Subutex and Suboxone were developed to aid in the field of opioid addiction.
Despite falling into the category of opioids themselves, these drugs are commonly used to treat the negative effects of rehabilitation.
During the first stages of rehabilitation, an individual will need to reduce the amount of toxins and other harmful chemicals that have built up as a result of an opioid addiction. As part of this, they are likely to experience withdrawal symptoms.
These can be of varying severity and every individual will be affected differently throughout the process of detoxification.
In the past, the treatment and alleviation of withdrawal symptoms has been met with methadone – a powerful painkiller and another opioid.
However, methadone is classed as a highly addictive drug in itself and therefore a new treatment was needed.
As a result of this, Subutex was developed as a less addictive treatment option for those suffering with an opioid addiction. Later research also revealed the number of Subutex addictions to be increasing at a slow rate and Suboxone was developed.
With the inclusion of another opioid, Suboxone was considered slightly less addictive, though the differences are still heavily debated.
In either case, both Subutex and Suboxone are considerably less addictive than the past treatment of methadone, and these drugs are amongst the most common methods of treating an addiction to other opioids.
Subutex was the first opioid to be developed to replace methadone as the primary treatment of opioid addictions.
Composed of buprenorphine – a less addictive opioid than methadone – this type of pharmacological addiction treatment is relatively effective for long-term treatment of opioid addictions.
Research shows that individuals using Subutex as a maintained pharmacological treatment are likely to abstain for longer than 6 months when followed exactly as prescribed and alongside other treatments (1).
However, there are some risks that are associated with Subutex and its usage. For example, as this was the first drug developed after methadone as an opioid treatment, it still has the potential for addiction.
Buprenorphine, when consumed in large quantities or abused as part of Subutex treatment, can be incredibly addictive. Although the same highs are not achieved as when consuming methadone or other opioids, the effect in the long-term can be just as harmful.
In addition, the number of cases of Subutex being sought outside of prescribed opioid addiction treatment is on the rise. More people are trying to access Subutex as a recreational drug rather than a medically prescribed treatment.
When used correctly, and just as prescribed or instructed by a licensed medical professional, Subutex is far more effective than methadone or other opioid addiction treatment options such as other forms of maintenance therapy.
Suboxone was developed after Subutex and methadone, as a precautionary form of buprenorphine that is not as addictive.
Suboxone still contains buprenorphine but also contains the opioid naloxone.
Naloxone was added to this opioid addiction treatment to combat the potential of abuse and addiction. It works by blocking the opioid receptors, therefore blocking opioids and their effects on the body.
For this reason, naloxone is known as an opioid antagonist.
This is a highly effective treatment for opioid addictions, as the inclusion of naloxone reduces the chance of addiction and abuse of Suboxone, therefore reducing the desire for the drug outside of its rehabilitative purposes.
Research has shown that Suboxone is considerably less addictive than Subutex, but that it can have some adverse effects when not managed properly.
One study showed that the same dosage of Suboxone is not as effective as Subutex and that this level must be carefully managed and adjusted in order to maintain positive effects such as long-term abstinence and physical well-being (2).
If an individual is considering transferring to Suboxone from Subutex, then the decision should be carefully discussed, planned, and carried out with the full support and supervision of a medical progression.
Regular checks should be made on the individual, their wellbeing, and any adverse effects that they may have as a result of the change.
Because buprenorphine in itself falls into the opioid category of drugs, it can be harmful or damaging to the individual if not properly managed and adjusted.
When first prescribed, an individual may take some time to react to the treatment, and the effects may not be evident straight away.
In addition, there are also several common side effects such as the ones listed below:
Buprenorphine can be addictive, meaning that there are also issues associated with someone struggling with addiction.
Furthermore, there can be some withdrawal symptoms from buprenorphine when used or abused for long periods of time.
This includes mild effects such as flu-like symptoms and headaches but can also cause more serious discomfort such as insomnia and bodily aches and pains.
Buprenorphine usage is also risky when combined with other substances such as alcohol and benzodiazepines (psychoactive drugs).
A metanalysis showed that both of these substances were found in 58% and 82% of cases of buprenorphine poisoning, and there was only one case in which neither of these substances were found (3).
As mentioned previously, and with all addiction treatments, they are very effective when followed correctly and when adjusted where needed.
In all cases, addiction treatment programmes should be followed as instructed including dosage, timing of consumption, and reporting any side effects or changes.
There is no outstanding evidence that shows that either Subutex or Suboxone-based treatment is more effective in terms of opioid addiction disorders.
These treatments are usually compared directly to methadone, and therefore both are seen are more effective and less risky treatments.
Although they both hold their own drawbacks, the evidence is clear for their usage over traditional methadone-based treatments or other standalone opioid addiction treatments.
The debate over the comparison of Subutex and Suboxone mainly focusses on the introduction of the two. Due to the fact that Suboxone was produced after Subutex as a further advancement on methadone, Suboxone is widely argued as the more effective treatment.
This is also supported by the presence of naloxone as well as buprenorphine – introduced to combat the addictive risk of buprenorphine alone.
According to statistics, Suboxone is also therefore less likely to be abused outside of medical addiction treatment due to the ‘dilution’ of the opioid due to the inclusion of naloxone.
Despite the fact that a higher dosage may be needed to achieve the same rehabilitative effects as Subutex, Suboxone is seen as a highly effective addiction treatment when employed correctly.
There is ongoing research as to the validity of these statements and the debate of which of Subutex or Suboxone is more effective.
As mentioned above, opioid addiction treatment can be highly effective when used according to direction and in cases where it is safe and appropriate to do so.
Not every individual is suitable for this type of treatment, whether this is due to personal differences or a previous history of long-term drug abuse and misuse.
However, in the cases where it is appropriate, there are still several things to keep in mind.
For example, Subutex and Suboxone are not standalone opioid addiction treatments. When used alone, their benefits will be minimal.
Although it may help to combat withdrawal symptoms and reduce cravings, these are only a few of the effects caused by long-term opioid use.
Opioid use is associated with many psychological and physical effects, meaning that a combination of treatments will be necessary for an efficient and long-lasting recovery.
Other types of therapies that could be used include cognitive behavioural therapy (CBT) which is used to help individuals alter negative cognitions associated with addiction and develop coping mechanisms to help them deal with addiction even after treatment.
With addictions, most counselling or therapies focus on finding the root cause of the addiction and the triggers that may worsen this.
Having a deeper understanding of addiction and the treatments involved is one of the first steps individuals can take, whether they are seeking help for themselves or for someone they know.
If you would like to learn more about Subutex, Suboxone, or any of the other drugs involved in addiction treatments, take a look at our other web pages, or call our addiction hotline 24/7 on 0800 140 4690.
[1] Proctor, S.L., Copeland, A.L., Kopak, A.M., Herschman, P.L. and Polukhina, N., 2014. A naturalistic comparison of the effectiveness of methadone and two sublingual formulations of buprenorphine on maintenance treatment outcomes: Findings from a retrospective multisite study. Experimental and clinical psychopharmacology, 22(5), p.424.
[2] Simojoki, K., Vorma, H. and Alho, H., 2008. A retrospective evaluation of patients switched from buprenorphine (Subutex) to the buprenorphine/naloxone combination (Suboxone). Substance abuse treatment, prevention, and policy, 3(1), pp.1-6.
[3] Häkkinen, M., Launiainen, T., Vuori, E. and Ojanperä, I., 2012. Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. European journal of clinical pharmacology, 68(3), pp.301-309.
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
