@stulerner As many people are coming here for advice, I feel it necessary to clarify one thing you said in your post: "It's a low-grade narcotic." My major was doctor of pharmacy and I tend to get pedantic when it comes to stuff like this so please don't take offense; with the current opioid epidemic, I feel it's necessary to make sure correct information and proper education are made available.
Buprenorphine is a partial opiate agonist (why some people think it's safer, less strong than other opioids). To give an example of the difference of partial agonists and full agonists, consider marijuana and synthetic cannabinoids known on the street as 'Spice' : THC in marijuana is a partial agonist at cannabinoid receptors and once concentrations reach a certain level, no more drug binds to receptors (no one has ever died from just marijuana). 'Spice', or synthetic cannabinoids are often full agonists, and the more one takes, the more hits receptors and it causes fever, psychosis (anecdotes from nurses and ER staff describe extreme aggression, dissociation, and cannibalistic actions [those stories you hear about high people taking bites out of their significant others are not urban legends, they're real and a major reason why the product that was once available at gas stations is now illegal). This is NOT a perfect example… the fact that buprenorphine is only a partial and not a full agonist DOES NOT mean that it is safer and unable to kill you. Any number of factors can cause it to be fatal such as respiratory depression from mixing it with other CNS depressants, being abused/being taken by an opiate naive patient, and the list goes on. I'm sure your doctor and or pharmacist counseled you on this, but be sure to dispose of the used patches appropriately by folding them (adhesive and drug side in the center) and disposing of them in a manner that prevents them from accidental exposure to anyone or from trying to abuse them. You'd be amazed what desperate people who are addicted to opiates will do to avoid withdrawal.
Even though buprenorphine is only a partial-agonist, its affinity for opiate receptors (how strongly the drug binds to the receptor) is so strong that a patient taking buprenorphine who finds themselves in severe pain from an accident or needing surgery, commonly used opiates like morphine cannot knock buprenorphine out of the opiate receptor and will have no effect. For this reason, ERs and hospitals have been known to keep an opioid called sufentanil on hand. Sufentanil is 500-1,000 times stronger relative to oral morphine (fentanyl is 50-100) with a stronger receptor affinity so that it can knock buprenorphine out of the receptor and provide analgesia to the patient. This is a very complex issue for anesthesiologists as it's not an every day issue they run into, nor does every hospital carry sufentanil. They need to take into account a patient's weight, the dose, route of administration, and length of time a patient has been on buprenorphine (possibly even obtaining drug/drug metabolite concentrations from blood/urine if time allows and the situation calls for it).
Sublingual buprenorphine is 40 times stronger relative to oral morphine; not a 'low-grade narcotic' by any means (and the term 'low-grade narcotic' is misleading; it's not medically descriptive nor is it a term that medical professionals use. It's vague and can lead one into, wrongly, thinking it's describing strength, binding affinity, risk, side effects, abuse potential, addiction potential, etc. It does not attempt to describe any one characteristic of any opioid and is dangerous). It carries the same risks, addiction/abuse potential as other opioids. To compare, oral oxycodone is 1.5 times stronger than morphine.
(Sublingual absorption of medications, very generally speaking, is similar to transdermal in that it bypasses the gastrointestinal system and is absorbed into the blood stream.)
Buprenorphine is expensive and often needs a prior authorization as it is not usually covered by insurances (I started off on sublingual buprenorphine until I had to switch insurances). Double check with your insurance company if a doctor says they submitted a prior authorization and it was denied… mine is an isolated case (I've worked in pharmacies since I was 16 [I'm 32]), but the doctor who prescribed it for me was understaffed and I found out from my insurance company that he/his office did not submit a prior authorization despite telling me he did and it was denied.
Many people think sublingual buprenorphine is Suboxone (Suboxone is buprenorphine AND naloxone and used for opioid dependence; solo sublingual buprenorphine (Subutex) does not have the opioid antagonist naloxone in it).
It's awesome that transdermal buprenorphine (Butrans) has provided you the level of pain relief that it has! I hope you don't take offense to my post or think I was singling you out to pick on. I just joined this group, and have made similar posts as I worry about misinformation being spread; most especially when it's referring to opioids.
For more information on transdermal buprenorphine (Butrans), talk to you doctor, pharmacist, and/or navigate to butrans dot com.
(I have never worked for a pharmaceutical company in case anyone had concern I may have a conflict of interest; I neither promote, nor discourage opioid use in patients who are deemed medically and psychologically appropriate for them and without a personal or family history of addiction of any kind. Before taking or discontinuing any medication, talk to your doctor/doctors and pharmacist about their risks versus benefits, any contraindications you may have, adverse reactions you may experience, and potential interactions with other drugs, food, or supplements you may be taking).