bpd.fyi

A patient-run resource on buprenorphine, BPD, and the endogenous opioid system.

Welcome

Many people with Borderline Personality Disorder continue to struggle with emotional pain and suicidal thoughts even after trying standard treatments.

A few years ago, I kept running into research linking BPD to the endogenous opioid system, and eventually to early evidence that low-dose buprenorphine might help. Even though it’s normally prescribed for opioid use disorder, very low doses reduced the emotional pain and instability that made daily life hard for me, and my suicidal thoughts resolved completely once I started treatment.

I built this page to share the research and my experience in case it helps someone else.

How Buprenorphine Works

Our brains have an endogenous opioid system that helps regulate physical pain, emotional pain, attachment, and distress. In BPD, several researchers have proposed that this system becomes dysregulated, often as a result of chronic invalidation, trauma, or ongoing inflammation.

Buprenorphine is unique because it:

Partially activates the mu-opioid receptor — reduces emotional and physical pain and supports social connection/seeking behavior
Blocks the kappa-opioid receptor — reduces dysphoria, stress-driven distress, and the aversive emotional pain response

It’s the only prescription medication that combines mu-agonism with kappa-antagonism.

Because buprenorphine is an opioid, people sometimes worry about addiction. At the very low doses studied for BPD and chronic suicidality, the addiction risk appears to be significantly lower than with full-agonist opioids, but physical dependence can still occur with long-term use. For people with a history of opioid addiction, this is an important consideration to discuss with a clinician. Many trials described their use as “time-limited,” partly because long-term data is still limited.

Other compounds with overlapping mechanisms:

Low-dose naltrexone (LDN, 0.5–4.5 mg) — at low doses, naltrexone briefly blocks opioid receptors and then appears to increase endogenous opioid activity and reduce inflammation after it wears off. This is different from the standard 50 mg dose typically used for addiction or alcohol use disorder, which produces full opioid blockade. Naltrexone is not an opioid, and LDN does not carry a risk of opioid addiction.
Kratom — a plant whose active alkaloids act as mu-opioid agonists with some kappa-opioid antagonism. It is much weaker and shorter-acting than buprenorphine, so people often need higher and more frequent doses to get similar effects. Kratom can be addictive and may cause dependence and withdrawal, and product quality and dosing are highly variable.

I'm sharing this information for context, not as a recommendation. LDN gave me some benefit, mostly improved sleep and a small lift in mood, but it didn’t address the social connection and emotional regulation problems that made daily life difficult. Some people also experiment with kratom because it has similar receptor activity, but it carries real risks. For my own BPD symptoms, prescribed low-dose buprenorphine has been far more effective and predictable than anything over-the-counter.

Medication is highly individual. Please research carefully and talk with a clinician.

My Experience

I started low-dose buprenorphine in November 2022. The effects were noticeable quickly, and importantly for me, they were stable over time.

My doctor started me at 0.5 mg, which ended up being too much — I had nausea, vomiting, and confusion. Lowering the dose resolved the side effects completely. To measure tiny amounts accurately, I diluted a 2 mg tablet in 2 mL of distilled water and used a 1 mL oral syringe to draw small measured doses from that.

I paused treatment in June 2024 to see whether I could manage symptoms through strict diet and inflammation control alone. That worked to a degree, but it was extremely limiting in practice. I ultimately chose to restart buprenorphine in November 2025 because it offered stability without requiring my entire life to revolve around symptom avoidance.

DBT gave me the tools to manage intense distress, but it didn’t change the cycles of suicidal ideation. Buprenorphine was the first treatment that ended those cycles and allowed my nervous system to calm down.

Here's what changed for me

Emotional regulation and baseline stability

My emotions became manageable. Even when I have a bad day, it’s no longer overwhelming or destabilizing. I don’t need to be on the edge of crisis to feel okay.

That baseline stability also improved my sleep, because I wasn’t carrying constant emotional volatility before bed.

Interpersonal sensitivity and fear of abandonment

I’ve always cared deeply about other people’s feelings. Before medication, I tended to absorb them as my own, especially distress or crying, which paradoxically made it harder to be present and supportive.

Buprenorphine helped create a boundary between my emotions and other people’s emotions. I still care, but their feelings no longer flood my nervous system.

My fear of abandonment also changed dramatically. I used to experience repetitive, intrusive thoughts that my partner was leaving me — even when I knew intellectually that it wasn’t true. Those thoughts no longer occur.

Relationships and splitting

I haven’t experienced relationship blowups or “splitting” while on buprenorphine. While splitting wasn’t frequent for me before, it did happen occasionally. After pausing treatment, I experienced one split that I was only able to recognize in retrospect. Since resuming treatment, this has not occurred.

As a result, my relationships feel steady rather than fragile. I’m also more socially connected and more inclined to seek connection. While off medication, reaching out to friends and family felt difficult or conditional — something I did only when required or when I could be useful. On buprenorphine, connection feels more accessible and less loaded. I reach out to friends and family now because it feels natural, not because I’m forcing myself to.

Chronic emptiness and sense of self

The chronic feeling of emptiness lifted. I can enjoy doing things by myself without needing to fill a void.

Relatedly, my sense of identity feels more coherent. I feel like my own person rather than someone whose identity depends on my environment or relationships to feel real.

