Subutex vs. Suboxone

Over 16 million people worldwide struggle with opioid use disorder (OUD). [1] Medications like Subutex and Suboxone are FDA-approved therapies for people with OUDs.

Both Subutex and Suboxone contain buprenorphine, a medication that can ease opioid cravings and lead to sustained recovery. But only Suboxone contains an anti-misuse ingredient, making it a safer choice for many people.

Key Facts About Subutex & Suboxone 

Subutex, Suboxone tablets, and Suboxone film were all FDA approved in 2002.[2,3, 4]

“Subutex” was the brand name for a pure buprenorphine product. It is no longer produced in the United States under the brand name, however there are still generic forms of pure buprenorphine.

“Suboxone'', in contrast, refers to a brand medication containing a combination of Buprenorphine and Naloxone. [5] If taken as instructed, Naloxone remains inactive and is not absorbed in the mouth at all. If injected, however, the Nalone becomes active in the bloodstream and blocks the opioid effects of the Buprenorhpine, preventing an overdose. [6] In this manner, the Naloxone component serves as an abuse deterrent and makes Suboxone “safer” than buprenorphine alone. This is why it is included along with Buprenorphine in the medication.

What's the Difference Between Subutex and Suboxone?

Both Subutex and Suboxone can help people with OUD. Both contain Buprenorphine, but only Suboxone contains Naloxone.

‍

‍

Who Primarily Uses Suboxone?

About 275 million people worldwide used drugs in 2019, and 62 million of them used opioids.[8] Prescription painkillers are powerful drugs that can lead to crippling misuse issues. Suboxone can help. It works by minimizing cravings to use and preventing acute withdrawal symptoms. 

Due to its effectiveness and low misuse potential, Suboxone is considered appropriate for almost anyone. 

Who Primarily Uses Subutex? 

Subutex is no longer produced in the US. Instead, there are generic forms of buprenorphine that are available. When someone says “Subutex”, they are usually referring to forms of Buprenorphine alone, without Naloxone included. 

Historically, there were two groups of people who might use buprenorphine alone instead of Suboxone (Buprenorphine-Naloxone):

• Pregnant women: Because we used to not know much about the safety of Naltrexone in pregnancy, we used to recommend that pregnant women be on Buprenorphine alone (Subutex) instead of Suboxone. However, these days we have a lot more research on the safety of Naloxone in pregnancy. Researchers say Suboxone is very safe for pregnant women.[9] In general, most doctors now recommend that it is fine for pregnant women to start or continue Suboxone therapy while pregnant.
  
  
• People with Allergy or Intolerance to Naloxone: Allergies or intolerances to Naloxone are exceedingly rare. However, if you have had an allergic reaction to Naloxone in the past, this might be a reason for you to use pure buprenorphine instead of buprenorphine-naloxone.

What Is Buprenorphine?

Researchers developed buprenorphine in the 1960s as they searched for painkiller alternatives.[11] Nowadays Buprenorphine is used for two reasons: For patients with OUD or for patients with chronic pain as an alternative to being on long term opioid therapy. 

Buprenorphine is a partial opioid agonist, meaning that it latches onto the same opioid receptors as other opioid drugs but without such a strong response. This means that is prevents opioid withdrawal symptoms and cravings but avoids the more serious side effects of opioids including “getting high” and risk for respiratory depression/overdose. 

While some people misuse buprenorphine products, it's rare. [12]

Buprenorphine vs. Suboxone

Buprenorphine refers to the active ingredient in Suboxone. Suboxone is a combination of Buprenorphine and another medication - Naloxone. Together, Buprenorphine-Naloxone is sold under the brand name “Suboxone”, although it is also sold in a generic form. 

Buprenorphine vs. Subutex

Buprenorphine is the generic name for a partial opioid agonist medication. Subutex was the “brand” name for this medication, although it is no longer sold under brand name in the United States. 

