Many patients who get Suboxone treatment for opioid use disorder wonder if Subutex might be better than Suboxone for opioid use addiction treatment.
Suboxone is a medication that dissolves under the tongue. It contains two medications: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist and an opioid blocker. Naloxone is only an opioid receptor blocker.
Subutex is similar to Suboxone because it also contains buprenorphine. Yet, Subutex does not contain naloxone. The Drug Addiction Treatment Act of 2000 approved buprenorphine medications to be used to treat opiate addiction, opioid addiction, and opioid dependence.
Buprenorphine works very well to prevent uncomfortable opioid withdrawal symptoms. It also prevents opioid cravings. Patients who get buprenorphine treatment have a much lower risk of relapse.
Medication-assisted treatment with this unique medication in an opioid treatment program helps patients to avoid returning to dangerous substance abuse. Suboxone therapy has become the gold standard for treatment of opioid use disorder.
Is Subutex better than Suboxone for getting off opioid drugs?
There is a perception among people struggling with opioid dependency that Subutex is superior to Suboxone. They believe that because Subutex does not contain a blocker, they can start treatment sooner after quitting heroin, fentanyl, oxycodone, or any other opioid drug.
Starting buprenorphine too soon can lead to precipitated withdrawal, which is an unpleasant reaction that occurs when the patient still has too much opioid in their system. The buprenorphine displaces the opioid molecule from the mu receptor, causing immediate opioid withdrawal symptoms.
Unfortunately, patients must wait until they are in a state of opioid withdrawal before starting Suboxone or Subutex. The minimum wait time is usually 12 hours, but the recommended wait time is about 18–24 hours.
Doctors ask patients to help them score their withdrawal symptoms with the The Clinical Opiate Withdrawal Scale (COWS). When the score is high enough, and an adequate amount of time has passed, the patient will take a small test dose of buprenorphine.
Many addiction treatment facilities that observe clients taking their buprenorphine will use Subutex tablets. Since staff members are watching to make sure there is no misuse of the medication, they can use Subutex instead of Suboxone.
Since it is the buprenorphine itself that causes precipitated withdrawal, it does not matter if the patient takes Subutex or Suboxone for buprenorphine induction. Either medication will work just as well.
Does Subutex have a blocker?
As discussed above, Subutex contains only buprenorphine. It does not contain naloxone. Naloxone is an opioid blocker that is contained in Suboxone, but it is not in Subutex.
Does this mean that Subutex does not have an opioid blocker at all? Actually, Subutex does contain an opioid receptor blocker.
The name of the blocker in Subutex is buprenorphine. Remember that buprenorphine is an opioid, but it is a unique opioid drug.
Buprenorphine is both a partial opioid receptor agonist, and it is an opioid receptor antagonist. This means that part of its mechanism of action is to block opioid receptors. So, buprenorphine is a blocker, hence Subutex contains a blocker.
When Suboxone and Subutex are taken properly, under the tongue, they work essentially the same. Very little of the naloxone in Suboxone is absorbed into the patient’s system from under the tongue or in the mouth.
In most cases, there are few arguments to make in favor of Subutex being better than Suboxone in any way. Unless the patient is pregnant or has had an adverse reaction to naloxone, they will find that Suboxone and Subutex are mostly interchangeable.
Since doctors, pharmacists, and authorities are more comfortable knowing that the abuse deterrent, naloxone, is in Suboxone, they prefer that medication-assisted treatment programs use Suboxone, or a similar buprenorphine/naloxone combination. Subutex is only used in those instances where Suboxone cannot be tolerated by the patient.
