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Subutex vs Suboxone - What's the Difference?

Updated: Dec 4, 2018

The difference between Subutex versus Suboxone was briefly explained in a previous post about how Suboxone works but this question comes up so frequently that I thought it was worth mentioning again. They are both very similar medications in that they are both are used to help treat opiate addiction and are one of three FDA-approved options collectively known as medication-assisted treatment (MAT) with the other two options being methadone and Vivitrol. The difference between Suboxone and Subutex, however, lies in their chemical makeup and essentially Suboxone is a combination product of both Buprenorphine and Naloxone while Subutex is just Buprenorphine by itself. In both cases, however, it is actually the Buprenorphine that is the active ingredient and is responsible for controlling cravings and mitigating opioid withdrawal symptoms so the Naloxone is just there to deter abuse. The Naloxone really only becomes clinically active if Suboxone is injected at which time you will be thrown into acute withdrawal but if Suboxone is taken properly under the tongue then you do not absorb enough of the Naloxone to be clinically effective. Another difference is that Subutex only comes in a tablet form while Suboxone only comes as a film although there are other forms of Suboxone such as the generic Buprenorphine-naloxone tablet and now generic Buprenorphine-naloxone film.

Subutex versus Suboxone

Other Common Questions about Suboxone vs Subutex

Since Subutex doesn't contain any Naloxone it technically could be abused although due to the chemical makeup of Buprenorphine there is still a ceiling effect that is reached after a certain dosage. One common misconception frequently encountered is the belief that you can take opioids and Subutex safely and that Subutex can't put you into precipitated withdrawal since it doesn't contain Naloxone. This is false and if you take Subutex too quickly without being in the correct state of withdrawal then the Buprenorphine will displace the opioids in your body, attach to the pain receptor, and partially block it. As a result you'll go into precipitated withdrawal the same way you would as if you had taken Suboxone. However, if you were already on a steady dose of Suboxone or Subutex and were to slip up and take an opioid or use heroin then you wouldn't go into precipitated withdrawal because the Buprenorphine would already be in your system and attached to the pain receptors. This prevents you from getting the same high as before which is one of the beneficial aspects of Buprenorphine. This can also be a serious problem if you were to get into an accident and needed stronger pain control since any pain meds you receive would essentially be ineffective although there are ways to overcome the effects of Buprenorphine. That is why it is crucial that you let all your healthcare providers know exactly what medications you are taking in the rare event that this should happen. It is also important to let your providers know you are on Buprenorphine before any elective procedure so that your doctors can come up with a game plan to manage your post-procedure pain.

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