Subutex vs. Suboxone

Table of Contents

How Subutex Came to Be
How Subutex Works
Suboxone
The Difference Between Subutex Vs Suboxone
Which is More Effective
Getting Treatment

Subutex and Suboxone are two drugs used to combat the opioid crisis in America. As of now, nearing the end of 2021, there have been over 100,000 deaths in the United States due to opioids, and this number is growing still. In this article, we look at the differences between these two drugs for Opioid Use Disorder.

How Subutex Came to Be

Subutex was approved for patient use by the FDA in 2002 and was the first drug formulated using buprenorphine. Subutex contains only one active ingredient – buprenorphine. It works by binding the opioid receptors in the brain, resulting in reduced pain and increased feelings of well-being.

Prior to the year 2002, the primary medication prescribed for fighting opioid addiction was methadone. Then, in the year 2002, a new drug was approved by the FDA for treatment of opiate addiction that would provide similar results with less chance of abuse. The generic name of the drug was buprenorphine.

Buprenorphine is classified as a Schedule III substance, meaning that it has a relatively low potential for abuse, whereas methadone is considered a Schedule II drug (meaning it has a higher potential for abuse). Buprenorphine was also a significant addition to the treatment of addictions because it was more accessible and patient friendly. 

Because of its high potential for overdose as an active drug, methadone dispensation needs to be highly controlled. Doses of methadone must be given directly by a medical professional, which can be costly when one factors in travelling to a medical facility, paying physician fees and when you consider that the dose needs to be given regularly.

Since buprenorphine has lower potential for abuse and overdose, it can be prescribed as Subutex Tablets (in the form of buprenorphine hydrochloride) for self-administration by any physician who has been trained and certified by the Center for Substance Abuse Treatment. When taken as directed, buprenorphine can help an individual stay comfortable during detox, it prevents opioid withdrawal symptoms and reduces cravings for opiate drugs and prescription painkillers, and ultimately, minimizes relapse.

How Subutex Works

Buprenorphine is a partial opioid agonist, which means that it binds to opioid receptors in the brain, while only partially having the typical opioid effects of a full agonist (such as the highly dangerous Fentanyl). Essentially, buprenorphine tricks the brain into functioning normally but does not result in the high that comes from the drug. Subutex is relatively effective but still carries a risk of misuse. 

There are also potential risks for those taking buprenorphine during pregnancy, as it can have fetotoxic effects and cause neonatal drug withdrawal syndrome in the resulting baby. Buprenorphine patients should be aware of the risks and talk to their doctor as soon as they know they are pregnant, to discuss options.  

Although participants reported a variety of symptoms during their clinical experience, there was one that was missed during clinical monitoring and reporting. The most common adverse event generally not reported in clinical trial runs was the misuse of buprenorphine. 

Users found that if they crushed up the pills, then snorted them or turned them into a liquid to be injected intravenously, they could get a small high. 

The route of administration matters in the efficacy of buprenorphine. The absorption of buprenorphine happens under the tongue since sublingual administration is more effective than oral administration in this case. It is taken as a single daily dose, and acts slowly, with peak activity happening 3-4 hours after taking it. Using a large dose of Subutex can result in adverse effects of buprenorphine in patients, such as extreme dizziness, confusion, labored breathing, and loss of consciousness or even death. 

If you are experiencing these symptoms, you should seek medical attention from your doctor to talk about dose adjustments or the possibility of a different medication. A good maintenance dose should allow one to live a normal life without too much discomfort. 

This abuse and potential for overdose lead developers to create a new drug – Suboxone.

Suboxone

Suboxone functions the same as Subutex as far as fighting the side effects of withdrawal, however Suboxone is administered as a combination tablet or film, which contains two active ingredients- buprenorphine with naloxone. 

Naloxone is an opioid antagonist (different from the agonist above). This means it blocks the effects of opioids at the receptor sites in the brain, and has a similar effect against the buprenorphine. This deters users from abusing Suboxone like they did Subutex, because there is no euphoric effect. Instead, if a user injects Suboxone, they will immediately experience precipitated withdrawal (intense and immediate withdrawal effects), which is highly distressing for the user.

The Differences Between Subutex Vs Suboxone

Both Subutex and Suboxone, when taken according to prescribed directions, allow a person to fight their drug addiction without painful withdrawal symptoms and without cravings. The main differences between the two is that Subutex only has one active ingredient and has a potential for misuse, while Suboxone has two active ingredients, one of which is an opioid antagonist, significantly reducing the opportunity for misuse. Both are available as a sublingual tablet (which goes under the tongue) where Suboxone has the extra option of being a sublingual film (which melts under the tongue). Another difference is that Suboxone is significantly more expensive than Subutex, up to double the cost per month.

So, Which Is More Effective?

There is little scientific evidence to suggest that either Subutex or Suboxone is more effective for treating opiate addiction. When used according to the prescriber’s orders and under constant medical supervision, the main ingredient in both drugs, that buprenorphine dose, will work as it should and alleviate opiate withdrawal symptoms. However, because of the drug abuse potential with Subutex, those suffering from severe addictions may find that Suboxone is a better choice for them personally. 

Getting Treatment

It is important to remember that medication alone is not sufficient treatment for addiction. Medication should be used in conjunction with therapy and other medical care as deemed necessary by the patient and his doctor.

Getting to an addiction treatment center can help further your recovery. If you are experiencing severe withdrawal symptoms from opioid drugs, it is best to get medical advice from a trained professional. 

They can help with Medication Assisted Treatment to find an effective dose of buprenorphine and/or naloxone for your needs, if naloxone or buprenorphine treatment is deemed necessary, while accounting for any drug interactions that may happen. 

It is best to be honest and open with your medical provider if you are using any illicit drug so they can best figure out a way to help you over a long period of time. 

At any good rehabilitation center, they will also set you up with counseling and other modalities of treatment to tackle your addiction from various fronts. 

Related: Opioid Treatment