- Addiction & recovery
Subutex vs. Suboxone
Vanessa de la Cruz, MD
January 17, 2022
There are currently three medications approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder (OUD), and these include methadone, naltrexone, and buprenorphine. And Suboxone and Subutex are two buprenorphine medications most recently approved by the FDA to treat opioid use disorder.
Addictions to opioids have been a concern for centuries. But now, with the prevalence and widespread use of powerful opioids such as fentanyl and codeine, the issue has turned into a serious global concern that has captured the attention of many federal governments and medical institutions. According to the National Institute on Drug Abuse (NIDA), around 49,860 opioid-related overdose deaths were reported in the U.S. in 2019 alone.
Before the Drug Addiction Treatment Act of 2000 was passed by congress, only official Methadone Clinics, also known as Narcotic Treatment programs (NTP) or Opioid Treatment Programs (OTP), were allowed to dispense these addiction treatment medications. But since then, physicians who meet certain qualifications to treat opioid dependence are now permitted to dispense certain FDA-approved medications (Schedule III-V) in treatment settings other than an opioid treatment program. This legislation resulted in a huge paradigm shift in opioid maintenance treatment (OMT), which provided easy access to treatment for those who needed it.
Subutex vs. Suboxone – What Are They?
Suboxone and Subutex are prescription medications for opioid use disorder (MOUD) that the FDA approved in 2002. Subutex is a sublingual tablet that helps alleviate intense withdrawal symptoms. Subutex contains buprenorphine hydrochloride as its active ingredient and is generally utilized during the induction phase of treatment.
Suboxone, on the other hand, contains a combination of buprenorphine and naloxone. Naloxone is not absorbed orally, so it has no effects unless the tablet is crushed and injected intravenously. If suboxone is crushed and injected, the naloxone will counteract the action of the buprenorphine. Suboxone is available as sublingual tablets and film strips and buccal film strips as a single daily dose. Suboxone is utilized during the induction phase and maintenance phase of treatment. Suboxone and Subutex are Schedule III controlled substances permitted to be prescribed by any healthcare practitioner who has received special training and certification from the U.S. federal government.
Subutex Vs. Suboxone – How Do They Work?
Both Subutex and Suboxone help to alleviate opioid withdrawal symptoms. The active ingredient buprenorphine in both medications is a partial opioid agonist that binds to opioid receptors in the brain without fully activating them. This reduces opioid withdrawal symptoms without generating intoxicating effects when the medications are taken as prescribed.
However, Suboxone also works to reduce the risk of relapse and opioid overdose. One of its active ingredients, naloxone, is an opioid antagonist (inhibitor) that blocks the effects of other opioids at the receptor sites in the brain. As such, it works as a deterrent in the background to prevent individuals from misusing Suboxone by crushing, snorting, or injecting it. Hence, Suboxone has a lower-risk potential for misuse compared to Subutex.
Treatment with Subutex or Suboxone (either product) is best when used alongside comprehensive therapy and/or behavioral treatment to facilitate sustained recovery.
Side Effects of Subutex
Subutex can cause side effects ranging from mild to moderate. Some of the common side effects of Subutex include:
- Stomach pain
- Profuse sweating
- Back pain
- Runny nose
- Watery Eyes
Most people on Subutex treatment do not experience any serious side effects. However, if the side effects are persistent or highly distressing, it’s important to contact a healthcare provider immediately.
Side Effects of Suboxone
Suboxone can also cause side effects that range from mild to severe. Most of the side effects of the medication usually subside in a matter of days or weeks.
Some of the common side effects of Suboxone include:
- Mouth pain
- Mouth redness
- Mouth numbness
- Stomach pain
- Troubles with concentration or focus
Suboxone can also cause tolerance and dependence. Although Suboxone addiction is highly unlikely due to the “ceiling effect” of the medication, prolonged use can lead to tolerance and dependence. As such, individuals on Suboxone maintenance treatment are usually tapered off the medication gradually to reduce the symptoms of withdrawal that occur from quitting the medication abruptly.
Like Suboxone, Subutex can also cause withdrawal symptoms when its use is stopped abruptly after prolonged use. Symptoms of Subutex withdrawal are similar to other opioids such as morphine but are less severe. Withdrawal symptoms of Subutex generally appear within 48 hours after the last dose and last for up to 10 days.
Some of the symptoms of Subutex withdrawal are:
- Muscle cramps
Symptoms of Subutex withdrawal may vary from one person to another based on factors such as the length of use, frequency of use, and the specific dosage taken.
Symptoms of Suboxone withdrawal may begin within two to four days after the last dose, peak within three to five days, and resolve within seven days. However, the psychological symptoms of withdrawal, especially depression and the inability to feel pleasure, may last for several weeks. Suboxone withdrawal is the most distressing during the first 72 hours of detox.
The symptoms of Suboxone withdrawal include:
- Body aches
- Digestive distress
- Difficulties in concentration
Due to the potential of prolonged withdrawal symptoms, it’s crucial to detox under the guidance of a medical professional to reduce the risk of relapse.
Subutex overdose can occur when individuals take large doses of the medication or misuse it by crushing, injecting, or snorting its substance. Symptoms of Subutex overdose are nearly identical to that of Suboxone.
Some of the symptoms of Subutex overdose include:
- Pinpoint pupils
- Extreme drowsiness
- Blurred vision
- Uncontrollable body movements
- Cold or clammy skin
- Weak pulse
Respiratory depression is less common with Subutex overdose as the medication only partially binds to opioid receptors in the brain. However, since Subutex isn’t as highly regulated and restricted as other MOUD treatments such as methadone, the risk of overdose should not be taken lightly.
The risk of Suboxone overdose is relatively low due to the presence of naloxone. The naloxone in the medication has a built-in mechanism that takes effect when the medication is crushed, snorted, or injected. However, overdose risk is increased if Suboxone is misused with substances such as alcohol and benzodiazepines.
Other substances to avoid to mitigate the risk of a Suboxone overdose include:
- Hormonal contraceptives
- Phenobarbital and other epilepsy treatments
- Synthetic cannabinoids
Although the risk of a Suboxone overdose is low, the risk of an accidental opioid overdose during a Suboxone treatment remains a possibility. There remains a possibility of an overdose if an individual consumes large quantities of opioids to get over the medications blocking effect or if an individual consumes their usual dose of opioids after a period of abstinence.
Symptoms of Suboxone overdose include:
- Abdominal pain
- Slow or shallow breathing
- Difficulty concentrating or poor memory
- Loss of physical coordination
- Nausea and vomiting
- Slowed heartbeat
As with any instance of an overdose, prompt medical attention is needed to revive an individual from a Suboxone overdose. Narcan can be used to reverse an overdose, but immediate medical attention is still required as the reversal can wear off depending on how much opiate medication has been used.
Despite their differences, both Subutex and Suboxone are effective tools in the battle against the opioid crisis. If you wish to overcome your opioid use disorder and achieve a prolonged recovery, talk to your Eleanor Health and decide on the best course of treatment for you. Eleanor Health offers whole-person care to support your recovery. Our mission is to help anyone concerned about their mental health or affected by addiction live amazing lives.
If you need help with your substance use disorder, we are here to help you build your confidence and momentum towards the future you want. We provide treatment services for adults with alcohol, opioid, and other substance use disorders. We are currently located in Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, and Washington.
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