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Subutex Vs. Suboxone: The Difference Between Suboxone And Subutex

Subutex doctors near me are doing Subutex treatment just like methadone maintenance.

There is a Subutex clinic near me that gives out Subutex and methadone. They work with patients who are trying to quit heroin or fentanyl. They also have patients who are switching from Suboxone to methadone.

At this particular clinic, they have methadone doctors and Subutex doctors. Regardless of which drug a client gets, the procedure is the same. A clinic tech watches closely as the client takes their medicine. Subutex and methadone clients are treated exactly the same.

They sweep their mouths for hidden subutex remnants. They make extra sure that the client is not walking away with a little extra methadone or Subutex. Clinic attendees line up every morning for their daily dose.

While this system works well to prevent methadone and Subutex diversion and abuse, it does not do much for the dignity of the person who wants to get medical treatment for opioid use disorder.

Bad behavior does not necessarily mean that there is a behavior problem.

Addiction treatment has traditionally been done where the employees watch the patients with a suspicious eye, treating them like bad, sneaky children, or a misbehaving puppy or kitten.

In fact, I once had a kitten whom I thought had a behavior problem because she was urinating all over the house. I gently reprimanded her and showed her the litter box each time it happened. After a day or two of this persistent behavior, I brought my kitten to the veterinarian. 

The doctor examined my cat and explained to me that her behavior was not due to a behavioral problem at all. She was suffering from a urinary tract infection. Her behavior was her way of letting me know that she needed help. Unfortunately, my lack of understanding led me to scolding a kitten that required straightforward medical treatment. 

What is the difference between Suboxone and Subutex?

Suboxone is a medication that has the distrust of the opioid use disorder patient built in. Suboxone is a combination of buprenorphine and naloxone. Buprenorphine is the stuff that helps you to stop obsessing over opioids and it keeps you from feeling the sickness of opioid withdrawal symptoms. If you are quitting heroin or fentanyl, buprenorphine can help you to feel normal again.

Naloxone is included in Suboxone as an abuse deterrent. People sometimes think of naloxone as “the blocker” added to buprenorphine.

Does Subutex have a blocker?

Subutex is the original brand of buprenorphine and it has no blocker added to it. There is no naloxone abuse deterrent in Subutex.

There is a fear that patients might sneak off with their Subutex, looking for an IV subutex high. Subutex is what they call a mono product. It is buprenorphine without the naloxone. Suboxone, on the other hand, is buprenorphine with the naloxone. If a patient liquefies their Suboxone and shoots it up in a vein with a needle and syringe, the naloxone will give them a chemical slap on the wrist.

Does Subutex cause precipitated withdrawal even though it has no naloxone in it?

When naloxone is injected into the vein of a person taking opioids, including buprenorphine, they will go into precipitated withdrawal. Precipitated withdrawal is what happens when opioids are forced off of opioid receptors and blocked from those receptors. Naloxone is a potent opioid receptor blocker.

Subutex does not contain naloxone. It only contains buprenorphine. So, does it cause precipitated withdrawal since it doesn’t have the blocker in it? Unfortunately, Subutex can cause precipitated withdrawal. 

Buprenorphine is a unique opioid that is a partial agonist/antagonist. It blocks the opioid receptor, just like naloxone, and it partially activates it. When a patient starts taking buprenorphine, in the form of sublingual Subutex or Suboxone, they have to be opioid free for a short period, usually about a day. If taken too soon, buprenorphine itself can cause precipitated withdrawal. Hence, Subutex will cause precipitated withdrawal if taken immediately after opioid use.

Is switching from Suboxone to Subutex ever done? 

Doctors tend to favor Suboxone over Subutex. In some regions of the U.S., Suboxone is legally required unless the patient is pregnant or has had an adverse reaction to naloxone. Even where it is not legally required, doctors still follow this guideline, only prescribing Subutex to patients who cannot take Suboxone. 

There are two major reasons why a doctor will switch a patient from Suboxone to Subutex. First, if the patient becomes pregnant, the combination of buprenorphine and naloxone is not known to be definitely safe for pregnancy. Hence, the patient is switched to Subutex for the duration of the pregnancy. Second, if a patient has an adverse reaction to naloxone, the doctor may switch that patient to Subutex.

Is naloxone an effective abuse deterrent when added to Suboxone?

Even though no study has ever proven the efficacy of naloxone as an abuse deterrent, Doctors don’t want to take any chances. Since, in most cases, the naloxone in Suboxone will not cause any problem at all, Doctors prescribe Suboxone to most patients, just in case, their patient is one of the very few who might try to shoot up their addiction treatment medication.

