Bunavail is one of many medications for treating the withdrawal symptoms and drug cravings that occur during detox and early recovery from opioid use disorder (OUD). Bunavail is used in medically-assisted detox. Bunavail, like other medications used to assist people in recovery from addiction, is not a stand-alone treatment for addiction. Bunavail is a part of an overall comprehensive treatment program for the complex challenges presented by addiction. What is Bunavail? Bunavail is a brand-name medication containing buprenorphine and naloxone. Buprenorphine is an opioid that has pharmacological properties that make it well suited for opioid replacement therapy: It displaces other opioids from their receptors in the brain and blocks other opioids from attaching It has low opioid activity (it is a partial opioid agonist), so it causes very little euphoria and has a low risk of overdose It has a long half-life, so it can be dosed every other day or twice weekly It has a “ceiling effect,” meaning its negative effects max out and don’t increase with further use Naloxone, the other active ingredient in Bunavail, is the perfect addition to buprenorphine. It is an opioid blocker (opioid antagonist). It prevents attempts at abusing opioids by blocking the effects of opioids. Although there are other pharmaceutical buprenorphine-naloxone combinations available, Bunavail is unique in that it comes as a small, thin strip that dissolves when it is applied to the inside of the cheek, inside the mouth. Bunavail strips are bi-layered with the medication side and a backing to prevent swallowing the medication. It is the only buprenorphine product that has this feature. Bunavail Approval by FDA Bunavail FDA approval was first received in 2002 for use in the maintenance treatment phase of medically-assisted treatment, and in 2017 for the initiation of buprenorphine treatment. Bunavail vs. Suboxone Bunavail and Suboxone both contain the same two medications but have slightly different delivery systems. Suboxone comes in a tablet that dissolves under the tongue. Because of how the Bunavail strip distributed medication, Bunavail gets more medication into the bloodstream and less swallowed than Suboxone does. This factor is important because buprenorphine does not work well when swallowed. How to Take Bunavail The manufacturer provides detailed guidance on how to take a Bunavail strip. The recipient wets the inside of the cheek with the tongue, then applies the side with the active ingredients (which is marked with BN2, BN4 or BN6) to the wetted area and holds it in place for 5 seconds. The strip sticks upon contact. The backing prevents any of the drug from being swallowed, ensuring that it is nearly all absorbed into the blood. The Bunavail film dissolves completely, so there is no residual film to remove afterward. The Bunavail strip is easy to apply with a fingertip and it stays in place. People can talk while the medication dissolves and the strip has a “citrus blend” flavor. How Long Does Bunavail Take to Dissolve? Bunavail comes in three strengths that each take a different amount of time to dissolve. However, according to the manufacturer, each should completely dissolve within 15 to 30 minutes. People should not eat or drink until the strip is completely dissolved. Bunavail Treatment for Opioid Dependence Does Bunavail block opiates? Yes, Bunavail works for treating OUD withdrawal by blocking opiate and opioid receptors, preventing other opioids from having any effect and preventing the brain from experiencing the shock of sudden withdrawal. Who Should Take Bunavail? According to the Bunavail prescribing information from the FDA, Bunavail should be used for the treatment of OUD in adults over the age of 18. Bunavail is intended for use as part of a comprehensive opioid addiction treatment regimen and should not be used as a stand-alone therapy. Bunavail is well suited to outpatient and office-based management, which makes it an especially useful option for people who are receiving outpatient treatment or are following discharge from a residential or inpatient rehab program. Who Should Avoid Bunavail? Bunavail should not be used for pain management; some buprenorphine medications are used for treating pain, but Bunavail is appropriate only for the treatment of OUD. Bunavail side effects may be magnified and have serious or even fatal consequences if taken together with benzodiazepines or other central nervous system depressants, including alcohol. People taking Bunavail should be forthcoming with their prescriber about their medications and consider the following: People with impaired liver function should not take Bunavail unless cleared by their physician Bunavail should not be used during pregnancy or in women who may become pregnant It also should not be used by women who are breastfeeding Bunavail should not be used by children Bunavail should not be started until withdrawal effects from opioid use have started, or a prescribed amount of time has passed since the last dose How Long Does Bunavail Block