Subutex and Suboxone are both prescription medications in the UK made to treat opioid addiction and withdrawal. These treatments emerged as a way to replace methadone as a medication for people detoxing from highly addictive drugs like heroin. When methadone proved to be addictive in itself, Subutex and Suboxone were created as alternatives.
What is the Difference Between Subutex and Suboxone?
Both of these medications are used to help people detox from opioids such as heroin and codeine. The main difference between them is that Subutex contains buprenorphine, and Suboxone contains both buprenorphine and naloxone.
Buprenorphine is a synthetic opioid which was designed in the 1960s to treat opioid addiction but also has a secondary use as a painkiller. Naloxone is a medication designed to prevent overdose from opioids such as heroin and fentanyl as well as block the effects of opioids to remove the desire to use addictive opioid drugs.
Your experience of detox will determine which of these medications is most suitable for you. This will usually be decided during the initial assessment in a rehab centre.
Both of these medications were designed around the same time as an alternative to more addictive treatments. They are widely used now in the UK instead of methadone which is viewed as more addictive and at a higher risk for overdose. Suboxone is growing in popularity compared to Subutex, but what are the reasons for this, and how should you make an informed decision about which medication to use?
Is Suboxone Better Than Subutex?
Subutex was the first of the medications to be used widely on prescription to treat people with opioid addiction. It was to be a replacement for methadone which was more addictive than buprenorphine. The results were excellent, and both Subutex and Suboxone are equally effective in managing opioid addiction and helping people to quit.
The issue arose with the abuse of Subutex. As it is a partial opioid, some people were becoming dependent and taking the medication at higher doses. By taking naloxone alongside the buprenorphine, you neutralize this possibility. It also discourages you from using other opioids as the effect is the same. You don’t get the euphoria from taking them.
Is Buprenorphine Addictive?
Buprenorphine does not offer any high or euphoria when used in the prescription dose, but it can offer some in high doses. In this way, it can cause abuse and addiction.
This is even more likely in people who have opioid use disorder as they are pre-disposed to addiction and physical dependence. To be clear, the chances of becoming addicted to buprenorphine in the doses given in Subutex are very low.
One of the reasons for this is that it is given on prescription and has little appeal as an illegal street drug. This is due to the slight effects and difficulty of producing it outside of a laboratory.
How Does the Added Naloxone in Suboxone Help?
Naloxone is an opioid antagonist meaning it counteracts the euphoric and other effects of buprenorphine and other opioids. For this reason, you might have heard of it being used to help those overdosing by blocking the opioid from the receptors.
This means that you cannot get the high from this medication even if you use it in high doses. This addition to the medication was made to combat addiction and remove the temptation to abuse Subutex as an opioid.
What are the Downsides of Suboxone?
Being less addictive and equally as effective as Subutex, Suboxone might seem like the perfect choice. However, it is worth considering the additional side effects, especially if you prove to be sensitive to naloxone but fine or stable with buprenorphine.
How Long Does Subutex Stay in Your System?
Buprenorphine starts to affect you physically within an hour to two hours after you take Subutex pills or tablets. It will last in your system for around 24 hours after being taken, depending on your metabolism.
The effect should be fairly stable throughout until it wears off towards the end. Most people take Subutex pills at the same time every day to get the best impact from the medication and minimise the side effects.
How Long Does Suboxone Stay in Your System?
The buprenorphine in Suboxone will stay in your system for 24 hours, the same as Subutex. Naloxone will only stay in your body and have an effect for 2-3 hours. However, considering the purpose of naloxone in Suboxone, this should not reduce its effectiveness. Because this is a daily tablet, you will top up the next time you take your medication. The naloxone in Suboxone will not last as long as extended-release injections of naloxone, and if the short half-life of the medication is an issue, you could discuss instead taking Subutex in combination with this injection instead. There have been some studies to show that this is, in fact, more effective short term.
Is There More Buprenorphine in Subutex or Suboxone?
The dose of buprenorphine will vary not based on which medication you take but on the individual prescription.
The amount varies between 4mg and 24 mg of buprenorphine, with the norm somewhere in the middle. How much you take will depend on your addiction, physiology and whether or not you are in a supervised medical environment.
How Can I Get Subutex or Suboxone in the UK?
Both medications are used as part of a medical detox. Medical detoxes are offered to anyone entering rehab for an addiction ranging from alcoholism to opiate dependence.
A detox doctor will meet with you when you are admitted and determine if Subutex or Suboxone is suitable for your detoxification management.
In rehab, you will have medical supervision round the clock and help to manage any side effects that arise. You are also at no risk of accessing drugs while in rehab as these are drug and alcohol-free zones.
Outpatients and Suboxone & Subutex in the UK
The NHS may prescribe you Subutex or Suboxone depending on your assessment by your GP or local team. However, the specific medication you receive may vary depending on your location and medical services in your area. You are also unlikely to stay in a hospital or under medical supervision while using public health services, increasing the risk of overdose due to misuse and mixing with other drugs.
Subutex vs Suboxone Withdrawal
The symptoms of withdrawal from Subutex are the same but less severe than other opioids. Because it is weaker than other opioids, the withdrawal won’t be as strong. Also, Subutex will be on prescription, and the doctor in charge of your detox will help you to taper it down in a manageable way.
You may experience the following:
- Aches and Pains
- Fever
- Insomnia
- Anxiety
- Mood Swings
- ‘Goose Skin’
- Cravings for Opioids
- Stomach Upset
With Suboxone, the main advantage when coming off the medication is that you are much less likely to have misused it and taken more than you should. It is also much less common for people taking Suboxone to take other opioids as the medication blocks the effects and removes the high from the equation. You will still be given a long tapering period when you come off your prescription.
Sources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150159/ Buprenorphine tapering schedule and illicit opioid use
https://www.communitypharmacy.scot.nhs.uk/documents/nhs_boards/fife/leaflets/suboxone_information_leaflet_2013.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/ Suboxone: Rationale, Science, Misconceptions
https://www.ncbi.nlm.nih.gov/books/NBK459126/ Buprenorphine
https://med.nyu.edu/research/lee-lab/research/extended-release-naltrexone-vs-buprenorphine-naloxone-opioid-relapse-prevention
