What is buprenorphine?
Buprenorphine is an old drug that has found an incredible new use in this new millennium. Originally intended for the treatment of pain, buprenorphine is now most widely used as a treatment for opioid addiction. When a doctor prescribes buprenorphine to a patient for opioid addiction, this is called medication-assisted treatment.
What are Suboxone and Subutex?
Suboxone and Subutex are both brand-name drugs made by the company, Indivior a former division of Reckitt Benckiser. Both medications are placed under the tongue to dissolve. And, both contain buprenorphine. We can essentially think of Suboxone and Subutex as being synonymous with buprenorphine. They are brands which have been approved by the Federal Drug Administration for treating opioid addiction.
What is the difference between Suboxone and Subutex?
There is one key difference between the two. Suboxone contains both buprenorphine and naloxone. Subutex contains only buprenorphine. Both are available as sublingual tablets. Suboxone is also available as a film or a strip. So, why are there two different addiction treatment drugs for opioid dependence? If buprenorphine treats opiate addiction and dependence, what does naloxone do? Why does Suboxone have naloxone and Subutex does not?
Naloxone and its dual purpose.
Naloxone is a powerful opioid blocker. It binds to receptors, such as the mu-opioid receptor. By doing this, it blocks access to opioid receptors by other opioids. The more naloxone that is given to a patient, the more receptors that will be blocked. Naloxone is used for two main purposes. It is available as an injectable and nasal spray that can be used to reverse an opioid overdose. This is the most important use of naloxone because it is proven to save many lives. The other purpose is as an abuse deterrent in various opioid medications. This works because naloxone does not absorb very well when swallowed or even placed under the tongue. When naloxone is added to an oral or sublingual medication, it essentially does nothing. However, if a drug abuser attempts to inject a prescription opioid containing naloxone, it will make them very sick.
Suboxone is preferred for most patients.
So, Suboxone contains buprenorphine and naloxone. This means that Suboxone has an abuse deterrent to stop drug abusers from injecting it into their veins. Because there are a significant number of opioid abusers who have become adept at preparing prescription opioids for injection, it is believed that naloxone added to Suboxone as an abuse deterrent will stop the drug user from trying to inject it. Since doctors can not be certain of the risk of patients attempting to inject their Suboxone, it is considered to be safer to prescribe Suboxone.
Subutex is still preferred in some situations.
Subutex is preferred over Suboxone for pregnant women. The combination of buprenorphine and naloxone is not considered to be safe in pregnancy. And, if a patient has had an adverse reaction to Suboxone and not to Subutex, it is possible that they have had a reaction to the naloxone component. In this case, Subutex may be the better choice.
Getting started on buprenorphine.
When you first see your Suboxone doctor, if you are not having withdrawal symptoms yet from stopping opioids, you may have to wait until you have moderate withdrawal symptoms. If you were using heroin or oxycodone, for example, you will likely have to wait about 18-24 hours before getting started with buprenorphine. After taking your first dose, if you feel better, you are on your way to freedom from active addiction to opioid drugs. The best treatment programs are long-term maintenance of buprenorphine treatment combined with therapy.
For further discussion on the subject, please tune in to episode 7 of The Rehab Podcast.