What is the Difference Between Subutex and SuboxoneAnna Ciulla
To understand the difference between Subutex and Suboxone, two medications used in the treatment of opiate dependence and addiction (opioid use disorder), it is helpful to first have a general knowledge of buprenorphine, the primary ingredient in both.
Buprenorphine was approved by the Food and Drug Administration (FDA) in 2002 for clinical use in medication-assisted treatment (MAT) to help people overcome dependence and addiction to opiates, such as illicit heroin, and prescription pain relievers that include morphine, hydrocodone, oxycodone, and others. Suboxone and Subutex are both classified as Schedule III controlled substances by the Drug Enforcement Agency (DEA).
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is an opioid partial agonist with unique pharmacological properties that help:
- Decrease the potential for abuse of opiates
- Reduce the effects of opiate physical dependency, such as cravings and withdrawal symptoms
- Increase safety relative to opiate overdose
Several buprenorphine products have received FDA approval: Suboxone (containing buprenorphine and naloxone), Subutex (containing only buprenorphine), Bunavail buccal film (buprenorphine and naloxone), Zubsolv sublingual tablets (buprenorphine and naloxone), and buprenorphine-containing transmucosal products for dependence on opiates.
The only legitimate way to get buprenorphine is through specially trained physicians in intensive outpatient and inpatient treatment centers, as well as by prescription from specially trained doctors in office settings, with prescriptions then filled at pharmacies. In addition, in order to be able to prescribe buprenorphine, the DEA requires doctors to sign a waiver.
Along with other medications prescribed in MAT, buprenorphine is prescribed to be used in combination with a comprehensive treatment plan that includes counseling and participation in various social support groups.
HOW SUBOXONE IS USED IN MEDICATION-ASSISTED TREATMENT
Both Subutex and Suboxone contain buprenorphine and both are used in MAT. Suboxone helps those undergoing detox from opiates to have a safe and more comfortable experience and achieve better treatment outcomes. Treating professionals make the determination which to use depending on several factors, not the least of which is what substance the client is addicted to, how long the addiction has continued, dose and frequency of use, whether there are other addictions (other drugs and/or alcohol), and whether co-occurring mental health issue exists, such as anxiety or depression. Overall medical condition, family and other social support network availability, history of relapse and multiple treatments stay also figure into the determination of what medications to be used in MAT.
MAT is especially important during detox from opiates. An evidence-based treatment, MAT not only helps users come off drugs and alcohol in a relatively short time and with greater comfort, but it also helps get at the specific causes of the chemical dependency for which treatment is sought. For long-term opiate addicts (those who’ve been addicted for decades), MAT may be needed for an extended time as maintenance therapy. Others may be able to be weaned off Suboxone, which is, at least during the short-term, crucial for those with OUD to get past the crisis stage in initial detox and treatment.
What Is Naloxone?
Naloxone is an FDA-approved medication used in the MAT for opiate dependence and OUD. It is added with buprenorphine in Suboxone to counter the effects of opiate overdose. The naloxone in Suboxone blocks the opiate receptor sites in the brain to reverse toxic overdose effects. Another reason naloxone is combined with buprenorphine in Suboxone is to help decrease the misuse and diversion of buprenorphine.
How Do You Take Suboxone?
Suboxone is a sublingual tablet placed under the tongue and allowed to dissolve completely. This method is different than other medications taken in pill form via the oral route.
WHAT IS THE ABUSE POTENTIAL WITH SUBOXONE?
Since Suboxone contains both buprenorphine and naloxone, there is less potential for abuse with Suboxone than Subutex. It’s the naloxone in the medication that helps tamp down the abuse. Someone who injects Suboxone intravenously will find themselves in immediate precipitated opiate withdrawal – a very uncomfortable and unpleasant situation involving some quite severe withdrawal symptoms.
Buprenorphine is less addictive than heroin, morphine and other opiate substances. There’s a slow onset of the effects of buprenorphine and the drug has a long duration. This does not mean that you cannot become addicted to Suboxone, however, since the medication does induce mild euphoria. Suboxone may be easier to get on the street than heroin for some opiate users looking to use it to stave off withdrawal symptoms. For others who are not dependent on other opiates, Suboxone may be abused for the mellower high users can get with the drug compared to stronger opiates. Furthermore, Suboxone may be cheaper or more readily available on the street than other prescription opiates.
Effectiveness of Suboxone
In the first long-term follow-up of opiate pain reliever addicts in buprenorphine/naloxone treatment, researchers at Harvard Medical School and McLean Hospital found results “cause for optimism.” They determined that half the study participants remained free of opiates 18 months after starting therapy, while an even greater percent – 61 percent — were opiate-free at 3.5 years. In addition, said the authors, less than 10 percent met the diagnostic criteria for opiate dependence at that time.
HOW SUBUTEX IS USED IN MEDICATION-ASSISTED TREATMENT
Subutex was formulated before Suboxone, although both were developed about the same time. Unlike Suboxone, which contains buprenorphine and naloxone, Subutex only contains buprenorphine hydrochloride as its active component.
A partial opioid agonist, Subutex can be prescribed for individuals who need long-term opiate maintenance treatment, or it can be used to slowly taper those who’ve become opiate dependence off those substances. Treating professional may opt to start a client on Subutex during the acute withdrawal phase and eventually transition them to Suboxone.
