What is Subutex (Buprenorphine)?

Subutex contains the active ingredient Buprenorphine HCL (Hydrochloride). It is commonly used in FDA-approved treatments for opioid dependence.

Since Buprenorphine is a partial agonist of opioid receptors, it has a lesser risk of causing adverse effects from higher doses. It’s used to maintain the treatment of recovering opioid users.¹

Buprenorphine can perform partial substitution, which activates opioid receptors to a lesser degree. It reduces feelings of pain by interrupting nerve signals between the brain and the body. During  Medication-Assisted Treatment (MAT), this drug helps reduce the adverse effects of withdrawal from opiate addiction or opioid use disorders (OUDs).²

How Much Subutex Should I Take

Subutex works effectively when a person experiences moderate to severe OUD withdrawal. Your doctor may initially prescribe a high dose of Subutex, ranging between 2 to 4 mg every 5 to 6 hours. However, this dosage may differ depending on the needs of each person.

To take Subutex, place the tablet under your tongue and let it stand for 5 to 10 minutes until it dissolves completely. Do not cut, chew, or swallow the Subutex tablets, as this will make the drug less effective. 

Before starting medication with Subutex, healthcare professionals recommend undergoing opioid abstinence for at least 12 to 24 hours. Remember that the period of abstinence may vary depending on the kind of opioid taken.

How is the Dosage Determined?

Subutex dosage is based on the patient’s medical condition and response to treatment. The duration of Subutex therapy is customized to each person's specific needs.

The maximum daily dose of Subutex is 24 mg, but some people may receive higher doses if instructed by their physician. Do not take higher doses or take it for longer than prescribed.

If you miss a dose, don’t try to compensate by double-dosing the medication. If you have any questions or concerns regarding the medication or dosage, consult your doctor on how to proceed.

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What’s the Difference Between Subutex and Suboxone? 

Subutex contains buprenorphine to perform partial substitution, whereas Suboxone blocks opioid receptors with a mixture of naloxone and buprenorphine. Healthcare providers use them to treat opiate addiction.

By blocking opioid receptors, Suboxone can also reduce Subutex’s potential to induce physical dependence or addiction.⁴ Doctors recommend taking either Suboxone or Subutex if you suffer from severe opioid dependence or if you have undergone a relapse after an initial recovery.

Subutex Vs. Suboxone

Although both Subutex and Suboxone are effective in treating OUDs, Suboxone is preferred because it is less likely to be abused. Suboxone’s added benefit of naloxone can help prevent misuse of the medication. Nevertheless, both medications have become more effective alongside comprehensive addiction therapy.

Where Can You Get Subutex

Subutex comes in sublingual tablets and is prescribed through, but not limited to, opioid treatment programs (OTPs). Physicians with specialized training in opioid dependence can prescribe this for treatment.

Various laws and provisions, such as the Drug Addiction Treatment Act of 2000 (DATA 2000) and the Comprehensive Addiction and Recovery Act (CARA), provide buprenorphine through qualified physicians with adequate training.³ 

Medical Conditions Affecting Subutex Treatment

A person’s medical condition can affect how well they receive Subutex in their body. You should brief your doctor on your medical history before taking Subutex, especially if you have:

• Any brain disorders
• Respiratory issues
• Liver disease
• Gastrointestinal issues
• Kidney problems
• Any problems with your teeth
• Addison's disease
• Alcohol dependence
• Trouble urinating
• Problems with your thyroid or adrenal gland
• Gallbladder issues
• Mental health conditions

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Is Subutex Addictive?

Similar to opioids, misusing Subutex can lead to physical dependence. Subutex is a Schedule III substance, which is an addictive substance by federal law.

If you take a higher dosage of Subutex than prescribed, you risk developing these adverse effects:

• Mood swings
• Bleeding nose or sinusitis due to intranasal intake
• Collapsed veins and skin infections due to intravenous intake
• Frequent flu-like symptoms/respiratory depression
• Altered sleep pattern
• Poor productivity at work or school

The best way to prevent Subutex addiction is by following the doctor’s instructions and avoiding irregular dosing.

What are the Side Effects of Subutex?

Taking Subutex can cause common and severe side effects. However, this is not a complete list of side effects. If you’re worried about side effects, contact your doctor or pharmacist.

Common Side Effects of Subutex

Here are the most common side effects of Subutex. Avoid driving or performing any activity that requires your full attention until you know how Subutex affects you.

