January is Substance Use Disorder Treatment Month

During this month, SAMHSA observes the annual campaign serving to raise awareness on substance use disorders, offer support, share resources, and break down barriers that keep people from seeking help. Learn more and find a helpful toolkit related to the campaign here.

This Week’s Focus: Buprenorphine

This week’s briefing focuses on buprenorphine (also referred to as “Bupe”), often combined with naloxone under the brand name Suboxone (or as Subutex without naloxone), a partial mu-opioid agonist approved by the FDA for treating opioid use disorder (OUD) and pain. Research has consistently demonstrated its effectiveness in reducing opioid use, cravings, and opioid-related morbidity and mortality. Compared to other opioids, buprenorphine offers a favorable safety profile, with a lower risk of misuse, addiction, and adverse effects when administered at approved doses under medical supervision.

Despite its effectiveness, research has also highlighted concerns regarding diversion and nonmedical use. Nonmedical use has been associated with emergency department visits and adverse outcomes, particularly among individuals without OUD, as buprenorphine can still produce opioid-like effects; with severe complications arising from polysubstance use which can result in respiratory depression and overdose.

This underscores the importance of careful clinical management and patient education regarding potential drug interactions, along with ongoing research into adverse events associated with buprenorphine, as this is essential to inform policy, enhance safety, and optimize clinical practice for opioid agonist therapy, especially as buprenorphine access continues to expand.

Our NDEWS Special Report identifies the top 10 US counties with the highest rates of emergency medical service (EMS) encounters for reported nonfatal buprenorphine-related overdoses between January 2023 and December 2025. Analyses of Reddit data from NDEWS Web Monitoring reveal increasing mentions of diversion and non-prescribed buprenorphine use, suggesting a potential shift from therapeutic use toward patterns occurring outside clinical supervision. This briefing also includes a selection of recent and historical papers on buprenorphine exploring both benefits and risks, followed by news updates and additional resources. 

Lastly, we invite you to join us for the upcoming Our Community, Our Health Town Hall - NDEWS Webinar with the National Association of State Controlled Substances Authorities (NASCSA) on January 20,2026 at 2:00 pm - 3:00 pm ET: The National Drug Early Warning System: Emergency Overdose Trends, Emerging Drugs of Abuse and Why this Matters to States. Register here.

As always, we welcome your input.

Out of 2,510 EMS encounters for nonfatal buprenorphine-related overdoses from January 1, 2023 to December 31, 2025, the data shows that most counties and most EMS encounters per 10,000 population were located in the Southern region.

Methodological note and limitations: Narrative Text search of patient complaint/narrative was used to identify reported nonfatal buprenorphine-related EMS encounters and were defined based on the Enhanced State Opioid Overdose Surveillance (ESOOS) criteria as defined by the state of Rhode Island. Encounters in which buprenorphine was administered by EMS were excluded. Data reflect pre-hospital EMS encounters and do not include hospital outcomes. Much of the data relies on clinical impressions, self-report, or bystander accounts, and polysubstance use contributing to overdose cannot be ruled out. Additionally, EMS encounters for nonfatal buprenorphine-related overdoses may be underreported, overreported or misclassified.

To view the entire Special Report from the weekly briefing, click here.

Click here to learn more about NDEWS Hotspot Alerts

Why are we reporting on this? Buprenorphine is a partial opioid agonist widely prescribed for Medication for Opioid Use Disorder (MOUD) and chronic pain management. While it remains a critical harm reduction tool, Reddit discussions increasingly reference diversion and non-prescribed use of buprenorphine. The online conversations analyzed for this report emphasize attempts to obtain euphoric effects, experimentation with non-medical routes of administration, and use of buprenorphine as a “bridge” between high-potency synthetic opioids such as fentanyl or nitazenes. These discussions suggest a shift from therapeutic use toward patterns of use outside clinical supervision, raising public health concerns related to overdose risk, polysubstance use, and misunderstanding of buprenorphine’s safety profile.

What is Buprenorphine? Buprenorphine is a long-acting, partial opioid agonist available in multiple formulations, including sublingual tablets and films (often combined with naloxone), transdermal patches, buccal films, oral solutions, and extended-release injectable products. It is approved for the treatment of opioid use disorder and certain pain conditions. Although its pharmacology can attenuate the effects of full opioid agonists, buprenorphine still carries risks of opioid use disorder and overdose, particularly when used outside prescribed parameters or in combination with other central nervous system (CNS) depressants.

Public Health Impacts: Across multiple Reddit threads, discussants describe adverse effects associated with non-prescribed or non-medical use of buprenorphine, particularly among individuals without established opioid tolerance. Commonly reported effects include severe nausea, prolonged vomiting, intense sedation, and significant constipation. Multiple Redditors describe dysphoric or “dark” mental states following use, characterized by emotional blunting, anxiety, and reduced enjoyment. Discussions also reference overdose-like symptoms, including unresponsiveness and dangerously shallow breathing, most often in the context of combining buprenorphine with benzodiazepines, gabapentinoids, alcohol, or other opioids. Confusion regarding buprenorphine’s role in overdose response—including incorrect beliefs that it can substitute for naloxone—is frequently noted, indicating elevated risk associated with misinformation.

How is it Being Discussed? Reddit commenters frequently discuss obtaining buprenorphine without a prescription through diverted pharmaceutical products or informal sources. There is substantial focus on routes of administration outside labeled use, including insufflation of sublingual tablets and injection of dissolved films, described as methods to achieve faster onset or stronger effects. Discussions commonly center on transitioning between buprenorphine and high-potency opioids, with Redditors seeking strategies to avoid precipitated withdrawal or to attenuate buprenorphine’s receptor-blocking properties.

