Suboxone and Subutex: Does the Difference Even Matter?
The opioid epidemic continues to grip the nation. According to the Centers for Disease Control and Prevention (CDC), drug overdose is the leading cause of accidental death in the U.S. — with overdoses resulting from opioid prescription medications including oxycodone, morphine, and hydrocodone leading the way.
An unexpected curveball was thrown into the opioid epidemic in 2020 when Covid-19 emerged. The pandemic propelled drug overdose rates to record levels — U.S. drug overdose deaths rose 30% during the pandemic, to more than 93,000 in 2020 alone, the highest ever recorded. In May of 2020, opioid overdoses rose a staggering 38.4% — these figures don’t even include 2021’s deaths and overdoses.
Suboxone and Subutex are two drugs used to help treat opioid addiction and avoid overdose, but both have the potential for abuse. Learn about the differences in these two drugs and how to get help.
At Zinnia Health, we are dedicated to empowering the public with as much knowledge as possible about addiction and alcohol use. In this post, we’re going to go over the FDA-approved drugs to help treat addiction, Subutex and Suboxone, how they work, and how you can get help today.
Subutex — one of buprenorphine’s original formulations — does not contain any other active ingredients. Subutex abuse became so widespread that in 2011, the drug was taken off the market.
When Subutex was available, it was prescribed as a sublingual tablet. Since it was pure buprenorphine, it was believed to be better for patients during their first few days of opioid addiction treatment. Subutex had to be picked up at a physician’s office.
Though pure buprenorphine doesn’t cause intense euphoria when taken in a prescription dose by people whose bodies have become tolerant to opioids, it can cause euphoria in people who have never taken opioids.
People often crushed and snorted Subutex to bypass the slow-release design when taken by mouth — this ‘workaround’ allowed the drug to quickly pass into their brains via their bloodstream and result in a “rush.” Although rare, Subutex overdose was possible. Potential side effects of becoming intoxicated on Subutex included:
- Confusion or delirium
- Loss of coordination and balance
- Nausea and vomiting
- Loss of appetite
- Shallow or reduced breathing
- Dark urine
- Back pain from kidneys
- Sleep changes
- Difficulty falling or staying asleep
- Loss of consciousness
Suboxone is made by combining buprenorphine and Naloxone. It was often used in combination with Subutex, but later in the recovery process to continue tapering the person off opioid drug abuse.
Naloxone blocks or reverses the effects of opioids and is often used in emergency situations. It’s important to note that Naloxone doesn’t last long in the body. So, even if Naloxone has been administered during an overdose, it’s essential to seek emergency medical attention. When drug makers added Naloxone to buprenorphine, they hoped it would reduce Suboxone’s potential for abuse.
The pill form of Suboxone has also been taken off the market in the United States. It was removed in 2012 due to some people abusing it by bypassing the Naloxone when they could. People tried to do this by taking large doses by crushing the pills and then snorting or even injecting them.
Although the Naloxone would have blocked buprenorphine’s intoxicating effects, rushing the brain with buprenorphine and waiting until the Naloxone wore off led to an intense ‘high’ and overdose.
Suboxone is still available in a different form. Today’s Suboxone comes in a dissolvable filmstrip. Many health care providers believe this method is much less prone to abuse. The side effects of Suboxone abuse are like those of Subutex and other narcotics and include:
- Extreme fatigue
- Appetite changes
- Skin rash
- Shallow or irregular breathing
- Appearing intoxicated
- Yellowed skin and eyes
- Difficulty falling and/or staying asleep
What Is Buprenorphine?
Helping people overcome addiction has long been a battle the U.S. government has tried to help fight — especially as opioid use skyrocketed. The federal focus in the ‘war on drugs’ shifted to developing medications to help people struggling with addiction to heroin, prescription painkillers, or other narcotics.
You’ve likely heard of Methadone — it was the primary medication used to treat heroin addiction for decades. But more recently, types of buprenorphine have become more popular to treat addiction in the U.S. The two FDA-approved buprenorphine formulas are Subutex and Suboxone.
Buprenorphine was originally developed as a pain reliever. The partial opioid antagonist binds with the brain’s opioid receptors, which causes reduced pain and increased feelings of well-being. If those feelings sound similar to what you experience taking opioids, they are meant to.
The goal of buprenorphine is to interact with the same brain receptors that interact with other drugs like heroin and trick the receptors into thinking you are taking an opiate. This is why people taking buprenorphine medications don’t experience the nasty symptoms of withdrawals or irresistible cravings.
Although buprenorphine is not a full opioid, it acts a lot like one by causing moderate receptor site activity. When taken as directed, it does not create a euphoric state — this is the key to buprenorphine being able to prevent withdrawal symptoms and reduce cravings for opiates, heroin, and/or prescription painkillers. Buprenorphine has several advantages when it comes to treating opiate addiction, including:
- Helps the person stay safe and comfortable during the detox process.
- Reduces or eliminates cravings for heroin and other opiates.
- Minimizes relapse because the patient won’t experience uncomfortable or painful withdrawal symptoms.
- Allows the person to focus on therapy without the distractions of withdrawal symptoms and cravings.