Side effects include:

• Pain
• Vomiting
• Dizziness
• Chills
• Nausea and headache
• Sweating
• Muscle aches and cramps
• Drowsiness and fatigue
• Blurred vision
• Constipation 
• Nervousness
• Dry mouth
• Insomnia
• Fever
• Anxiety and/or depression

Severe Side Effects of Subutex

Severe side effects include:

• Respiratory issues
• Stomach pain or indigestion
• Tooth or gum pain
• Diarrhea
• Adrenal insufficiency
• Overdose
• Dependence
• Mood changes such as agitation or confusion
• Hallucinations
• Neonatal abstinence syndrome
• Painful or difficult urination
• Allergic reactions
• Liver problems
• Sleep apnea
• Problems with coordination

People are urged to report any side effects they experience to MedWatch via 1-800-FDA-1088. MedWatch is a product safety reporting program for patients and healthcare practitioners.

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Is Subutex Dangerous?

Subutex can be dangerous if it’s used without supervision or prescription. It can lead to adverse interactions with other substances, such as:

• Alcohol
• Sedatives
• Tranquilizers
• Muscle relaxants
• Illegal drugs such as cocaine and marijuana

These drug interactions may be toxic and possibly fatal. Like other opioids, extended Subutex use can increase tolerance and lead to an overdose.

Signs of Subutex Overdose

The following are the expected symptoms of a Subutex overdose:

• Slowed or stopped breathing
• Loss of consciousness
• Pale face
• Confusion or lethargy
• A bluish tint to the lips or fingernails
• Low blood pressure
• Vomiting
• Bodily pain
• Brain damage from oxygen deficiency

 If these symptoms aren’t handled properly, inaction may lead to death.

How to Deal with Subutex Overdose

If you or someone you know has overdosed on Subutex, contact the poison control helpline at 1-800-222-1222.  While waiting for help, first responders should do the following⁵

• Evaluate the signs of the overdose
• Administer naloxone
• Support the victim’s breathing
• Contact 911 or the local emergency service for further assistance

Can Subutex Cause Withdrawal Symptoms? 

If you stop using Subutex after an extended period, you may experience withdrawal symptoms. This may happen even if you take Subutex as prescribed.

However, unlike other opioid withdrawal symptoms, Subutex withdrawal is less severe. Most healthcare professionals recommend gradually reducing Subutex use to prevent unpleasant withdrawal symptoms.

Symptoms of Subutex withdrawal include:

• Gastrointestinal distress
• Muscle aches
• Sweating
• Nausea
• Dilated pupils
• Runny nose
• Teary eyes
• Insomnia
• Fatigue
• Restlessness
• Irritability
• Aggression

It’s also advised to seek medical attention in case of severe withdrawals.

What to Tell Your Doctor Before Taking Subutex

Tell your doctor if you’re pregnant or planning to become pregnant so they can provide medical advice. You should also brief your doctor on your medical history before taking Subutex, including:

• Any brain disorders (such as tumors, seizures, and injury)
• Respiratory issues (such as sleep apnea or asthma)
• Liver disease
• Gastrointestinal issues
• Kidney problems
• Any problems with your teeth
• Addison's disease
• Alcohol abuse
• Trouble urinating
• Problems with your thyroid or adrenal gland
• Gallbladder issues
• Mental health conditions

When using Subutex, monitor yourself and let your doctor know if you experience any adverse opioid effects or withdrawal symptoms such as: 

• Mood changes
• Trouble sleeping
• Nausea
• Diarrhea
• Muscle aches
• Runny nose
• Sweating

Treatment for Opioid Use Disorder

Healthcare providers can use many remedies to treat opioid addiction. If you or someone you know is addicted to Subutex, seek professional help, especially for severe addictions.

Available treatment options for Subutex or opioid addiction include:

• Medical detox: Medically supervised detox used to avoid harmful withdrawal effects
• Inpatient treatment: Involves checking yourself into a rehab facility for 24-hour medical supervision 
• Outpatient treatment: A treatment program where you are freely allowed to leave the rehab facility
• Cognitive behavioral therapy: A short-term therapy technique explores the link between thought patterns and addiction
• Medication-assisted treatment: Involves using medication, counseling, and therapy to treat addiction
• Support groups and aftercare programs: Provide a much-needed community to help maintain sobriety after treatment

Summary

Subutex (buprenorphine) is a less risky medical solution while undergoing medical detox by functioning as a partial agonist to opioid receptors.

Although it has a lower risk of causing drug dependence, Subutex can still lead to drug dependence if misused. This is why using it while under Medication-Assisted Treatment (MAT) and aftercare programs is the best way to reach healthy sobriety.

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