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Suboxone vs. Belbuca: What’s the Difference?

October 6, 2021

Opioid Use Disorder (OUD) is a growing concern worldwide.[1] Declared a nationwide public health emergency in 2017, recent statistical data related to OUD paints a grim picture.[2] In 2020, approximately 100,000 Americans lost their lives due to drug overdoses. Compared to data from the previous year, this is an increase of 30% in deaths resulting from substance misuse.[3] 

For people struggling with an OUD, buprenorphine-based treatments provide hope for recovery. This form of Medication Assisted Treatment has been scientifically proven to be the most effective solution for people trying to overcome an OUD.[4] 

In this article, we will compare two medications used in clinical practice today which contain buprenorphine — Suboxone and Belbuca. 

What Is Suboxone?

Suboxone is a medicine approved by the US Food and Drug Administration (FDA) for the treatment of OUD which contains buprenorphine and naloxone as its two main ingredients.

Buprenorphine is a partial opioid agonist, which means it occupies opioid receptors in the brain.[5] In doing so, it reduces cravings and prevents withdrawal symptoms associated with OUD. 

The medication has a dosing limit, meaning it loses its capacity to activate opioid receptors at higher doses. This characteristic makes it safer than other OUD treatment options. These is also a reduced risk of overdose compared to complete agonists such as methadone.

To prevent patients from abusing Suboxone via injections or snorting, naloxone is added to the formulation.[6] Naloxone is an antagonist and prevents abuse by blocking opioids from occupying the receptor in the brain. If Suboxone is used in any other way than as prescribed, naloxone enters the bloodstream and blocks the agonist aspect of buprenorphine from inducing a high.

Suboxone is available both as a sublingual film/strip or tablet. When applied beneath the tongue or between the cheek and gums, it dissolves in less than 15 minutes. The effects of Suboxone can last for up to 72 hours.[7]

Although both Suboxone formulations are equally effective, there are a couple of key differences to keep in mind: 

  • Suboxone in tablet form is less expensive than the films/strips. 
  • The strips dissolve faster than tablets, but both should be left in place for at least 15 minutes until they are completely absorbed. 
  • Some patients may prefer the flavor of one over the other, although this is a personal choice. 

Suboxone Side Effects

Suboxone is safe to consume, but like many other medications, it can cause side effects.[8] The most common side effects include:

  • Headache
  • Nausea
  • Vomiting
  • Constipation
  • Excessive sweating
  • Insomnia
  • Swollen hands and legs
  • Stomach pain
  • Numbness in the mouth

It's important to note that Suboxone may cause opioid withdrawal symptoms when consumed while there are other opioids in the system. To avoid this, the medication should be started only under the supervision of a healthcare provider. 

What Is Belbuca?

Belbuca is the brand name for a buprenorphine buccal film used to treat chronic pain. The term “buccal film” simply refers to the administration route. The film/strip can be placed on the inner wall of the cheek or inside the mouth. It usually takes 30 minutes for the strips to completely dissolve and the effects can last for up to 27 hours.[9]

Belbuca is not approved by the FDA for the treatment of OUD. It is approved only for the treatment of chronic pain. 

The medication is similar to Subutex except for its administration route. Subutex is a buprenorphine-only tablet that is commonly used to treat OUD, especially in pregnant women or people who cannot tolerate Suboxone. Therefore, if your doctor is prescribing Belbuca for chronic pain and you also have an OUD, Belbuca may also help you with your opioid craving and reduce your risk of relapse.

Belbuca Side Effects

It is possible to develop a physical tolerance to Belbuca or withdrawal symptoms when stopping it because it has an opioid effect. Although rare, people can develop an addiction to it as well, synonymous with an OUD. There are some notable side effects associated with Belbuca.[10] 

Physical adverse effects include:

  • Sleep disturbances
  • Palpitations
  • Dizziness
  • Drowsiness
  • Nausea, vomiting, and constipation
  • Headaches
  • Difficulty concentrating
  • Low blood pressure
  • Sweating

As with Suboxone, Belbuca may cause opioid withdrawal symptoms if consumed while there are other opioids in the system. To avoid this, the medication should be initiated only under the supervision of a healthcare provider. 

