Suboxone Vs. Subutex - What's the Difference?

Suboxone and Subutex are two drugs that have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of opiate addiction. Both medications work to eradicate opiates' influence on the brain, and both medications allow opiate addicted users to stop taking drugs such as heroin (or pills such as OxyContin or Vicodin) without feeling withdrawal symptoms or drug cravings.

But what's the difference between the two medications, and which one should you use?

Both Suboxone and Subutex Contain the Same Active Ingredient, Buprenorphine

The active ingredient in both Suboxone and Subutex – buprenorphine – works in the brain as a replacement for other opiates.

Understand Buprenorphine's Effect by Understanding Why You Experience Withdrawal Symptoms

An opiate addiction changes the physical structure of your brain. People who are not addicted to opiates have a certain number of opioid receptors in the brain, and these receptors are normally activated by endogenous neural endorphin chemicals. When you take a drug like heroin or an opiate medication, you saturate these opioid receptors in the brain and create euphoria.

All opiate users develop a tolerance to the effects of opiates (needing increasing doses just to feel the same high) because the brain responds to the regular use of opiates by sprouting increasing numbers of opiate receptors. With more receptors present, you need to take a higher dose to saturate these receptors as completely.

If your opioid receptors are not sufficiently activated, you feel increased sensations of pain, dysphoria and other symptoms (the opposite feelings of an opiate high). Problematically, once you have an increased number of opioid receptors in the brain, normal levels of brain chemicals cannot sufficiently activate all of these receptors and without supplementing normal levels of brain chemicals with drugs, you feel sick. You reach a state whereby without the continuous use of opiate drugs, you go into opiate withdrawal.

The buprenorphine in Suboxone or Subutex can fill and activate opioid receptors in the brain. Once you activate these receptors sufficiently, you stop feeling opiate withdrawal.

Buprenorphine Is "Sticky"

Buprenorphine is considered "sticky," which means it will bump other drugs out of opioid receptors and "stick" on these opioid receptors very well. If you took buprenorphine at the same time as heroin, the buprenorphine would bump out all of the heroin and stick on the receptors, not allowing the heroin to have its normal effect.

Buprenorphine Is a Partial Agonist

As a partial agonist, buprenorphine only has a limited ability to activate opioid receptors. It can fill them up enough to stop someone from feeling sick, but it cannot activate these receptors enough to cause euphoria.

As a partial agonist, buprenorphine, even in high doses, is unlikely to slow breathing to a dangerous level. It is much harder to overdose on buprenorphine than on normal "full agonist" opiates, such as heroin or methadone.

Buprenorphine in Summary

  • Opiate addiction leads to an increased number of opioid receptors in the brain.
  • Normal levels of brain chemicals are not able to fully activate this increased number of opiate receptors.
  • When opioid receptors are left vacant (inactivated) a person will feel symptoms of opiate withdrawal.
  • An opiate-addicted person needs to take opiate drugs continuously to avoid feeling sick.
  • Buprenorphine activates these opioid receptors in the brain and will keep an opiate addicted person from feeling withdrawal.
  • Buprenorphine is stickier than other opiate drugs – even if a person tried to use heroin at the same time as buprenorphine, the heroin would have no effect.
  • Buprenorphine is a partial opiate agonist. It will not create much of a high and it is less dangerous than full agonist drugs

Subutex Does Not Contain Naloxone – Suboxone Does

  • Subutex contains a single active ingredient: buprenorphine.
  • Suboxone contains two active ingredients: buprenorphine and naloxone.

Both Suboxone and Subutex work to keep a person from feeling opiate withdrawal symptoms, because they both contain buprenorphine.

Suboxone contains a second medication – naloxone – that is added to the formulation to keep people from abusing the medication. Due to this decreased risk of abuse and diversion, doctors have greater freedom to prescribe Suboxone in take-home doses (unlike methadone, for example, which is almost always distributed in single daily doses).

What Does Naloxone Do?

If you were high on heroin and took an intravenous dose of naloxone, you would crash into an immediate state of opiate withdrawal.

Naloxone works as an opiate antagonist. It will fill the opiate receptors in the brain and it won't let other drugs activate these receptors, but unlike buprenorphine (which fills and activates receptors) naloxone will not activate opiate receptors. With all receptors full but not activated, a person feels immediate and intense withdrawal pains.

If you take Suboxone as directed (by letting the pill dissolve under your tongue) the small amount of naloxone contained within has no noticeable effect. The buprenorphine will travel to the brain, and you will feel relief from withdrawal symptoms.

If you attempt to abuse Suboxone by injecting it, the naloxone becomes fully activated and you go into a full state of withdrawal. This state of withdrawal cannot be reversed by taking heroin or other opiate drugs.

Suboxone and Subutex Work in the Same Way

Unless you abuse suboxone, there is no functional difference between the two medications. Subutex is sometimes used for the first dose or couple of doses under a doctor's care, but for continuing use and for a take-home prescription, people are normally prescribed Suboxone.

If you decide on buprenorphine treatment, you will more than likely get prescribed Suboxone for continuing use. Unless you intend on abusing the medication to try to get high, then Suboxone will work exactly and equally as well as Subutex.

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