Polysubstance use is a dominant theme, with discussions describing combinations involving benzodiazepines, gabapentin or pregabalin, kratom, dextromethorphan (DXM), stimulants, cocaine, and other opioids—often framed as efforts to enhance sedative or euphoric effects. Many threads describe self-directed use of buprenorphine to manage withdrawal symptoms without medical supervision. Redditors also discuss early euphoric effects reported among non-tolerant individuals and note that these effects diminish with continued use, sometimes leading to escalation or higher-risk combinations.

Click here to read more about NDEWS Online Monitoring.

A paper published early last year in Current Addiction Reports by da Costa et al., featuring NDEWS SAG member Mark Gold, reviews the principles of buprenorphine in treating opioid use disorder (OUD), emphasizing recent advances and strategies for complex clinical scenarios. Risks of misuse and diversion are noted in the review, highlighting data showing that buprenorphine misuse trended down from 2015 to 2019. In response to challenges posed by synthetic opioids, new strategies have emerged, including modified buprenorphine initiation protocols and alternative overdose management approaches, aimed at reducing risks and improving patient-centered care. Read the full review here.

A 2023 publication in the Journal of Studies on Alcohol and Drugs by Dai et al., analyzed data on drug-related deaths in West Virginia from 2005 to early 2020 using demographic data, toxicology reports, autopsy findings, and medical/prescription histories; with comparisons made between buprenorphine-involved deaths (BIDs) and other drug-related deaths. Among the total 11,764 drug-related deaths, 564 (4.8%) involved buprenorphine. Buprenorphine alone caused death in 0.2% of cases (20 deaths), with most buprenorphine-involved deaths (BIDs) involving polydrug use (≥5 drugs in 23% of cases); common co-intoxicants identified include benzodiazepines (47.3%), methamphetamine (27.1%), fentanyl (22.9%). Cardiovascular and pulmonary comorbidities were present in 43% and 21% of BIDs. Only 23.4% of BIDs had a current buprenorphine prescription. Read the full study here.

A 2023 published cross-sectional study in JAMA Network Open by Tanz et al., analyzed data from 4,474 opioid-involved overdose deaths between July 2019 to June 2021 to assess whether COVID-19 pandemic prescribing flexibilities increased buprenorphine-involved overdose deaths. While overall opioid-involved overdose deaths rose during the pandemic, the proportion involving buprenorphine fluctuated but did not increase, with 2.6% of overdose deaths involving buprenorphine. Most buprenorphine-involved deaths (92.7%) involved at least one other drug compared to other opioid deaths. Prescribing flexibilities during COVID-19 did not lead to an increase in buprenorphine-involved overdose deaths. Expanding access to buprenorphine treatment remains essential. Read the full study here.

A recently published paper in Academic Emergency Medicine by Cowan et al., featuring NDEWS SSD Director Jeanmarie Perrone, assess opioid and nonopioid drug use during the week following emergency department (ED)-initiated extended-release buprenorphine (XR-BUP) treatment using self-reports and urine drug screens (UDS) from July 2020 - May 2023 across 4 urban academic EDs in the US. Results support ED-initiated XR-BUP's effectiveness for early overdose risk mitigation and its potential as an ED-based intervention for OUD. Of the 81 participants who completed at least 1 daily drug use survey, 98% reported at least one opioid-free day; 63% reported no opioid use for all 7 days. Day 7 UDS showed reduced detection of opioids, stimulants, and benzodiazepines, with polysubstance use declining over the week. Read the full study here.

A recently published retrospective cohort study in Forensic Science International by Stam et al., analyzes methadone- and buprenorphine-related deaths in the state of Victoria, Australia between 2009–2021 using coronial data, treatment permits, toxicology, and autopsy findings to identify opportunities for improving opioid agonist treatment practices. Results suggest that there 131 buprenorphine-related deaths, with drug diversion accounting for 41.2% of buprenorphine deaths. The breakdown of polydrug involvement in buprenorphine deaths is as follows: 75% involved other opioids; 77% involved central nervous system depressants; 61% involved opioids + benzodiazepines + buprenorphine. Read the full study here.

In August 2025, the City of Seattle celebrated a milestone resulting in more patients receiving follow-up care initiated through the Health 99 post-overdose response team pilot program. The program began with paramedics in early 2024 and expanded to Emergency Medical Technicians (EMT) later that year, which made Seattle the first city in the United States to allow firefighters/EMTs to provide buprenorphine in the field. Since the launch, 148 administrations have been reported, with 48 by paramedics and 100 by EMTs. Read the full press release here.

The U.S. Drug Enforcement Administration, in partnership with the Department of Health and Human Services (HHS), has issued a Fourth Temporary Extension of the COVID-19 Telemedicine Flexibilities for the Prescription of Controlled Medications, extending the current telemedicine flexibilities through December 31, 2026. The two final rules published by the DEA and HHS are titled Expansion of Buprenorphine Treatment via Telemedicine Encounter and Continuity of Care via Telemedicine for Veterans Affairs Patients. Read the full press release here.

SAMHSA's Buprenorphine Practitioner Locator lists practitioners authorized to treat opioid dependency with buprenorphine by state. While it is not an exhaustive list of all practitioners able to prescribe buprenorphine nationwide, this tool serves as a good starting point for those seeking treatment. Access the locator here.