Opioids are an essential medication in treating pain symptoms from various sources, but they have a significant drawback. Though proper use is generally safe, opioid misuse can lead to chemical dependence and addiction. Opioid use disorders are common in the United States, leading to medical, psychological, and social problems. Most alarming, they can lead to overdose and death;  46,802 opioid overdose deaths occurred in 2018.

Opioid addiction is a chronic disease, but it can be treated with the right therapy options for your needs. One of these treatment approaches involves the use of medications like Subutex and Suboxone, among others. But how do these drugs work, and what’s the difference between the two? Learn more about Subutex, Suboxone, and medication-assisted treatment (MAT).

What Is Subutex?

Subutex is the brand name for a drug called buprenorphine. This medication is used in treating opioid use disorders and addiction. Buprenorphine is a partial opioid agonist used to treat addiction by easing withdrawal symptoms without causing notable intoxication. Addiction and chemical dependence often go hand in hand. Addiction is a disease that affects the reward center of the brain and causes powerful compulsions to use a drug that gets out of control.

Chemical dependence affects brain chemistry and involves the brain adapting to the consistent presence of a foreign psychoactive chemical. If you stop using a drug after you have developed a chemical dependence, your brain chemistry will become unbalanced, and you’ll experience withdrawal. If you stop after battling addiction, you’ll experience powerful cravings and compulsions to use again. People with substance use disorders often experience both.

Opioids can cause dependence and addiction after a period of high doses, long-term use, or misuse. When you quit abruptly, withdrawal symptoms may be similar to a bad case of the flu, with chills, nausea, vomiting, sweating, and diarrhea. In many cases, opioid withdrawal is extremely unpleasant and challenging to get through without succumbing to cravings and the urge to use. Opioids bind to natural opioid receptors that are designed to bind with your body’s endorphins. However, opioids like heroin, morphine, and others are much stronger than your endorphins, leading to dependence and addiction.

While opioids like heroin are full opioid agonists, Subutex is a partial opioid agonist, which means it has a weaker effect on opioid receptors than other opioids. However, the drug is enough to stop opioid withdrawal symptoms without causing intoxication. This can allow people who have been caught in a cycle of intoxication and withdrawal to pursue goals and live a normal life.

Subutex is often used in addiction treatment alongside other treatment approaches. The drug allows people who have relapsed several times to skip the withdrawal phase and go straight to treatment.

Subutex can also be used to treat chronic pain.

What Is Suboxone?

Suboxone is a medication that contains buprenorphine and another substance called naloxone. Naloxone is an opioid antagonist, which means it has the opposite effect as opioid agonists. It binds to opioid receptors and blocks them from being activated. When it’s used by itself, naloxone is sold under the name Narcan, and it’s an important life-saving drug. It’s used to reverse deadly opioid overdoses.

If a drug like heroin is taken in a large dose, the nervous system suppressing qualities of the drug can start to slow your breathing and heart rate. This can be deadly, but naloxone can kick opioids off their receptors and block them, ending and reversing the opioid’s effects.

Though this process has saved countless lives, taking naloxone when you’re dependent on opioids can be unpleasant. The drug kicking any opioids off their receptors and halting their effects can lead to acute withdrawal symptoms, and that effect is how it’s used in Suboxone. Suboxone and Subutex are used for the same purpose, which is to treat opioid use disorders. However, buprenorphine can cause intoxicating effects when it’s abused. Though buprenorphine addiction treatment is strictly monitored, it’s possible for some people to misuse the drug.

For instance, the drug is often taken sublingually, which means it’s placed under the tongue. Only a portion of the drug makes it to the bloodstream with this route of administration, but this allows it to achieve the withdrawal-preventing effects without causing intoxication. If someone were to take the normal dose and inject it, 100 percent of the drug would reach the bloodstream, causing more pronounced effects.

The naloxone in Suboxone is nearly inert when the drug is taken as directed. Not enough of the drug can make it into the bloodstream sublingually for it to have much of an effect. However, if someone tried to abuse the drug by taking it intravenously, the naloxone would kick buprenorphine off the opioid receptors and cause acute withdrawal. Subutex and Suboxone offer some of the same uses, but Suboxone has the additional safeguard against misuse and overdose.

What Are the Disadvantages of Subutex and Suboxone?

Buprenorphine, the main active ingredient in both drugs, is an opioid, and it comes with some of the same side effects that opioids do. It can cause nausea, dizziness, drowsiness, headache, constipation, itchiness, and other mild symptoms. However, it may be less likely to produce severe side effects than full opioid agonists.

Buprenorphine misuse can lead to intoxicating effects, which is counterproductive to the addiction treatment process. It can also lead to dangerous overdose effects like respiratory depression. However, buprenorphine is less likely to lead to a fatal overdose on its own than other opioid medications. Still, combining buprenorphine with alcohol or benzodiazepines can lead to a fatal overdose.

Buprenorphine treatment will also mean chemical dependence on the drug. While you receive MAT, you may no longer be in active addiction, but you will still be dependent on an opioid. If you stop taking the drug, you’ll experience uncomfortable opioid withdrawal.

When Would You Use Subutex or Suboxone?

Both drugs contain buprenorphine and can be used to treat opioid dependence and addiction. They both can be used in opioid replacement treatment, similar to methadone treatment. However, they offer some advantages over methadone. Buprenorphine and methadone are equally effective when it comes to reducing opioid use. Both are deemed safe for pregnant women with opioid use disorders, but methadone may be more likely to cause neonatal abstinence syndrome, a complication that causes babies to be born in opioid withdrawal, needing long-term special care.

Buprenorphine addiction treatment is often reserved for people who have gone through several attempts at treatment and relapsed. It’s used in conjunction with behavioral therapies and other evidence-based approaches. However, MAT often requires longer treatment periods. You may continue to be dependent on the drug for up to a year before completing a tapering process.

Suboxone is generally preferred over Subutex when it comes to MAT because it has an additional safeguard against misuse. However, Subutex may be more likely to be used for general pain management and chronic pain symptoms.

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