How to Take Buprenorphine (Subutex) & Buprenorphine-Naloxone (Suboxone)

Both Buprenorphine alone and Buprenorphine-Naloxone (Suboxone) are taken in the same way: sublingually (under the tongue). Suboxone is more “bio-available” (better absorbed) under the tongue than it is if it is ingested by swallowing. For that reason, it is administered by dissolving under the tongue in the form of a tablet or strip, NOT as a pill to be swallowed.

To use tablets, you will do the following:

• Place the tablet under your tongue.
• Hold the tablet there until it dissolves. 
• Repeat if you have another tablet in your daily dose.

To use the strips, you will do the following:

• Place the strip under your tongue.
• Keep the strip there until it dissolves. 

Your doctor or pharmacist should demonstrate how to use the medication if you have any questions.

How Do Both Medications Treat Opioid Withdrawal and OUD?

Both Subutex and Suboxone contain buprenorphine, a partial opioid agonist. When taken properly under the tongue, the Naloxone component of Suboxone is NOT absorbed. Only the buprenorphine is absorbed. Partial opioid agonists like buprenorphine attach to the same receptors used by opioids like heroin and prevent withdrawal symptoms and cravings.

Which Is Better: Subutex or Suboxone?

Both formulations - generic buprenorphine (“Subutex”) and Suboxone - work equally well for preventing OUD. However, Suboxone is manufactured to contain Naloxone which serves as an abuse deterrent. [1] For this reason, the Suboxone formulation is considered “safer” and insurance companies usually prefer to pay for Suboxone. Some insurance companies will pay for buprenorphine alone, but it may be more expensive or require special authorization from your doctor.

Learn About Bicycle Health Opioid Use Disorder Treatments 

Bicycle Health provides Suboxone therapy for opioid use disorder. Bicycle offers educational resources on Belbuca, Subutex, and Sublocade, but we do not currently offer those therapies. If you're interested in treating your OUD with medication, Bicycle Health could be a good choice for you.

We use telemedicine techniques to bring medical expertise to you, no matter where you are. Call us today or find a time to speak with one of our team members to hear more about just how effective our treatments are.

Sources

1. Opioid Use Disorder. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK553166/. June 2022. Accessed October 2022.
2. Subutex Sublingual Tablets Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020732s018lbl.pdf. February 2018. Accessed October 2022.
3. Suboxone Sublingual Tablets Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed October 2022.
4. Suboxone Sublingual Film Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf. August 2010. Accessed October 2022.
5. TDH Finds Some Overdose Deaths Associated with Buprenorphine. Tennessee Department of Health. https://www.tn.gov/health/news/2018/1/8/tdh-finds-some-overdose-deaths-associated-with-buprenorphine.html. January 2018. Accessed October 2022.
6. How to Reverse an Overdose. Commonwealth of Massachusetts. https://www.mass.gov/service-details/how-to-reverse-an-overdose. Accessed October 2022.
7. Only One in Four People Needing Treatment for Opioid Use Disorder Received Medication. Columbia University. https://www.publichealth.columbia.edu/public-health-now/news/only-one-four-people-needing-treatment-opioid-use-disorder-received-medication. June 2022. Accessed October 2022.
8. Opioid Overdose. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose. August 2021. Accessed October 2022.
9. Buprenorphine-Naloxone Use in Pregnancy for Treatment of Opioid Dependence. Canadian Family Physician. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830675/. April 2016. Accessed October 2022.
10. Intolerance of Sublingual Buprenorphine-Naloxone During Induction in a Patient with End-Stage Liver Disease: A Case Report. Mental Health Clinician. https://meridian.allenpress.com/mhc/article/6/3/131/102732/Intolerance-of-sublingual-buprenorphine-naloxone. 2016. Accessed October 2022.
11. Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed October 2022.
12. Buprenorphine in the United States: Motives for Abuse, Misuse, and Diversion. Journal of Substance Abuse Treatment. https://www.sciencedirect.com/science/article/pii/S0740547218304720. September 2019. Accessed October 2022. 
13. Opioid Overdose Reduced in Patients Taking Buprenorphine. Washington University. https://medicine.wustl.edu/news/buprenorphine-protects-against-opioid-overdoses-even-in-benzodiazepine-users/. March 2021. Accessed October 2022.