It is surprising that buprenorphine isn't used more often, at in the most severe cases. I'm guessing some of that reluctance comes from the fact that, althought it is a synthetic opioid, it's still an opioid. That can make some doctors nervous, especially with patients who have never taken an opioid or who have histories of any kind of addiction. It might not be the solution for everyone, but I would think doctors would consider it for those with severe RLS who can find no other relief. Warm wishes. - Lori (Team Member)