Subutex vs. Suboxone: What’s the Difference?

Suboxone (naloxone and buprenorphine) and Subutex (buprenorphine) both contain the opioid drug buprenorphine. Both can be used to treat pain as well as opioid addiction.

Classification of the Buprenorphine in Subutex and Suboxone

Subutex and Suboxone are different medications that are primarily designed to deliver the drug buprenorphine to people who need it to control opioid withdrawal symptoms or for pain. Both drugs were approved in the early 2000s by the U.S. Food and Drug Administration (FDA).

Any product containing buprenorphine is a controlled substance, classified in the Schedule III classification by the U.S. Drug Enforcement Administration (DEA). This means that products containing buprenorphine are at lower levels of control than many of the other opioid drugs.
The majority of other opioids are classified in either the Schedule I or Schedule II category. This is because buprenorphine products are considered to have less potential for abuse than most other opioid drugs.

Mechanism of Action

Buprenorphine is classified as a partial opioid agonist. Like other opioids, it attaches to the receptors in the brain that are specialized for opioids, but it does not produce the full effects that full opioid agonists (like most opioid painkillers) produce.
When you take a product containing buprenorphine, you will not experience the same euphoric effects that are produced by morphine products like heroin, Vicodin, and other opioids. The opioid receptors in your brain are still occupied by the buprenorphine, meaning that the brain responds as if you were taking any other opioid drug, so you do not experience cravings and withdrawal symptoms that are common during opioid withdrawal.

Buprenorphine also stays attached to the receptors for a relatively long time (24 hours) and fully occupies them (a ceiling effect). This means that once you take buprenorphine, taking any other opioid will not get you high.

Buprenorphine Can More Easily Be Discontinued

Because buprenorphine does not produce the intense euphoria that other opioids produce, it can easily be more gradually decreased if you are in recovery.
Your physician will begin with a dose of Subutex or Suboxone that is sufficient to control any withdrawal symptoms you have from other opioids you have abused. Then, at specific stages, your physician will slowly decrease the dose of medication to wean you off the drug eventually.
This approach is extremely effective in helping people in the early stages of recovery from opioid use disorders successfully begin their recovery without experiencing distressing withdrawal symptoms and relapsing.

The upside is that if you are taking Subutex or Suboxone to assist you in the early stages of recovery, you are getting an opioid drug that will control your withdrawal symptoms and help you get on the road to recovery.
The downside is that if you are taking a buprenorphine product to assist in recovery from an opioid use disorder, you are still taking an opioid that can be abused. In fact, buprenorphine can be a drug of abuse, even though it does not produce the same intense euphoria as other opioids. The need for safeguards for the potential misuse of buprenorphine resulted in the development of Suboxone.

How Suboxone and Subutex Differ

Suboxone and Subutex are similar in many respects, but they are also different.

  • The primary active ingredient in both products is the opioid drug buprenorphine.
  • Subutex only contains buprenorphine.
  • Suboxone contains buprenorphine and the opioid antagonist naloxone.
  • Subutex is a lozenge that is dissolved under the tongue.
  • Suboxone is in pill form.
  • Both drugs can be used for the treatment of opioid withdrawal.
  • Subutex may be more likely to be used for pain than Suboxone.

Naloxone

The drug naloxone is classified as an opioid antagonist, and it’s most commonly used to treat opioid overdoses. Known by the brand names Narcan or Evzio, naloxone reverses the effects of opioid drugs.
When you take naloxone, the drug attaches to the opioid receptors in the brain and spinal cord and removes any opioids that are already there. It also reverses the effects of the opioid drug and produces withdrawal symptoms.
People who overdose on opioids can be saved if naloxone is administered quickly enough.

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What Suboxone Adds to Buprenorphine

Subutex does have the potential for abuse since buprenorphine can be abused. The addition of naloxone with buprenorphine in Suboxone is added as a safeguard against abuse.
When you take Suboxone normally, the naloxone is not activated. However, if you try to grind up the pills to inject or snort the buprenorphine, the naloxone is activated. You will then immediately go into opioid withdrawal and will not get any psychoactive effects from the buprenorphine.

The Bottom Line

Subutex and Suboxone are both medications that utilize buprenorphine; however, Suboxone has the added safeguard of naloxone to protect against abuse of buprenorphine.
If you are in recovery from an opioid use disorder and prescribed a buprenorphine product to address withdrawal symptoms, you will most likely get Suboxone. If you are prescribed buprenorphine to treat pain, you may be more likely to get Subutex, especially if you have no history of drug abuse.