Will you receive take-home doses, or will you get your medication
    from a pharmacy?
    Urine testing procedures --How often will you provide urine samples, and how will the results
    be interpreted? What happens if your urine sample shows that you have been using drugs?

If your provider does not bring up these issues when starting your treatment, be sure to ask about
them. Remember, open communication, trust, and honesty will help make your treatment

Buprenorphine and Pregnancy -- What You Need to Know

This patient handout sheet explains concerns and risks for buprenorphine treatment of patients who are or wish to become pregnant.

Buprenorphine and Pregnancy -- What You Need to Know

Abusing heroin or prescription painkillers while you are pregnant is very dangerous --both for your own health and for the health of the baby you are carrying. The best action you can take is to get into treatment and stop using drugs.

What happens if you are pregnant (or want to become pregnant) and want to start taking buprenorphine?

Methadone maintenance treatment and buprenorphine monotherapy are both appropriate choices for pregnant women with opioid use disorder.

Drug-free treatments, naltrexone treatment, or "detox" are also good choices if you are just planning a pregnancy, but they are a bad idea if you are already pregnant --these treatments will force you to go into withdrawal, which could cause a miscarriage.

Your provider can advise you about other treatments and help you choose one that it right for you.

What happens if you are already using buprenorphine and want to get pregnant?

If you want to get pregnant, the safest thing to do is switch to another treatment that is safe to use during pregnancy -- methadone, naltrexone, or a drug-free treatment.

Let your provider know in advance if you want to become pregnant so you can work together to plan your change in treatment. Also, use birth control to reduce the chance of having an unplanned pregnancy.

But what happens if you are taking buprenorphine and get pregnant unexpectedly?

In this situation, you have 2 things to consider:
 There is a small chance that buprenorphine will hurt your child, but

If you switch from buprenorphine to any other kind of treatment (except for the buprenorphine only form --see below), you will probably go into withdrawal --and withdrawal could cause a miscarriage.

Miscarriage from withdrawal is the greater of these 2 risks. So, if you are already on buprenorphine and you become pregnant, you should not switch to another treatment.

There is only one change you should make --your provider will probably switch you from buprenorphine/naloxone combination to buprenorphine only form (monotherapy). Monotherapy has the same active ingredient as the buprenorphine/naloxone combination formulation and is used in the same way, but it doesn't have another ingredient (naloxone) which could be dangerous to take during pregnancy.

Remember to talk to your provider if you wish to become pregnant or suspect you are pregnant at any time while taking buprenorphine.

Starting buprenorphine: A Patient's Guide

This patient handout explains what each patient should do before, during, and after induction with buprenorphine.

Starting buprenorphine: A Patient's Guide

You can't just start or stop using buprenorphine-you have to be eased onto and off of it. The process of easing you onto buprenorphine is called induction.

Before induction: Heroin, prescription painkillers, and methadone all belong to a family of drugs called the opioids. Before you start on buprenorphine, your provider will ask you to stay off all opioids for a little while--usually less than a day. The exact amount of time you'll need to stay off opioids depends on what kind of
drugs you've been taking and how much you use per day.

After going for a day or two without using opioids, you will be in the early stages of withdrawal. You may feel uncomfortable for a little while, but you will feel better when you start taking buprenorphine.

If you do slip up and use an opioid during this time, you run the risk of going into sudden, intense withdrawal. Tell your provider if you used opioids, and he or she will reschedule your induction.

During induction:

Over the course of a few days (usually 1-3 days), your provider will gradually increase your dose of buprenorphine until he or she finds your ideal dose.

During this time DON'T use any opioids --you will probably go into withdrawal and be very uncomfortable!

DO expect to spend an extended period of time (2-4 hours each day) in the provider's office --your provider will need to keep you under observation while you adjust to the medication.

DO be prepared for a few days of craving -- you may crave opioids until the buprenorphine begins to kick in, but it is very important that you do not use them!

DO be honest with your provider how you're feeling --your provider needs to know about your mood, your level of craving, and your physical state to accurately determine your ideal dose of buprenorphine.

After induction:

DON'T stop using buprenorphine without talking to your provider --you will go into withdrawal.

DO tell your provider if you experience side effects due to the buprenorphine or if you crave opioids --your dose may need to be adjusted if you do.

DO take advantage of therapy and other resources that can help you stay drug free and stable!

Patient Handout: Buprenorphine or Naloxone Combination-What Does It Mean for You?

This patient handout explains buprenorphine, its makeup, and how it works to treat withdrawal.

