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Suboxone vs Subutex

  • The default for all patients should be Suboxone as there is much less stigma surrounding the combination product–particularly among pharmacists, which means less trouble getting it filled. Also there is less theoretical risk for abuse and diversion. However in reality, Subutex has the same antagonistic effect as Suboxone and getting “high” of Subutex is not likely. Overdosing on it (unless taken with co-ingestions) is difficult as well due to the ceiling effect.  
  • When is it okay to Rx Subutex over Suboxone:  
    • Generally subutex should not be prescribed instead of suboxone
    • a patient has been on it for a while, even though the reason might not be apparent, but they are doing fine on the medication, we want to support the patient in their path to recovery and not disrupt this process. If we are not consistent, the patient will just go back to their original doctor  
    • Suboxone should be tried first and then eventually if severe side effects. a patient has had a past experience with Suboxone with a side effect (they should at least give you the name of the doctor or clinic where they had an Rx from). Common legitimate side effects include: headaches/migraines, withdrawal symptoms (although sometimes precipitated withdrawal symptoms may be attributed to the naloxone when in fact it has nothing to do with it), tongue swelling or other allergic type reactions.  
    • Subutex is also preferred in pregnant patients, although, it is safe to prescribe both.
  • When is it NOT okay to Rx Subutex instead of Suboxone? 
    •  “works better for me” 
    • “medication is cheaper” – this should not be a good reason, offer pharmacy coupons, etc. that make suboxone more accessible
    • supposed allergy but without having had prescribed trial with Suboxone (prescribed, not off the street) some pharmacies refuse to prescribe it without clear documentation of allergy
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