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Buprenorphine vs Suboxone: Key Differences & Misconceptions

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Key Points

Buprenorphine vs Suboxone: What Are The Key Differences Between Buprenorphine and Suboxone?

Buprenorphine and Suboxone are both opioid agonists approved by the FDA to treat opioid use disorder. Buprenorphine is a single drug, while suboxone is a combination medication made up of buprenorphine and naloxone. Both medications are effective at treating opioid use disorder.

What is Buprenorphine?

Buprenorphine is a synthetic opioid approved by the U.S. Food and Drug Administration (FDA) to treat pain and opioid use disorder. [1]  Buprenorphine is a Schedule III drug, meaning it has a moderate-to-low potential for physical dependence or a high potential for psychological dependence.  

Buprenorphine is a partial opioid agonist. This means that it binds to the same receptors as opioids do, causing the same action as the substance. Since it is only a partial opioid agonist, its opioid effects are limited, and therefore, receptors are not activated in the same way to experience a high or overdose. 

It is substituting a potent opioid (fentanyl or heroin)  with a less potent opioid (buprenorphine). Once you are stabilized, the medical professional can taper the buprenorphine. This reduces the uncomfortable experience of withdrawal due to opioid addiction with fewer withdrawal symptoms and less discomfort.

Buprenorphine treatment allows you to focus on treatment and therapy rather than suffering through uncomfortable withdrawals. Buprenorphine has been shown to be an effective drug in treating opioid dependence by decreasing cravings and improving overall quality of life during the addiction treatment process.[2] 

By alleviating the uncomfortable symptoms of opioid withdrawal, one is more likely to participate in treatment planning, follow through with the goals of the treatment plan, and reduce their morbidity and mortality rate.

Buprenorphine is marketed under the brand names Subutex, a sublingual tablet, and Probuphine, a 30-day subcutaneous implant. 

A warning regarding the prescription of buprenorphine: it does have a high risk for intravenous abuse. It can be prescribed to people who are pregnant or have severe liver impairments, but caution and medical monitoring are advised due to the potential impacts on liver health and fetal development.[3]

What is Suboxone?

Suboxone is a combination medication of buprenorphine and naloxone.[4] Naloxone is an opioid receptor antagonist, meaning it binds to the opioid receptors and can block or reverse the effects of an opioid. Naloxone is combined with buprenorphine to lower its risk for misuse when injected. 

If someone were to dissolve the Suboxone tablet and inject it intravenously, the naloxone in the combination would act to block the opioid effects of buprenorphine, potentially triggering withdrawal symptoms in opioid-dependent individuals. There is also the potential for an opioid-dependent person to experience withdrawal if they were to inject buprenorphine; with the addition of naloxone in the suboxone, this risk is eliminated. Because of this, most people will be prescribed suboxone as it does not have to be taken under direct supervision like buprenorphine alone has to be.

Brand names for buprenorphine and naloxone include Suboxone, which is taken as a sublingual film, Zubsolv, which is taken as a sublingual tablet, and Bunavail, which is taken as a buccal film (inside the cheek). [5]

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Medication-Assisted Treatment for Opioid Use Disorder

In 2022, the Mainstreaming Addiction Treatment Act aimed to increase access to buprenorphine by eliminating the requirement for providers to obtain a special waiver to prescribe this medication for Opioid Use Disorder. [6] However, providers still need to have appropriate DEA registration and adhere to state laws. 

Medication-assisted treatment (MAT) is a combined therapeutic approach of medications to treat opioid use disorder and mental health therapy. Medications can help alleviate cravings, which helps one overcome their physical dependence. It also minimizes withdrawal symptoms.

Common opioid withdrawal symptoms include [7]

Research shows buprenorphine lowers mortality and adverse outcomes risk.[7]  It is more successful than detox alone in terms of treatment retention, adverse outcomes, and relapse rates. Research shows lower all-cause and overdose mortality and increased improved quality of life ratings for those on maintenance buprenorphine

Those on buprenorphine also had lower rates of HIV and hepatitis C transmission when compared to those in abstinence-based programs and detox programs. Buprenorphine has a low overdose rate outside of those who are also using alcohol or other sedative drugs. 

Research is expanding in the area of MAT, and new studies are showing that buprenorphine may be able to treat other addiction disorders. One off-label study has found that suboxone has the potential to treat cocaine addiction. The buprenorphine and naltrexone bind to more receptors than just opioid ones, which may reduce the compulsive use that often comes with cocaine addiction without leading to an opioid addiction.[9]

Misconceptions about buprenorphine and suboxone.

There are numerous misconceptions surrounding medication-assisted treatment. The following are frequent misconceptions regarding buprenorphine and suboxone treatment, followed by the facts.[10]

Effective Treatment for Opioid Use Disorder

There is significant research that supports the use of buprenorphine and suboxone for the treatment of opioid use disorder. Despite its safety and efficacy, it is an underused treatment for those with an opioid use disorder. 

Medications for opioid use disorder are most effective when paired with counseling and psychosocial support. People seeking treatment for OUD should work closely with their healthcare provider to determine what type of treatment will best meet their needs.

Frequently Asked Questions About Buprenorphine vs Suboxone

Side effects of buprenorphine and suboxone include:[11]
  • Nausea
  • Vomiting
  • Drowsiness
  • Dizziness
  • Headache
  • Memory Loss
  • Sweating
  • Dry mouth
  • Sudden drops in blood pressure
  • Pupil constriction
  • Adverse sexual effects
  • Urine retention

The following are some symptoms that may indicate you or a loved one have an opioid use disorder [12]

  • Not being able to quit, even when using, causes problems with one’s health, relationships, or work
  • Needing more opioids to get the same high
  • Experiencing withdrawal symptoms when unable to use
  • Spending a significant amount of time each day using or seeking opportunities to use
  • Wanting to decrease the amount used but unable to
  • Not participating in previously enjoyable activities but instead using

People with OUD have the best results when they are provided MAT for as long as it is providing them benefits. Once you are stabilized on OUD medication, many discontinue their use of opioids, while others reduce their use amounts and frequency, reducing their risk for overdose and death. 

OUD medications give you time to make life changes for long-term recovery and remission. It allows them to make changes to the people, places, and things linked to their past drug use. Maintenance treatment minimizes withdrawal symptoms and cravings, making it easier to manage life responsibilities such as school, work, and parenting (SAMSHA, 2021).

It is critical to reduce or discontinue long-term opioid therapy gradually, in close consultation with a healthcare provider, to manage side effects and minimize withdrawal symptoms effectively. There is a risk of overdose if individuals resume illicit opioid use at previously tolerated doses after tapering.[14]  During tapering, it is recommended that the client be prescribed naloxone and monitored closely by their healthcare provider.

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