Does Your Clinic Ever Prescribe Subutex (Bup-Mono therapy)?

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Bicycle Health provides Suboxone therapy for opioid use disorder. Bicycle offers educational resources on Belbuca, Subutex, and Sublocade, but does not currently offer those therapies.

Subutex is a brand-name version of Buprenorphine that’s no longer produced in the United States. 

Keep reading to find out more about what Subutex is, how it works, where to get it, and what else you can use to address an addiction. 

What Is Subutex? 

Subutex is a prescription medication the U.S. Food and Drug Administration approved in 2002 for the treatment of OUD.[1] It was sold as a dissolving tablet that patients took once per day. 

Each Subutex tablet contained buprenorphine, a partial opioid agonist. In the 1960s, researchers developed buprenorphine as a solution for chronic pain.[2] 

When taken properly, products with buprenorphine can do the following:

  • Reduce withdrawal symptoms: People with OUDs are physically dependent on opioids and feel sick when they do not have opioids. Buprenorphine attaches to opioid receptors and helps ease those cravings and withdrawal symptoms.
  • Lower relapse risks: Buprenorphine prevents withdrawal. Therefore, people who are on Buprenorphine are less likely to return to drugs and more likely to stay in treatment programs. This means lower relapse rates overall.
  • Enhance focus: People taking buprenorphine don’t get high. Instead, they feel normal and healthy. This allows them to better focus on other areas of life.

Buprenorphine products are remarkably effective. In one study, 100% of people taking a placebo relapsed to drugs, while only 25% of people taking buprenorphine relapsed. [3]

Was Subutex Discontinued?

Reckitt Benckiser Pharmaceuticals discontinued Subutex in 2011.[4] The product was effective, experts point out, and the manufacturer didn't stop making it due to reasons involving safety or public health. Instead, the company chose to focus on other products. 

The company that made Subutex also makes Suboxone, which contains an anti-abuse ingredient (naloxone). Rather than making and marketing two anti-addiction drugs, the company chose to focus exclusively on Suboxone.

How to Get Buprenorphine

Subutex is a brand name for the drug Buprenorphine. Now, “Subutex” brand is no longer available, but it is possible to get generic Buprenorphine alone, although most insurances cover Buprenorphine-Naloxone (Suboxone) preferentially over Buprenorphine-only products. 

Buprenorphine-monotherapy is available for people who cannot have the Naloxone component of Buprenorphine for some reason. Historically, the two main reasons someone cannot have Naloxone is if they are allergic (very rare) or potentially if they are pregnant (although nowadays Naloxone is generally considered very safe in pregnancy and most providers recommend continuing Buprenorphine-Naloxone therapy during pregnancy). 

Therefore, there are very few situations in which a person would require Buprenorphine-only products instead of Buprenorphine-Naloxone.  However, if you are someone who needs or simply prefers to take Buprenorphine without the Naloxone component, talk to your doctor about whether or not insurance would cover a buprenorphine-only product. 

The federal government tightly regulates the distribution of buprenorphine products. Even though this medication is a partial opioid agonist and doesn't intoxicate people with OUDs, those with little previous drug experience can get high on substances like Subutex. Regulating the drug reduces that risk, but it makes getting the medication harder.

Doctors need a special waiver to prescribe Buprenorphine. Medical professionals with waivers might work in the following places:

  • Emergency rooms: If you're experiencing withdrawal, you might need emergency Buprenorphine. [5]

  • Urgent care centers: If you're experiencing mild or moderate withdrawal, you might get Buprenorphine in an urgent care setting rather than the emergency room.

  • Doctors’ offices: Some primary care physicians and nurse practitioners have waivers and can treat patients with OUDs with Buprenorphine

  • Addiction treatment centers: A clinic specializing in OUDs likely has waivered medical professionals on staff and can provide Buprenorphine

Other Options for Opioid Misuse Treatment 

Subutex is no longer available in the United States. Instead, there are generic versions of Buprenorphine available. However, most insurance companies cover Suboxone (generic Buprenorphine-Naloxone) but may NOT cover Buprenorphine alone, unless you have prior approval from your doctor. This is because Suboxone is generally considered safer than buprenorphine alone because it contains Naloxone as an abuse-deterrent. [5] 

At Bicycle Health, we offer Suboxone treatment for people with OUDs. Our telemedicine model allows you to contact talented providers with buprenorphine waivers. They know how OUDs work, and they're licensed to prescribe the medications that can help. 

You'll work with our team remotely, and you'll get the treatment you need. Contact us to see if our model is right for you.

Sources

  1. Subutex Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020732s018lbl.pdf. February 2018. Accessed October 2022.
  2. Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed October 2022.
  3. Medications to Treat Opioid Use Disorder Research Report. National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder. December 2021. Accessed October 2022.
  4. Determination that Subutex (Buprenorphine Hydrochloride) Sublingual Tablets, Equivalent 2 Milligrams Base Equivalent 2 Milligrams Base and Equivalent 8 Milligrams Base, Were Not Withdrawn From Sale for Reasons of Safety or Effectiveness. Federal Register. https://www.federalregister.gov/documents/2015/02/13/2015-03001/determination-that-subutex-buprenorphine-hydrochloride-sublingual-tablets-equivalent-2-milligrams. February 2015. Accessed October 2022.
  5. Use of Medication-Assisted Treatment in Emergency Departments. Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep21-pl-guide-5.pdf. 2021. Accessed October 2022. 
  6. Treatment of Opioid Use Disorder in Hospitalized Patients. The Hospitalist. https://www.the-hospitalist.org/hospitalist/article/249902/neurology/treatment-opioid-use-disorder-hospitalized-patients. December 2021. Accessed October 2022.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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