When a person with opioid use disorder (OUD) decides to commit to professional treatment and support for opioid addiction, they learn that one approach to treatment is with medications like Suboxone® or Subutex, which leads to the question we pose in the title of this post:
What’s the difference between Suboxone® and Subutex?
Suboxone® and Subutex are both medications for opioid use disorder (MOUDs) approved by the Food and Drug Administration (FDFA) for the treatment of opioid use disorder (OUD) in federally licensed medication-assisted treatment (MAT) programs.
Understanding the various treatment options available for OUD is important, because in the U.S., drug overdose has claimed over a million lives since 1999, with over 75 percents of those deaths attributable to opioids.
So what’s the difference between Suboxone® and Subutex?
Gold Standard Treatment for OUD
We’ll start with the similarities:
- They’re both medications approved for the treatment for OUD.
- They both contain the partial opioid agonist buprenorphine.
- Both medications are core components of medication-assisted treatment (MAT), widely recognized as the gold-standard treatment for OUD.
- They both mitigate the symptoms of withdrawal, reduce cravings for opioids, normalize brain chemistry, and allow people with OUD to fully engage in all aspects of treatment.
- Patients who stay in treatment in MAT programs show improved outcomes across multiple life domains, including reduced criminal behavior, increased ability to participate in family life, social life, and health relationships, improved vocational opportunity, and improved overall health.
Now we’ll address the differences.
What is Suboxone®?
Suboxone® is the brand name of a medication that contains buprenorphine, a partial opioid agonist, and Naloxone, a full opioid antagonist.
Note: Naloxone is the active ingredient in the lifesaving opioid overdose reversal medication, Narcan.
Let’s clarify what we mean by the terms partial opioid agonist and full opioid agonist.
A partial opioid agonist is a chemical that fits into and occupies the opioid receptors in the brain and nervous system, but the fit is not exactly perfect: it’s partial. Therefore, the chemical triggers some, but not all of the same responses in the nervous system as an opioid. In the case of buprenorphine, it occupies receptors enough to reduce the symptoms of withdrawal, reduce cravings for opioids, and normalize brain chemistry, but not enough to cause the euphoria, sedation, and/or high caused by opioids themselves.
A full opioid antagonist, on the other hand, completely occupies the opioid receptors in the brain and nervous system. In the case of the full opioid antagonist Naloxone, it occupies opioid receptors without causing any of the effects associated with opioids or partial opioid agonists. More importantly, it prevents opioids or partial opioid agonists from occupying opioid receptors. That’s the main reason many patients and providers choose Suboxone®: the added Naloxone prevents diversion and misuse.
We’ll explain.
When taken as directed – in sublingual (under tongue or inside cheek) tablet or gel, almost no Naloxone makes it into the bloodstream, and therefore, almost no Naloxone makes it to the opioid receptors. However – and this is how the Naloxone + buprenorphine combination prevents diversion or misuse – if a person alters Suboxone® in order to inject it for recreational purposes, the Naloxone does make it to the bloodstream, does make it to the opioid receptors.
When it does that, it kicks any opioids or partial opioid agonists – like buprenorphine – off the opioid receptors, which triggers opioid withdrawal. When comparing Suboxone® and Subutex, this is often the deciding factor: the potential of withdrawal discourages misuse, which many patients and providers prefer.
What is Subutex?
Subutex is the brand name for sublingual (under the tongue or inside the cheek) form of buprenorphine that comes in 2mg and 8mg doses.
Subutex is a partial opioid agonist used in MAT programs for people with OUD. We’ve mentioned MAT several times, but we’ll elaborate on how MAT works here. When a person develops opioid use disorder, their brain and body changes. With prolonged use, the body achieves homeostasis – a.k.a. balance – in the presence of opioids. When a person stops taking opioids, the body reacts, and temporarily goes far out of balance: this is opioid withdrawal.
Symptoms of opioid withdrawal include:
- Agitation
- Muscle aches
- Respiratory depression
- Restlessness
- Anxiety
- Runny nose
- Excessive sweating
- Insomnia
- Diarrhea
- Abdominal pain
- Nausea/vomiting
- Goose bumps
- Dilated pupils
- Rapid heartbeat
- High blood pressure
- Severe cravings for opioids
It’s easy to see why patients who enter treatment want to avoid experiencing these symptoms as much as possible: they’re miserable. That’s what makes Subutex an effective medication for opioid use disorder: it mitigates the worst of these symptoms. Most importantly, it drastically reduces cravings for opioids, which is one of the primary reasons people with OUD cite for relapse to opioid use after attempting to discontinue use.
Which One Is Best for Me? Suboxone® or Subutex?
If you meet the clinical criteria for opioid use disorder (OUD), you’ll make this decision in collaboration with your treatment team. They’ll tell you that the best medication for you depends on factors unique to you. Those factors include:
- Medical history
- Mental health history
- The opioid you use/used
- Frequency and duration of use
- Treatment history/MAT history
The biggest difference between these two medications is the presence of Naloxone. We explain the effect of Naloxone above. It’s a significant deterrent to misuse. The relevance of this is also unique to you, your treatment goals, and the shape you want your treatment plan to take. The best way to decide which is best for you – Suboxone® or Subutex – is to have an open, honest, and direct conversation with your treatment team, weigh the alternatives, and make an informed decision that matches your long-term goals.
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