Suboxone vs. Belbuca

Both Suboxone and Belbuca contain buprenorphine, but they differ in several key ways.

Usage

Suboxone is an FDA-approved medication for treating OUD. It prevents withdrawal symptoms and cravings while discouraging misuse. Belbuca is not approved for treating OUD.

Abuse Potential

Suboxone has a low abuse potential since it contains both buprenorphine and naloxone. When added to a buprenorphine formulation, naloxone prevents buprenorphine misuse. Injecting it or snorting it will not induce a high when naloxone is present. Since Belbuca contains only buprenorphine, it carries with it a greater risk of abuse.

Dosage Differences

Suboxone is available in four distinct strengths in the forms of sublingual film or tablet, each with a buprenorphine-to-naloxone ratio of 4:1:

  • 2 mg buprenorphine / 0.5 mg naloxone
  • 4 mg buprenorphine / 1 mg naloxone
  • 8 mg buprenorphine / 2 mg naloxone
  • 12 mg buprenorphine / 3 mg naloxone

Belbuca is available in many dosages as a square yellow dissolvable film:

  • 75 mcg
  • 150 mcg
  • 300 mcg
  • 450 mcg
  • 600 mcg
  • 750 mcg
  • 900 mcg

Formulations and Administration

Administered sublingually, Suboxone is available both as a tablet and film. This means you can place the tablet or film beneath the tongue or inside the cheek. Also used sublingually, Belbuca is only available as a film/strip.

Forms (Brand vs. Generic)

Currently, no generic versions of Belbuca are available. Drug manufacturers such as Sandoz and Alvogen do produce FDA-approved generic forms of Suboxone.

Learn More About Bicycle Health

If you think buprenorphine/naloxone (Suboxone) might be right for you or if you have questions about the difference between Suboxone and Belbuca, please call us at (844) 943-2514 or schedule an appointment here.

Photo by belbuca.com

Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.
Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

Citations

1. Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. In: StatPearls. StatPearls Publishing; 2021. Accessed September 24, 2021. http://www.ncbi.nlm.nih.gov/books/NBK553166/

2. Haffajee RL, Frank RG. Making the Opioid Public Health Emergency Effective. JAMA Psychiatry. 2018;75(8):767-768. doi:10.1001/jamapsychiatry.2018.0611

3. Products - Vital Statistics Rapid Release - Provisional Drug Overdose Data. Published September 7, 2021. Accessed September 24, 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

4. Magnelli F, Biondi L, Calabria R, et al. Safety and efficacy of buprenorphine/naloxone in opioid-dependent patients: an Italian observational study. Clin Drug Investig. 2010;30 Suppl 1:21-26. doi:10.2165/11536010-000000000-00000

5. Kumar R, Viswanath O, Saadabadi A. Buprenorphine. In: StatPearls. StatPearls Publishing; 2021. Accessed September 24, 2021. http://www.ncbi.nlm.nih.gov/books/NBK459126/

6. Jordan F, Quinn TJ, McGuinness B, et al. Aspirin and other non-steroidal anti-inflammatory drugs for the prevention of dementia. Cochrane Database Syst Rev. 2020;4:CD011459. doi:10.1002/14651858.CD011459.pub2

7. Webster L, Hjelmström P, Sumner M, Gunderson EW. Efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet for the treatment of adults with opioid dependence: A randomized trial. J Addict Dis. 2016;35(4):325-338. doi:10.1080/10550887.2016.1195608

8. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.

9. Gimbel J, Spierings ELH, Katz N, Xiang Q, Tzanis E, Finn A. Efficacy and tolerability of buccal buprenorphine in opioid-experienced patients with moderate to severe chronic low back pain: results of a phase 3, enriched enrollment, randomized withdrawal study. Pain. 2016;157(11):2517-2526. doi:10.1097/j.pain.0000000000000670

10. Hale M, Gimbel J, Rauck R. Buprenorphine buccal film for chronic pain management. Pain Manag. 2020;10(4):213-223. doi:10.2217/pmt-2020-0013

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