Buprenorphine/Naloxone Combination Film or Tablets -- What do They Mean for You?

Your physician has prescribed buprenorphine/naloxone combination tablets (generic or Zubsolv®*) or film (Suboxone®) for you. There are a few things you should know before you begin taking it.

What is buprenorphine?
Buprenorphine is a type of drug called an opioid, similar to heroin, methadone or Oxycontin®. Taking buprenorphine will prevent you from going into withdrawal and should stop you from craving other opioids.

What is naloxone?
Naloxone counteracts opioids --including buprenorphine. If you take naloxone while you have an opioid in your system, or if you are dependent on opioids and find that you go into withdrawal without them, naloxone can trigger withdrawal.

That doesn't make sense --why would my provider prescribe a drug which will send me into withdrawal?
Your buprenorphine/naloxone combination medication will not send you into withdrawal --provided you take them as your provider prescribes!

If you dissolve the tablets or film under your tongue, or if you accidentally swallow one, the naloxone will not affect you --your body breaks the naloxone down too quickly for it to take effect! However, if you inject a combination tablet or film, the naloxone will take effect. You will probably not feel anything from the buprenorphine, and you could go into withdrawal.




How Taken Buprenorphine Naloxone What you feel
Under the tongue (as directed)
  • Works properly
  • Broken down by the body
  • No withdrawal; reduced craving
Swallowed (accidental)
  • Broken down by body
  • Medicine will not work; you could go into withdrawal or feel cravings
Injected (abuse)
  • Blocked by naloxone
  • Blocks effects of opioids
  • You could go into withdrawal very quickly




*We are using brand names since there is a difference in the product that is not reflected in the generic name. We are not advocating one brand or the other.

Factores claves para un tratamiento exitoso de adicción (Keys to Successful Addiction Treatment (en Español))

This patient handout sheet offers a list of suggestions and reminders for successful addiction treatment.

No es fácil superar una adicción – requiere coraje y dedicación. No obstante, como muchas personas han
descubiertos, las recompensas de estar limpio y mantenerse sobrio valen la pena.

Empezar tratamiento es un paso importante de superar el consumo de drogas. Si usted siga las pautas
enumerados abajo, el tratamiento será más efectivo y usted tendrá una mejor probabilidad de mantenerse
sobrio. Estos claves a un tratamiento exitoso se basan en investigaciones médicas y en las experiencias
de millones de pacientes quienes dejaron de consumir las drogas durante el tratamiento y luego se
mantenían sobrios.

   Sobre todo, ¡quédese en tratamiento! Pacientes que se quedan en tratamiento tienen una
   probabilidad más grande de mantenerse sobrios que los que abandonan el tratamiento.

   Especialmente durante el primer mes del tratamiento, es posible que usted no sienta muy
   motivado a continuar. Esto es normal – la mayoría de los pacientes que abandonan el tratamiento
   lo hacen durante los primeros treinta días. Es importante que usted se prepare para este
   sentimiento para que usted pueda mejor resistir las ganas de abandonar el tratamiento.

   Obedezca las reglas del programa – existen para ayudarle a volverse sobrio. Además, muchos
   programas pararán su tratamiento si usted no obedece las reglas.

   Desarrolle una relación buena con su médico o consejero. Muchas personas que han vuelto
   sobrios dicen que relaciones confiadas con el consejero fueron importantes en ayudarles a acabar
   el tratamiento.

   Comprométase a su tratamiento y a cambiar su vida. No simplemente vaya a las sesiones del
   tratamiento – tome parte en las también.

   Siga el plan del tratamiento y use los servicios que su médico o consejero se los recomienda a

   No permita que un lapso se convierta en una recaída. Muchas personas tienen lapsos y usan
   las drogas una vez, dos veces, o aun más veces durante el tratamiento. Si esto pasa a usted, no
   significa que el tratamiento ha fracasado – pero sí significa que usted está teniendo dificultades.
   Hable con su médico o consejero sobre el lapso, y permita que él/ella le ayude a usted prevenir
   que se convierta en una recaída – un vuelto al abuso de drogas.

   ¡Pida ayuda si la necesita! Su médico está allí para ayudarle.
   Esté preparado hacer algunos cambios grandes en su vida. Es muy difícil mantenerse sobrio
   cuando la gente en su alrededor todavía consume drogas. Usted necesitará evitar amigos que
   consumen drogas y, si sea posible, evitar casas o aun barrios donde el consumo de drogas

¡Siga estos claves al tratamiento y usted estará de camino hacia una vida sobria y libre de drogas!