Counseling and other therapies are a crucial part of drug rehab and occur simultaneously with MAT to provide clients with the best treatment outcomes.
How Do You Take Subutex?
Subutex is also a sublingual tablet like Suboxone and it placed under the tongue where it should remain to completely dissolve. No eating or drinking should occur until the Subutex tablet has completely dissolved.
WHAT IS THE ABUSE POTENTIAL WITH SUBUTEX?
Having been formulated before Suboxone, Subutex was found to be relatively effective for treating OUDs. The downside was that Subutex users had a tendency to abuse the drug. Since the sole active ingredient in Subutex is buprenorphine, users injected the drug intravenously (instead of taking it sublingually) for the main purpose of achieving the high they were used to with heroin, other illicit opiates, or prescription pain relievers. With numbers of Subutex users who injected the medication rising, another drug was created to help curb this trend. That medication was Suboxone.
Yet, as a study published in Psychopharmacology found, both Subutex (buprenorphine alone) and Suboxone (buprenorphine/naloxone) may be abused by non-opioid dependent users.
BOTH SUBOXONE AND SUBUTEX HAVE OVERDOSE RISKS
It is important to note that there are severe negative side effects possible with both Subutex and Suboxone. These include overdose, resulting in unconsciousness, severe respiratory depression, and death. This is especially risky for those who inject the drugs and also take tranquilizers or sedatives or drink alcohol. Life-threatening situations can develop from taking excessive amounts of Suboxone or Subutex in combination with other opiate medications, certain antidepressants, sedatives, tranquilizers or alcohol.
WHICH IS BETTER: SUBUTEX OR SUBOXONE?
The two medications have definite benefits in treating opiate dependence and addiction. As to which is better for you, that will depend on the determination of your treatment professionals. If you’re in treatment for severe addictions or have relapsed multiple times, the best MAT medication to address both your cravings and to help provide a line of defense against opiate overdose may be Suboxone. On the other hand, for your particular situation, your treating professional may discuss with you that Subutex could be your initial short-term MAT and then transition you to Suboxone once you’ve become more stabilized.
Keep in mind that both Subutex and Suboxone should only be used as part of a comprehensive drug addiction treatment program. Subutex and Suboxone can help address the physical aspects of the disease of addiction, yet the psychological aspects are best dealt with during therapy, ideally in residential drug and alcohol treatment programs.
You need more than medication alone to overcome opiate addiction. You also need counseling, behavioral therapies and support systems to get at the root cause of your addiction, learn healthier non-drug ways to cope with stress, prepare effective relapse prevention strategies and plans, and nurture and develop relationships with others in recovery who can help solidify your recovery foundation.
For more about Subutex, Suboxone, addiction, and recovery, check out these articles:
- Behavioral Healthcare Executive. “Address the Opioid Crisis by Treating Depression.” Retrieved from https://www.behavioral.net/blog/s/ron-manderscheid/prescription-drug-abuse/address-opioid-use-crisis-treating-depression
- Cochrane Database of Systematic Reviews. “Buprenorphine for managing opioid withdrawal.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28220474
- Cochrane Database of Systematic Reviews. “Opioid agonist treatment for pharmaceutical opioid dependent people.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28447766
- Cochrane Database of Systematic Reviews. “Supervised dosing with a long-acting opioid medication in the management of opioid dependence.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28447766
- Contemporary Clinical Trials. “NIDA Clinical Trials Network CTN-0051, Extended-Release Naltrexone vs. Buprenorphine for Opioid Treatment (X:BOT): Study design and rationale.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27521809
- Drugs.com. “Opioid Withdrawal Record (Induction Form). (Adapted from Clinical Opioid Withdrawal Scale). Retrieved from https://www.drugs.com/resources/opioid-withdrawal-record.pdf
- Drugs.com. “Suboxone.” Retrieved from https://www.drugs.com/pro/suboxone.html
- Food and Drug Administration. “FDA approves first monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder.” Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm587312.htm
- Lancet. “Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29150198
- MedlinePlus. “Buprenorphine Sublingual and Buccal (opioid dependence).” Retrieved from https://medlineplus.gov/druginfo/meds/a605002.html
- Narcan.com. “Here’s What Happens in an Opioid Overdose.” Retrieved from https://www.narcan.com/patients/what-is-an-opioid-overdose-emergency
- National Institute on Drug Abuse. “Buprenorphine.” Retrieved from https://archives.drugabuse.gov/buprenorphine
- National Institute on Drug Abuse. “Long-Term Follow-Up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields ‘Cause for Optimism’.” Retrieved from https://www.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism
- National Institutes of Health. “Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults.” Retrieved from https://www.nih.gov/news-events/news-releases/extended-suboxone-treatment-substantially-improves-outcomes-opioid-addicted-young-adults
- Psychopharmacology. “Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10928310/
- Substance Abuse and Mental Health Services Administration. “Buprenorphine.” Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
- Substance Abuse and Mental Health Services Administration. “Naloxone.” Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone
- Substance Abuse and Mental Health Services Administration. “The Facts about Buprenorphine for Treatment of Opioid Addiction.” Retrieved from https://store.samhsa.gov/product/The-Facts-about-Buprenorphine-for-Treatment-of-Opioid-Addiction/SMA15-4442