Buprenorphine treatments work to replace drug addiction, whether it’s to a prescription painkiller like hydrocodone, or an illegal drug like heroin. It works by binding to opioid receptors in the brain to ease withdrawal symptoms for up to 24 hours.
As you go through treatment, your physician will decrease your dosage to ‘wean you off.’ Although the two drugs are different, they share some similarities and have been shown to treat addiction effectively. However, there is a downfall to these two medications — people can still abuse them.
Subutex vs. Suboxone — What’s the Difference?
The main difference between Subutex and Suboxone is that Suboxone contains buprenorphine and Naloxone. Subutex contains only buprenorphine. Subutex was formulated first, and while it was found to be effective in treating opiate addiction, there was still a tendency for abuse — as discussed above. The increased rates of Subutex led to the creation of Suboxone.
Subutex vs. Suboxone — Which One is Better?
Since the medications are so similar, there’s not much evidence suggesting that either is more effective at treating opiate addiction. When both medications are used as directed and under supervision, the buprenorphine works as intended to mitigate opiate withdrawal symptoms and reduce cravings. Suboxone does have a leg up in the competition when it comes to abuse potential.
Since Suboxone contains Naloxone, it may be less likely to be abused. Therefore, many health care providers believe Suboxone is the better choice for people dealing with severe addictions or who have completed treatment before and relapsed.
Suboxone and Subutex should be used as part of a comprehensive treatment plan. Medication alone does not suffice for addiction treatment, it must be used along with therapy that gets to the root cause of the addiction and can teach you new and healthy coping skills.
Frequently Asked Questions About Subutex and Suboxone
1. Do Subutex and Suboxone do the same thing?
In short, yes. Both medications work to ease opiate withdrawal symptoms and reduce cravings. The buprenorphine in Subutex and Suboxone satisfy opiate cravings while producing less powerful effects than heroin or hydrocodone, for example.
2. When is Subutex used?
Subutex is used in clinical settings, such as drug detox or addiction treatment centers. At these treatment facilities, Subutex is administered under the supervision of medical staff. On the other hand, you can take Suboxone at home.
3. If Subutex has no opioid blockers, why do doctors prescribe it?
Subutex is the best medication to use when someone starts treatment for opioid addiction — this is the time when their withdrawal symptoms are the most aggressive. Surprisingly enough, the fact that Subutex doesn’t contain Naloxone (opioid blocker) is an advantage during these early days of treatment. This is because the patient can start taking the medication immediately upon entering treatment.
Suboxone is not recommended for people still actively taking opioids or who still have the drugs in their system. Taking Suboxone before the opioids have the chance to leave your system will worsen withdrawal symptoms. This is a phenomenon called precipitated withdrawal.
4. Why do doctors prescribe Suboxone and Subutex?
Like we mentioned, buprenorphine is key in treating opioid addiction because of its ability to lessen the effects of withdrawal while still satisfying the brain’s craving for the opiate.
Subutex, which only contains buprenorphine, helps reduce the desire to use, which is strongest within the first few days of not taking opioids. Suboxone does the same thing; it just has the added opioid blocker, Naloxone. Also, Suboxone is safe for long-term use as a maintenance medication.
5. Can any doctor prescribe Suboxone?
No. Only physicians registered with the Food and Drug Administration (FDA) and who obtain a waiver can prescribe Suboxone or Subutex.
It’s important to remember that while buprenorphine is safe when used appropriately, it’s still a powerful opioid. It is listed as a Schedule II controlled substance by the FDA — it is tightly restricted to prevent the medication from landing in the wrong hands and being abused.
6. Are Subutex and Suboxone dangerous?
When Subutex and Suboxone are taken as directed, they are not dangerous. Since the drugs are partial opioids, there is still potential for abuse, but there is also a ceiling effect when taking the medications, meaning:
- It will not get you high
- It is less likely to cause overdose
- Effects don’t increase with higher doses
7. Can you become addicted to Suboxone or Subutex?
Although uncommon, it is possible to become addicted to Suboxone or Subutex. Suboxone and Subutex addiction are uncommon because of the following reasons:
- Buprenorphine is a partial opioid which means the effects of Suboxone and Subutex are less intense than typical opioids.
- People who are prescribed buprenorphine already have an opioid tolerance.
- Suboxone has another layer of safety to prevent overdose — Naloxone.
People with opioid addictions do not get the sensation of feeling high from buprenorphine since they already have a tolerance to opioids. Since the effects are less intense, Suboxone and Subutex can satiate the craving without reinforcing the addiction.
8. Do Suboxone and Subutex work for opioid addiction?
Both medications are considered safe and effective treatment options for opioid use disorders. It’s important to note that these medications are by no means perfect, and some people who take them continue abusing opioids and/or other medications.
When the medications are combined with therapy and support, the likelihood of success is much higher.
How Zinnia Health Can Help
If you or a loved one is suffering from opiate addiction, you are not alone. At Zinnia Health, we are deeply committed to providing comprehensive, customized addiction recovery treatment plans for our clients.
We have a low staff-to-patient ratio, which ensures every patient receives the attention and care they need to battle addiction and begin their recovery journey the right way. Contact us today to learn more.