Both Subutex and Suboxone are prescribed for opiate use disorder (opioid addiction). Both contain buprenorphine, a type of opiate that binds to the same brain receptors as drugs like heroin and oxycontin. However, what differentiates buprenorphine from other opioids is that it has both an opioid effect as well as an anti-opioid effect on the opioid receptor (i.e. it is both an agonist and antagonist). In other words, it treats opioid withdrawal symptoms, cravings and even pain, yet it has a so-called ‘ceiling effect’, and it is hard to overdose on it alone. Additionally, it is much harder to overdose from other opioids while on buprenorphine as it partially blocks the opioid receptors. It is therefore an ideal medication for opioid users who want to stop using dangerous schedule II opiates and not go through the horrible withdrawals that people experience when they stop using opioids cold turkey. Furthermore, it treats cravings and therefore prevents relapses.
Why is there naloxone in Suboxone?
The naloxone which is part of Suboxone is the medication that first responders such as paramedics and police officers give to treat acute opiate overdoses. It is an opioid antagonist (it blocks the effect of opioids on the opioid receptor within minutes and can therefore revive/wake up an overdose victim). While it can make withdrawal symptoms worse, the naloxone in Suboxone is not absorbed in any meaningful way—therefore there is no difference between the effects of Suboxone vs the buprenorphine mono-product (Subutex). It is merely added to prevent people from injecting it into their veins. In that case the mixed-in naloxone would cause withdrawal symptoms rather than a “high”.
In which circumstances is Subutex prescribed?
Subutex mostly just given in hospitals and in detoxification facilities, because of its potential for abuse—with some rare exceptions, like reported reactions to naloxone or breastfeeding. Suboxone may be taken at home with a prescription and can now even be prescribed via telemedicine (Tele-MAT).
Subutex only exists as a sublingual dissolvable tablet, while Suboxone is available as both dissolvable tablet and sublingual film. The most common dose is 8 mg of buprenorphine and 2 mg of naloxone, taken twice a day.
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