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  • Writer's pictureDr. Soroosh Hashemi, M.D.

Suboxone vs. Subutex




Suboxone, whether in tablet or film form, is a medication comprised of two drugs. Its active ingredient, Buprenorphine, binds competitively to the mu-opioid receptor site. It slowly and steadily stimulates the opioid receptor in order to provide relief from opioid withdraw and cravings. This is the portion of the medication largely responsible for its beneficial properties. 


Suboxone’s second ingredient is Naloxone. This drug is an Opioid receptor blocker. It is inactive if Suboxone is taken properly using oral, sublingual, or buccal routes. Naloxone usually only becomes active if Suboxone is misused. If a Person attempts to use Suboxone inappropriately, in perhaps the intravenous or intranasal methods, Naloxone becomes active. The result is full blown precipitated withdraw and a short-term blockade of the Opioid receptor. 


To reiterate, the main active ingredient in Suboxone is Buprenorphine. Buprenorphine is responsible for all the beneficial properties of this medication. Naloxone is simply added as a safety net protecting against medication misuse. If Suboxone is used properly, Naloxone remains inactive and plays no role in the medication’s efficacy. 


Subutex, on the other hand, is comprised solely of Buprenorphine. Subutex does not contain Naloxone, but essentially acts the same way as Suboxone. Usually, this drug is used during the induction phase of Medication Assisted Treatment, when patients have recently used other opiates and the risk of precipitated withdraw is high. It is used in this setting because of the theoretically increased risk of precipitated withdraw. That said, I have previously used Suboxone in the induction phase without issue. 


Subutex is also used in the case of a Naloxone allergy. Though rare, allergies to Naloxone may occur and it is important to allow patients access to Medication Assisted Treatment regardless of this issue. Allergies can present differently and each patient’s recovery must be managed on an individual, case-by-case basis. 


Because of it’s increased abuse potential, Subutex is rarely used for long term maintenance therapy except in the case of a Naloxone allergy. That being said, we at Hashemi Healthcare prioritize the well-being of our patients and do use Subutex when necessary. 


Because Subutex is less commonly used, it is not as frequently available in retail pharmacies. Often obtaining Subutex takes a little more work. We often need to call pharmacies directly and a waiting period is sometimes necessary while pharmacies order the drug. 


We do our best to work with and advocate for our patients. We take a patient-centered, harm reduction approach and believe a supportive environment is imperative to recovery. Suboxone is always used first line, but in the initial induction phase or in the case of a Naloxone contraindication, we are willing to use Subutex. Even if it means a little extra work, we always do our best to support our patients.  

 

            

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