I was recently at a lecture sponsored by Indivior, the company that makes Suboxone. The lecturer stated that Indivior is now aware that naloxone is not an effective abuse deterrent. She told us that they believe there are drug abusers out there who shoot up Suboxone and then wait for the naloxone to wear off. 

Naloxone happens to have a much shorter half-life than buprenorphine, so this is a possibility. What was Indivior’s solution to the problem of naloxone not being effective as an abuse deterrent in Suboxone? Surprise! They have a new patented drug that can address the problem. 

Sublocade is Indivior’s monthly injectable buprenorphine that forms an implant-like solid structure under the skin that releases medication for one month. Suboxone’s patent has run out and is available as a cheap generic and coincidentally, the company has a solid argument for why we should forget about it and switch over to the new drug. I can imagine, in another twenty years, experts will discover that Sublocade might somehow be diverted. By then, they will have another foolproof plan to keep patients from misusing buprenorphine. 

Suboxone vs Subutex, which is better to take for MAT induction?

MAT is medication-assisted treatment and induction is the act of getting started with Suboxone or Subutex treatment. There are people who swear by starting only with Subutex because they believe that it is less likely to cause precipitated withdrawal. However, in most cases, Suboxone and Subutex are interchangeable for induction.

Some Subutex doctors, such as the Subutex doctors near me in the methadone clinic, prefer Subutex over Suboxone for daily treatment. This may be because generic Subutex is cheaper than generic Suboxone. And, they don’t have to worry about their clients shooting up the Subutex because they observe them taking each dose.

Is Subutex stronger than Suboxone?

Actually, in many cases, Suboxone may be stronger than Subutex. How is this possible? Suboxone and Subutex are sublingual medications. They must be placed under the tongue to dissolve. Many generic Subutex tablets do not dissolve easily. They may take up to 15 minutes or more to fully dissolve. 

The difference in efficacy and dissolving time may vary significantly from one generic brand of Subutex pill to another. For example, some patients have complained about a particular Subutex white pill taking a very long time to dissolve, as long as 30 minutes, where another brand, a Subutex orange pill, dissolves in just a few minutes.

The longer it takes for the tablet to dissolve, the more likely the patient might not wait the full amount of time. They may become frustrated and swallow the remaining part of the tablet. Any of the Suboxone or Subutex that is swallowed is wasted. It is only effective when dissolved under the tongue.

Additionally, generic medications can vary in potency. The actual dosage contained in a tablet may vary by as much as 20% or 25%. So, if you were to compare a brand-name Suboxone Film to a generic Subutex tablet, there could be a real difference in the amount of medication that each contains.

Are there benefits to brand-name buprenorphine products?

For many years, Suboxone Films were a brand-name-only product. Suboxone was known as the standard of buprenorphine sublingual medications. When it came to Suboxone vs Subutex, one clear benefit of Suboxone was that it was a reliable and consistent brand-name product. Every film tasted the same, dissolved the same, and worked the same. The dosage on the package was what was in the medication. 

Reliability has always been the major reason to stick with a brand name medication, even when the price is significantly higher compared to the generic. Not long ago, a generic substitute for Suboxone Films was released. Several other generic buprenorphine/naloxone strips came out shortly afterwards. So, now, when a doctor prescribes Suboxone Films, pharmacists are allowed to substitute for the generic equivalent.

Is there a Suboxone-like sublingual medication that is still brand-name only?

Interestingly, there is a drug named ZubSolv that fits this description. When it comes to ZubSolv vs Subutex or ZubSolv vs Suboxone, is there really that much difference?

ZubSolv is more similar to Suboxone in that it contains both buprenorphine and naloxone. However, like Subutex, ZubSolv is a tablet, not a film.

While ZubSolv tablets may resemble Subutex tablets, and they have the same main active ingredient, the resemblance ends there. ZubSolv dissolves quickly, in just several minutes, and it has a pleasant minty taste. 

Suboxone Films have a bad reputation when it comes to taste and aftertaste. Many patients who take Suboxone do not look forward to the lingering aftertaste. Usually, they are able to find a way to cope with it, drinking coffee, chewing gum, having a mint, or some other way to mask the taste.

With ZubSolv, you are left with a minty-fresh taste in your mouth and the tablet is dissolved and gone in about three to four minutes. In addition to these advantages, Orexo, the manufacturer, offers a one-time 30-tablets-free offer for anyone who would like to download a free voucher from their website. 