Opiates? How long does it take for Bunavail to kick in? Bunavail may precipitate withdrawal symptoms quickly when it is started too early because of naloxone’s rapid onset of action. However, buprenorphine, which relieves withdrawal symptoms, takes three to four hours to reach peak levels in the blood. How long does Bunavail last? The two active ingredients in Bunavail have different half-lives: Buprenorphine: 16.4 to 27.5 hours Naloxone: 1.9 to 2.4 hours It takes six to seven half-lives for a drug to be generally eliminated from the body, with buprenorphine taking three to five days until its levels are low enough to start causing withdrawal symptoms. Bunavail Side Effects Side effects vary from person to person and may diminish over time. Common side effects of Bunavail may include: Dependence/addiction Withdrawal symptoms Headache Low energy, lethargy or fatigue Sweating Constipation Drowsiness Low blood pressure People should not operate machinery or drive until they see how Bunavail affects them. Overdose Despite being only a partial opioid agonist, Bunavail may produce a high. People who have been using opioids usually do not feel any high because of their high tolerance, but the Bunavail high is usually noticeable for those who don’t regularly use opioids. As with any opioid, some people may try to figure out how to abuse Bunavail, and an overdose may occur. Some symptoms of a Bunavail overdose are: Pinpoint pupils Sedation, loss of consciousness, coma Low blood pressure Respiratory depression (slow, shallow breathing, or not breathing at all) Death The risk of an overdose occurring is reduced in Bunavail because of the presence of naloxone and because of buprenorphine’s ceiling effect. However, an overdose is possible in opioid-naive individuals who take Bunavail, people who try injecting Bunavail or in people who take large doses of opioids to try to overcome the opioid blocking effects of Bunavail. Bunavail Effectiveness for Opiate Addiction Recovery Buprenorphine is superior to methadone for tolerability (i.e., people are more likely to remain on buprenorphine than they are on methadone). One study showed that buprenorphine is associated with a one-year retention rate of 75% (in a recovery program) and 75% passed urine drug tests, compared to 0% on both measures in people taking a placebo. Other studies have shown that buprenorphine is highly effective, and has been associated with: Reduced mortality Reduced relapse rates Reduced HIV and Hepatitis C transmission rates Improved outcomes in pregnancy Improved retention within recovery programs Improved quality of life. The combination of buprenorphine and naloxone, such as in the Bunavail medication, has been shown to offer the same benefits as buprenorphine alone, but with the added benefit of further reducing abuse potential or relapse. Additionally, the Bunavail buccal film delivery system has demonstrated improved uptake of the drug and reduced swallowing compared to other oral delivery systems. The Recovery Village Palm Beach Offers Bunavail Treatment to Help You Recover The Recovery Village Palm Beach offers Bunavail treatment and a number of other options for addressing opioid addiction. Treatment plans are highly individualized and all options are discussed with clients. Medical detox is the safest way to begin long-term sobriety. Key Points: Understanding Bunavail Treatment and Your Recovery Bunavail is a useful option for MAT. Keep the following key points in mind regarding Bunavail: Bunavail is a combination formulation of buprenorphine and naloxone, used only for OUD Bunavail has a unique route of administration: a double-sided strip that sticks to the inside of the cheek Bunavail, like other medications, is not a stand-alone treatment for OUD. It is only a part of an overall treatment plan. Bunavail has abuse potential Bunavail has proven effectiveness as part of a comprehensive treatment plan for OUD If you or a loved one struggle with a substance use disorder, The Recovery Village Palm Beach can help. Call to speak with a representative to find out what treatment options may work best for you. Take the first step toward a healthier future, call today. SourcesBunavail. “Medication guide Bunavail.” February 2018. Accessed July 19, 2019. Food and Drug Administration. “Highlights of prescribing information: Bunavail.” February 2018. Accessed July 19, 2019. Kakko, Johan; et al. “1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: A randomised, placebo-controlled trial.” The Lancet, February 22, 2003. Accessed July 19, 2019. Kleber, Herbert. “Pharmacologic treatments for opioid dependence: Detoxification and maintenance options.” Dialogues in Clinical Neuroscience, December 2007. Accessed July 19, 2019. Mauger, Sofie; Fraser, Ronald; Gill, Kathryn. “Utilizing buprenorphine-naloxone to treat illicit and prescription-opioid dependence.” Neuropsychiatric Disorder Treatment, April 7, 2014. Accessed July 19, 2019. Velander, Jennifer. “Suboxone: Rationale, science, misconceptions.” The Ochsner Journal, 2018. Accessed July 19, 2019.