Impulsivity, anger, and internal calm

I have what’s often described as “quiet” BPD, so my anger tended to be internal rather than outwardly visible. That didn’t make it less intense.

Buprenorphine brought a noticeable internal calm. People who know me well can see that difference now.

I also don’t feel pulled toward impulsive or edge-of-crisis behavior to regulate my mood. Feeling okay no longer requires chaos.

Self-esteem

My confidence and self-esteem improved in a way that other treatments hadn’t addressed for me. I was told that my level of self-esteem was something I would have to accept. I didn’t find that answer workable. In my case, medication changed that baseline.

Timing and limits

I noticed positive effects the same day I started. The benefits seemed to peak over the first few weeks as I adjusted dosage.

This hasn’t made everything perfect. It has made my life substantially more stable and livable.

Safety, Interactions, & Tapering

This section isn’t medical advice. It’s harm-reduction context from my experience with buprenorphine, meant to help you go into conversations with your clinician more informed and prepared.

Interactions

Buprenorphine is an opioid medication. Even at low doses, it can interact with other substances, especially those that depress the nervous system. Combining buprenorphine with any of the following increases the risk of sedation or respiratory depression:

Benzodiazepines (Xanax, Klonopin, Ativan)
Alcohol
Other opioids (including “weak” ones like codeine or tramadol)
Gabapentin or pregabalin
Sedating sleep medications
Muscle relaxants

This isn’t unique to buprenorphine. It’s a general opioid safety principle, and it still applies even when the dose is very small.

Dependence & Withdrawal

Buprenorphine has a lower addiction risk than full opioid agonists, and low-dose approaches reduce that risk further. Even so, dependence can still occur, and stopping suddenly may lead to withdrawal symptoms. When I discontinued buprenorphine after a year and a half without tapering, I experienced mild withdrawal for about a week.

Discontinuation Risk

In people being treated for opioid use disorder (OUD), research shows an increased risk of suicide or overdose in the 8–14 days after stopping buprenorphine. This appears to be related to a combination of withdrawal stress, loss of opioid tolerance, and the return of symptoms the medication was helping to manage.

We don’t yet know whether this elevated risk also applies to opioid-naive individuals using low-dose buprenorphine for emotional dysregulation or suicidality — it hasn’t been studied. Still, it's worth being aware of if buprenorphine is ever used short-term, since follow-up and continuity of care would be important for anyone in crisis.

Tapering

In my case, I didn’t get much guidance on how to taper off low-dose buprenorphine. Many people report that the smaller the dose, the more important it becomes to taper very gradually.

I found this resource helpful for understanding general tapering principles:
http://www.helpmegetoffdrugs.com/taper

It explains why reducing the dose to very tiny amounts can make withdrawal more manageable. They also include a clear disclaimer: their taper schedule isn't personalized, and anyone who chooses to follow it is responsible for their own decisions.

Dental Warning

If you take buprenorphine under the tongue or inside the cheek, it can damage teeth and gums over time — even at low doses.

Common issues include:

Cavities
Enamel erosion
Gum irritation or recession

Rinse with water after each dose and wait at least an hour before brushing. Let your dentist know you take buprenorphine so they can monitor your oral health closely.

Research & Background

Key papers on buprenorphine for BPD or treatment-resistant depression:

The Interpersonal Dimension of Borderline Personality Disorder: Toward a Neuropeptide Model (2010)
Proposes that many BPD symptoms stem from dysregulation in the brain’s endogenous opioid system, and suggests that buprenorphine could be therapeutic because of its partial opioid-agonist effects.
Safety, Tolerability, and Clinical Effect of Low-Dose Buprenorphine for Treatment-Resistant Depression (2014)
Shows low doses improve mood in people whose depression didn’t respond to standard treatments.
Ultra-Low-Dose Buprenorphine for Severe Suicidal Ideation (2015)
Finds a rapid and clinically significant reduction in suicidal thinking, often within the first week. (Some patients improved within several days.)
Use of Buprenorphine in Treatment of Refractory Depression — A Review (2017)
Summarizes evidence supporting buprenorphine’s antidepressant and anti-suicidal effects.
The Use of Buprenorphine/Naloxone to Treat Borderline Personality Disorder: A Case Report (2022)
Documents successful treatment of BPD symptoms using buprenorphine/naloxone. The patient started at 2 mg and titrated up to 6 mg, which is higher than the doses used in low-dose studies but was effective for this individual case.

Most low-dose buprenorphine studies used doses in the range of 0.1–0.44 mg per day. These microdoses are far smaller than the doses used for opioid use disorder, and the clinical effects in BPD and chronic suicidality appear to come from partial mu-agonism at very low levels. My own effective dose fell in this range as well.

Another important paper is Borderline Personality Disorder: A Dysregulation of the Endogenous Opioid System? (2010). Seeing a biological explanation for BPD that matched my lived experience helped me understand my symptoms in a way that finally made sense.

Access to Research

Full-text papers aren’t always freely available. Tools like Sci-Hub and other publicly available mirrors exist, and many people use a DOI or article title to look up papers directly.

Access to medical information shouldn’t be gatekept. For many people, being able to read the research directly is the difference between suffering without answers and finding something that works.