Subutex and Suboxone are two medications that share an active ingredient: buprenorphine. The difference between them is that Suboxone has an additional active ingredient called naloxone. Naloxone is the same medication that first responders use to reverse the effects of an opioid overdose.
Suboxone is designed to help manage opioid dependency, and the opioid-blocking ingredient provides it with a safeguard that Subutex does not contain.
Does Subutex do the same thing as Suboxone?
Yes, both medications work in the same way. Suboxone and Subutex contain buprenorphine, a partial opioid agonist that binds to the opioid receptors in the body but produces less powerful effects than other opioids like heroin or Oxycontin. The key difference is that Suboxone also contains naloxone, an ingredient that helps lower the risk of overdose. Subutex, on the other hand, is the brand name for buprenorphine without any added blockers.
Suboxone and Subutex are used to treat opioid addiction because they lessen the effects of withdrawal while satisfying the brain’s craving for the drug. The idea is to reduce the individual’s desire to use, which is especially strong in the first few days without opioids. Once we address the physical symptoms, the patient can fully engage in their recovery by attending therapy, going to meetings and forming connections with other sober people.
Can any doctor prescribe Suboxone?
No, physicians must be registered with the FDA and obtain a waiver to prescribe Suboxone or Subutex. Even though buprenorphine is safe when used appropriately, it is still a powerful opioid medication. Buprenorphine is listed as a Schedule III controlled substance by the FDA and is tightly restricted to prevent the medication from being abused or falling into the wrong hands.
Is Suboxone more expensive than Subutex?
Looking strictly at the retail price, Suboxone is more expensive than Subutex because it contains an extra ingredient, naloxone. However, health insurance covers or greatly reduces the costs of both medications, so the price isn’t usually a deterrent for those who are insured. The most important thing is that you work with your doctor to find the medication that works the best for you and your circumstances.
Medicaid also covers buprenorphine treatment with Suboxone or Subutex. With Medicaid coverage, these medications are much more affordable. Each state has its own Medicaid program, so coverage and costs vary depending on where you live. Tennessee Medicaid, for example, requires prior authorization and proof of enrollment in substance abuse counseling.
Why do doctors prescribe Subutex if it has no opioid blocker?
Subutex is the best medication to use when beginning treatment for opioid addiction. This is when withdrawal symptoms are at their worst. Suboxone contains naloxone, and taking it too early in the detox process can make withdrawal symptoms worse. Subutex does not contain the opioid blocker Naloxone, so the patient can begin taking the medication as soon as withdrawal symptoms occur. After they are stabilized, I typically switch them to Suboxone to take advantage of the opioid blocker as a built-in safety measure. If they aren’t going to use buprenorphine as a maintenance medication long-term, we titrate the individual off while they are still in treatment.
For the most part, Subutex is used in a clinical setting, like a drug detox or addiction treatment center. There, it can be administered under the supervision of medical providers. Suboxone, though, can be taken at home.
On very rare occasions, naloxone can cause adverse reactions. In these cases, Subutex might be the best option for long term treatment. This is rare though, and for the most part, buprenorphine therapy is a safe, effective method of treating opioid addiction.
Are Subutex and Suboxone dangerous?
When taken according to the directions of the prescribing doctor, Subutex and Suboxone are considered safe medications. With that said, there is potential for abuse with any opioid, including buprenorphine. The risks are greater with Subutex since it does not include naloxone. While misuse of either drug is risky and should be avoided, most patients comply with their scheduled dosing and are successful.
Buprenorphine is considered safer than other opioids partially because of the ceiling effect. The ceiling effect means that at a certain level, taking more buprenorphine will not increase the effects. This is an important feature because it makes buprenorphine less appealing to use recreationally. Other prescription opioids, like oxycodone or hydrocodone, do not have the ceiling effect, which is one reason why they are so addictive. From what I’ve observed, the ceiling effect works. Those who are addicted to opioids tend to view Suboxone and Subutex as a means of reducing withdrawal pains, not an alternative drug used to get high.
Suboxone adds yet another layer of safety with the addition of naloxone. When suboxone is injected, the opioid-blocker naloxone activates and prevents the individual from feeling the full effects. This is meant to discourage patients from using the medication to get high. Subutex, on the other hand, does not contain naloxone.
The most important thing to recognize is that the benefits of medication-assisted treatment outweigh the risks. MAT isn’t about substituting one substance for another- it’s about using the tools available to help you get better and prevent a relapse.
Can you become addicted to Suboxone or Subutex?
The consensus is that long-term buprenorphine use could result in dependence but typically not addiction. Dependence is when a person feels like they need the medication to function, whereas addiction is a compulsion to use to the point that the medication is abused and interferes with the user’s ability to live their life. This does not rule out the possibility of an addiction to Suboxone or Subutex developing; it just means it is unlikely.
Suboxone is considered safer than Subutex when it comes to the potential for addiction. The naloxone ingredient in Suboxone means makes it less likely to be abused than Subutex.
Do Suboxone and Subutex work for opioid addiction?
Yes! Both Suboxone and Subutex are considered effective treatment options for opioid use disorders. It does need to be said, though, that they are not perfect. Some people who take Suboxone continue abusing opioids or other medications. In my experience, the greatest treatment success stories come not from medication alone, but a holistic approach that includes appropriate individual and group therapies.