Eligibility Criteria:
Inclusion Criteria:
* Subject has a diagnosis of RLS, defined by International Restless Legs Study Group (IRLS) essential criteria:
* An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.
* The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting.
* The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.
* The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night.
* Subject has moderate to severe RLS symptoms,defined as an International Restless Legs Scale (IRLS) score greater than or equal to15 at the baseline visit (visit 2).
* Subject has RLS symptoms that, in the opinion of the investigator, require round-the-clock treatment.
* Subject speaks and reads English.
* Subject is able to provide informed consent.
* Subject is age ≥25 and ≤75.
* Subject has BMI ≥18 and ≤35
* Subject is naïve to opioid treatment, defined as subjects not having received ≥5 mg oxycodone in the past 14 days and no history of daily use of ≥5 mg oxycodone equivalents in the past 3 months.
* If subject is currently being treated for RLS, s/he must have an inadequate response to or be intolerant of current, non-opioid regimen.
* If subject is not currently being treated for RLS, s/he must have a contraindication to or a history of intolerance to non-opioid treatment options for RLS, concerns about side effects of such options, or a preference for non-oral medication.
* If subject is currently being treated with a medication for RLS, a washout period of at least 3 days will be required (or 5 half-lives for longer-acting agents).
* Subject's history and/or clinical records document no change in medications active in the central nervous system (antidepressants, analgesics, antipsychotics, antiepileptics, hypnotics, etc.) for at least 30 days prior to visit 1.
* Subject is able to understand study procedures and agrees to remain on stable medications during the period of the study.
* Women of childbearing potential must agree to use a medically accepted method of birth control. Acceptable forms of birth control include:
* Condom + spermicide
* Diaphragm + spermicide
* Oral contraceptive pills, hormone implants (like Norplant), or injections(like Depo-Provera)
* Intrauterine Device
Exclusion Criteria:
* Lifetime history of DSM-IVopiod, alcohol, or other substance abuse.
* History of opioid treatment for RLS with inadequate response
* Positive urine toxicology screen at visit 1.
* Another chronic pain syndrome that would, in the opinion of the investigator, interfere with evaluation of RLS symptoms or the response to the study medication.
* Plan to undergo a procedure that may require short or long-term opiates for pain control during the course of the trial.
* History of severe mental illness.
* Women who are pregnant, lactating, or planning to become pregnant.
* Shift work or other commitments that do not allow for regular sleep at night.
* Known hypersensitivity or intolerance to opioids.
* History of Long QT Syndrome or an immediate family member with this condition, or known prolongation of QTc interval.
* QTc interval prolongation \>500 ms on screening EKG at Visit 1.
* History of malignant melanoma.
* Current use of monoamine oxidase inhibitors.
* Prior or current clinically significant impulse control disorder, as determined by clinical interview and the Modified Minnesota Impulse Disorders Interview at Visit 1.8
* Untreated severe sleep apnea, defined as AHI \>30.
* Iron deficiency, defined as ferritin\<15 at Visit 1.
* Any dermatologic condition resulting in widespread compromise of skin integrity, defined as \>50% of the surface area within the 8 sites described for BTDS application.
* Current use of class IA or class III anti-arrhythmic medication.
* Significant risk for suicide by clinical interview.
* Known hypersensitivity to buprenorphine or any excipient of BTDS.
* Current unstable medical illness.
* Any medical or psychiatric condition that, in the opinion of the investigator, would interfere with participation in the study.