The voucher makes it possible to get started with treatment while waiting for insurance approvals to come through. Also, when it comes to the issue of pharmacists substituting the brand for generic, it is not possible with ZubSolv. There is no generic equivalent that they are allowed to substitute.

Subutex vs methadone: which works best for getting off of pink heroin?

This is a good question. Pink heroin is a street name for a synthetic designer opioid named U-47700. The current legal status of this drug puts it in the same category as heroin. Another street drug to look out for is called Gray Death.

While a drug user may believe they are using one of these street opioids because of its appearance or what a dealer has told them, there is no way to be certain. Advanced testing, such as liquid chromatography or mass spectrometry, may be needed to be certain of what is in a particular powder purchased on the streets.

The issue with heroin and heroin-like drugs is that, in most cases, the user has no idea what is in the powder they are snorting or shooting up into their veins. Recently, street heroin has been making the transition to Suboxone difficult. Somehow, an opioid-like component is being stored in the fat cells and released gradually over time.

Precipitated withdrawal sometimes complicates early Subutex and Suboxone treatment.

When a person using heroin goes in to see a doctor for Suboxone treatment, after waiting for a long enough time and feeling appropriate withdrawal symptoms, they take their first dose of Suboxone. Because of the nature of exotic synthetic opioids mixed into the heroin, the patient goes into precipitated withdrawal when they take their first Suboxone, even if they have waited 24, 48, or even 72 hours.

While this situation makes the transition to Subutex or Suboxone more difficult from unusual street opioids, such as pink heroin or gray death, it is possible. However, if a person using these substances is concerned about precipitated withdrawal, methadone is an excellent treatment option.

Because methadone is a potent full opioid receptor agonist, it can be started on the same day that the drug user quits heroin. With the appearance of these exotic new designer opioids contaminating street heroin, methadone has become a more useful treatment in many cases.

Does Subutex help with pain?

This is a very interesting question. I once attended an addiction treatment conference, and in one lecture, the addiction treatment specialist told us that buprenorphine works very well for pain, especially back pain. 

Then, he added that we don’t really want this information getting out because if there is widespread use of Subutex for pain, there may be more of a media focus on any problems that come up. He said that specialists in the addiction treatment community are concerned about Subutex and Suboxone being used to treat chronic pain, leading to more regulatory issues with these medications. They do not want it to be more difficult for addiction treatment patients to get access to medical care.

That being said, it is true that buprenorphine is effective as an analgesic, or pain reliever, for many people with chronic pain. It provides pain relief at about five times the potency of morphine, so taking Subutex 8 mg can provide similar pain relief as 40 mg of morphine. 

Additional benefits of buprenorphine are that patients tend not to develop tolerance to the drug, so there is no need for the doctor to keep increasing the dose for it to work. Also, there are less side effects with buprenorphine compared to other opioids. Patients report that they can think clearly and feel almost as if they are not taking medication when on Subutex.

What about Belbuca vs Suboxone? And, what is Butrans?

Belbuca is a buccal film that contains buprenorphine, just like Suboxone. While Suboxone indications include treating opioid dependence, Belbuca is indicated for treating pain. It is available in low, microgram dosing. Butrans is a seven day patch that contains buprenorphine in microgram doses. It is also indicated for treating pain. For doctors who want to prescribe buprenorphine to patients for pain, these are some alternatives so they don’t have to prescribe Subutex or Suboxone off-label for pain.

How do I know if Suboxone or Subutex doctors near me are accepting new patients?

The best way to find out is to call and ask! Unfortunately, the government places limits on how many patients a doctor can see for medication-assisted treatment with buprenorphine. So, a doctor who provides Suboxone treatment can only accept a certain number of patients, no matter how many patients want to see that doctor. Still, many Suboxone doctors do have available spaces for new patients in their practices.

Placing limits on the number of patients makes it more difficult for individual practicing doctors to focus their practice on medication-assisted treatment of opioid use disorder. In many cases, they have to include it as part of a larger practice. So, if you go in to see a doctor for your first Suboxone visit and you are sick with opioid withdrawal, you might sit in the waiting room beside a family of children coming in for their school or sports physicals.

However, there are doctors who do focus solely on Subutex and Suboxone treatment. There are even doctors who are now providing Suboxone telemedicine treatment, to protect patients from possible COVID-19 exposure.

Again, the best way to see if a doctor has an available space for you as a new patient is to call and ask. And, the best way to find out if that doctor is a good fit for you in treating your opioid dependence is also to call. Additionally, some doctors focused on MAT will have a Suboxone blog or Suboxone podcast for you to learn more about treatment. Following a doctor’s blog and podcast will also give you insight into that doctor’s treatment philosophy.

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