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Substitution of heroin and methadone with buprenorphine using an overlap method without needing to wait for withdrawal

David Kingsley Payler (Worcestershire Drug and Alcohol Services, Worcester, Malvern and Evesham, UK)

Drugs and Alcohol Today

ISSN: 1745-9265

Article publication date: 5 December 2016



The purpose of this paper is to examine whether it is possible to switch patients from heroin or methadone to buprenorphine without needing to experience symptoms of withdrawal?


Review of author’s experience in 1980s where three patients transferred to 4 mg buprenorphine from 40 ml (1mg/ml) methadone without symptoms of withdrawal. Review of literature where patients were transferred to buprenorphine without waiting for withdrawal symptoms to occur. Presentation of six case histories in author’s clinic.


Provided the buprenorphine is commenced at a very low dosage, is gradually increased and the heroin/methadone is reduced over a period of time, it is possible to change from heroin or methadone without inducing withdrawal symptoms. It is not necessary to stop the heroin/methadone and wait for withdrawal symptoms to occur.

Research limitations/implications

Due to the author’s retirement in October 2015 further research into the production of a template which could be used universally has not yet been possible.

Practical implications

Transferring patients from heroin and methadone to buprenorphine has often been difficult. Waiting for withdrawal symptoms to occur has often resulted in treatment failure. The method described eliminates the problem for patients.

Social implications

Patients find the method is more acceptable and allows normal functioning.


Confirmation that the findings of the original case histories from 1980s were valid. The value to the treatment service should be considerable in simplifying the prescribing practice.



The author is grateful to Dr Steve Brinksman, Clinical Lead of SMMGP for his enthusiastic advice and referral to Dr Euan Lawson, Deputy Editor BJGP for guidance on getting the paper published. Blaine Stodhart, Deputy Editor of DAT has given freely of his time in proof reading the paper and giving practical help in submitting it.

Declaration of interests: none declared.


Payler, D.K. (2016), "Substitution of heroin and methadone with buprenorphine using an overlap method without needing to wait for withdrawal", Drugs and Alcohol Today, Vol. 16 No. 4, pp. 259-266.



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