# Suboxone vs. Belbuca: Is Belbuca For Addiction, Or Is It For Pain?
Is Belbuca the same as Suboxone?
Is Belbuca the same as Suboxone? If your pain management doctor prescribes the Belbuca buccal film, which patients usually call a strip, you may notice on the package that the generic name of the drug is buprenorphine. When you look that word up, you will quickly discover that buprenorphine is also the main ingredient in the Suboxone film.
Did your pain doctor just prescribe an addiction drug to treat your pain? Does the doctor think you are addicted? Should you be offended? The answer to all three questions is no.
Many chronic pain patients become angry when a doctor suggests Suboxone for pain, because a Suboxone prescription seems to say that the doctor believes the patient is addicted. The fact is that buprenorphine is an opioid, and it works well for pain. In my experience, it often works better than the other opioids.
Suboxone is a film that dissolves under the tongue or against the inside of the cheek, and Belbuca is a film designed to stick to the inside of the cheek, on what doctors call the buccal mucosa. Both contain buprenorphine as their active ingredient. With so many similarities, how could these two drugs be different?
There is no Belbuca generic.
While you may find a Belbuca coupon online, you will not find a generic Belbuca. Belbuca was approved in 2015, and new prescription drugs are protected for many years by patents that keep the generic manufacturers out. Yet, Suboxone does have generics, because the Suboxone film has been on the market much longer, its patents were fought over in court, and the generic makers won.
As of this update, I have still not seen a generic Belbuca come through a pharmacy, so the only way to bring the price down is insurance, and possibly a copay card from the manufacturer. Your insurance company may then ask your doctor for a prior authorization, which means that your doctor fills out a long form so that a person who has never met you can decide whether you may have the medication.
The insurer is not wrong to ask questions about an opioid. The problem is who gets to answer them. When a generic Belbuca finally arrives, your pharmacist will be the first to tell you.
What are some Belbuca side effects to be concerned about?
Since Belbuca and Suboxone have the same active ingredient, we would expect their side effects to be similar. Suboxone insomnia, headaches, sweating, constipation, and difficulty urinating can all occur with Belbuca as well.
A man in his fifties who cannot urinate as easily may assume that his prostate is the problem, and a woman who sweats through the night may blame menopause. Yet, if either of them started Belbuca recently, the medication is a suspect.
If you notice a new symptom after starting Belbuca, tell your doctor. Often, when a Suboxone patient has a side effect, lowering the dose improves it, and the same principle should hold for Belbuca. Since Belbuca comes in much lower strengths, we might expect fewer side effects to begin with, though I am not aware of any head-to-head comparison.
Is Belbuca stronger than Suboxone?
Belbuca comes in seven strengths, from 75 mcg to 900 mcg, and it is taken once or twice a day. Suboxone film comes in four strengths, with 2 mg, 4 mg, 8 mg, or 12 mg of buprenorphine, each paired with a smaller amount of naloxone. There is no 16 mg Suboxone film.
A microgram is one thousandth of a milligram. So, the strongest Belbuca film, 900 mcg, is 0.9 mg, which is less than half of the weakest Suboxone film.
While both films are absorbed through the lining of the mouth, Belbuca is absorbed more efficiently than a sublingual film, so film for film the strongest Belbuca is closer to the weakest Suboxone than the milligram numbers suggest. At the doses Suboxone is actually used, 8 mg to 24 mg a day, Belbuca is not stronger than Suboxone, and it is not even close. Belbuca is not stronger than Suboxone, and it is not even close.
Why does the same drug come in micrograms for pain and milligrams for addiction?
This is an excellent question, and it is the one that people searching “Belbuca 300 mcg vs Suboxone 8 mg,” or 450 mcg vs 8 mg, are really asking. The two prescriptions are trying to do different jobs with the same molecule.
For a person who is not used to opioids, a very small amount of buprenorphine relieves pain. The Belbuca label starts such a patient at the lowest film and moves up slowly, and 300 mcg or 450 mcg twice a day is a middle step on that ladder. The doses are low, and buprenorphine’s effect on breathing levels off as the dose climbs, which is why pain specialists like it. In my opinion, it is the safest opioid we have for this job.
For a person who has been using oxycodone, heroin, or fentanyl, the goal is different. The doctor wants buprenorphine to fill and hold most of the opioid receptors, so that withdrawal and craving are switched off and other opioids have nowhere to land. That takes milligrams, not micrograms.
The Suboxone label puts the maintenance dose somewhere between 4 mg and 24 mg a day, based on how the patient responds, and 16 mg is a common place to land. Doses above 24 mg have not been studied in the trials, though the label leaves room for them, and in my experience they rarely add much. So, 8 mg on a Suboxone film and 450 mcg on a Belbuca film are not a strong version and a weak version of the same treatment. They are doing two different jobs, and the dose follows the job.
Can Belbuca be taken with Suboxone?
The US Food and Drug Administration, or FDA, approved Suboxone for treating opioid dependence, and it approved Belbuca for treating pain. Could a person who takes Suboxone for opioid addiction also take Belbuca if they are in pain? In theory, a doctor could write both prescriptions, but in practice it would be like taking Advil and Motrin together.
Advil and Motrin are both ibuprofen. Nobody takes one bottle for the headache and the other for the backache, because the second bottle adds nothing but a second label. While this is not a perfect analogy, Belbuca and Suboxone are the same drug in the same way.
Would it be dangerous? Imagine a patient who takes Suboxone 8 mg and adds Belbuca 900 mcg at the same time. That is 8.9 mg of buprenorphine, which, at that end of the dose range, would have little if any additional effect.
The bigger concern is not the arithmetic. Suboxone is one of only a few drugs approved to treat opioid addiction, and the doctor prescribing it needs to know about every other opioid you take, including Belbuca. If you are in pain while taking Suboxone, that is a conversation to have with your Suboxone doctor, not a second prescription to fill quietly.
What’s the difference between Belbuca and Suboxone?
Belbuca has one active ingredient, buprenorphine. Suboxone has two, buprenorphine and naloxone. Naloxone is the opioid blocker sold as Narcan, and it is in Suboxone to discourage injecting the film: taken in the mouth as directed, very little naloxone is absorbed, but injected, it can bring on sudden withdrawal.
Why does Belbuca not contain naloxone? I do not know the manufacturer’s reasoning. Of course, my guess is that a film sold to pain clinics in doses this small was not expected to be diverted, while Suboxone was built from the start for patients with a history of opioid addiction.
So, beyond the naloxone, it is the same drug with a different label and a different dose.
Can Belbuca be placed under the tongue?
Belbuca is for buccal use only, which means the inside of the cheek. The label says not to cut, chew, or swallow the film, and not to move it around with your tongue or your fingers once it is in place.
Interestingly, some Suboxone patients have told me that their films seem to work better against the cheek than under the tongue. The Suboxone label allows either location, so that is a choice a Suboxone patient can discuss with their doctor. Belbuca was not built with that choice in mind.
There are no data that I know of on what happens when Belbuca is placed under the tongue, and it is not worth the experiment. The label says the cheek. Use the cheek.
Can Suboxone be prescribed for pain? Can Belbuca be prescribed for addiction?
Since Belbuca is approved for pain, why would any doctor prescribe Suboxone for pain? In fact, FDA approvals, known as indications, are most of the answer. Any licensed physician with a Drug Enforcement Administration, or DEA, registration for Schedule III drugs may prescribe Belbuca for pain, and that prescription is on-label.
The same doctor may also prescribe Suboxone for pain, but that prescription is “off-label,” meaning that the drug is being used for something other than its FDA-approved purpose. And, doctors are allowed to do that as long as they can justify it medically. In my opinion, a doctor who prescribes Suboxone for pain should write “for pain” right on the prescription, so that the pharmacist and everyone after them know what it is for.
When this article was first written, in 2022, a doctor who prescribed Suboxone for opioid use disorder also needed a special “X” number on their DEA registration. That requirement is gone. Congress eliminated the X-waiver in the Consolidated Appropriations Act, 2023, signed on December 29, 2022, and since that day any prescriber whose DEA registration covers Schedule III drugs may prescribe buprenorphine for opioid addiction, subject to state law.
The mirror-image question comes up just as often. Belbuca is not approved for opioid use disorder, and its only FDA indication is severe and persistent pain that needs an opioid and that other treatments, including short-acting opioids, cannot handle. While the law allows a doctor to prescribe it off-label for addiction, the strengths top out at 900 mcg, and a person coming off of fentanyl usually needs many times that amount to feel stable.
You may have read articles that present Belbuca as an addiction treatment alongside Suboxone. In my opinion, that is a misreading of the label. Belbuca is a pain-clinic drug, it earns its place there because the doses are low and the drug’s effect on breathing has a ceiling, and Suboxone and its generics are the buprenorphine products built for opioid dependence.
Belbuca dependence is not addiction.
Belbuca contains buprenorphine, and buprenorphine has a reputation on the street that it does not deserve. Patients have told me, again and again, that the buprenorphine they bought before coming to treatment was to stay out of withdrawal, not to get high. It works very well for staying out of withdrawal and very poorly for getting high.
Could a person become addicted to Belbuca? It is possible, but it is not common. Or, far more likely, a patient who takes Belbuca for pain, as prescribed, for months or years, will become physically dependent.
Physical dependence means that the body has adjusted to the drug and will protest if the drug stops suddenly. Addiction is a pattern of behavior, and one does not require the other.
Unfortunately, a pain patient who decides it is time to come off of Belbuca is sometimes told that they need a detox or a program. They do not.
Fortunately, what they need is a gradual taper, worked out with their doctor. Each reduction is sized to the current dose, so the steps get smaller as the dose gets lower, and the seven film strengths give a doctor plenty of steps to work with.
If the taper is going too fast, your doctor must slow it down. If it is going well, you and your doctor may agree to go a bit faster, as tolerated. The label on the box was never a verdict about you. Neither is the way you come off of it.
Dr. Leeds treats opioid dependence with buprenorphine, including Suboxone and its generics, by telemedicine throughout Florida. Many of his patients first became dependent through a prescribed opioid for pain, and each of them decides with him whether the goal is a stable dose or a gradual taper, at a pace they control. Belbuca for pain remains a conversation for you and your pain doctor.
If you are physically dependent on an opioid and want to talk about buprenorphine treatment or a gradual taper, contact Dr. Leeds through the contact form.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
