Subutex (Buprenorphine)

What is Subutex (Buprenorphine)?

Subutex is also known as Buprenorphine because of its active ingredient, buprenorphine HCL.¹

Subutex is available as a sublingual tablet (a tablet you place under your tongue) and is used as a maintenance treatment for recovering opioid users. As a partial agonist at the mu-receptor, Subutex helps prevent withdrawal symptoms. 

The Food and Drug Administration (FDA) has approved Subutex as part of medication-assisted treatment (MAT).² This means that Subutex should be used as part of other addiction treatment programs such as counseling, compliance monitoring, and other recovery-focused therapies for people with opioid use disorder (OUD). 

Buprenorphine is a prescription available through opioid treatment programs (OTPs). Physicians who have undergone specialized training in opioid dependence can also prescribe buprenorphine.

However, its accessibility is not limited to OTPs only as various law provisions such as the Drug Addiction Treatment Act of 2000 (DATA 2000) and the Comprehensive Addiction and Recovery Act (CARA) provide for accessibility through qualified physicians with adequate training.³ 

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How is Subutex Used? 

Before you start using Subutex, read through the medication guide provided by your healthcare provider or pharmacist.

It’s recommended to abstain from opioid use for at least 12 to 24 hours (or until the opioid levels in the blood are significantly low before taking the medication), or it could cause precipitated withdrawal syndrome. Subutex works effectively during the early onset of withdrawal.

During your first day of treatment, your healthcare provider may prescribe multiple doses of Subutex. After that, Subutex is typically taken once a day. Place the tablet(s) under your tongue, sublingual, and let it stand for 5 to 10 minutes until they dissolve completely. Do not cut, chew, or swallow the Subutex tablets, as this will make them less effective. Injecting Subutex may lead to overdose or death.

Subutex dosage is based on the patient’s medical condition and response to treatment. Do not take higher doses or take it for longer than prescribed. Even when you forgot to take your dose, never try to compensate for the missed dose by taking a double dose. 

The duration of Subutex therapy is customized to the specific needs of each patient, and in certain instances, treatment may be indefinite. Individuals may participate in ongoing treatment—with or without MAT—to avoid relapse. When the time comes to stop taking Subutex, do so faithfully.

The most important thing is to follow the doctor’s instructions. Your health practitioner or pharmacist should be able to answer all your questions regarding the proper use of Subutex and other treatment options that exist.

What are the Side Effects of Subutex?

Taking Subutex can cause various side effects, from common/mild to severe.

Common side effects include:

• Pain
• Vomiting
• Dizziness
• Sweating
• Muscle aches and cramps
• Drowsiness and fatigue
• Blurred vision
• Constipation, nausea, and headache
• Dry mouth
• Insomnia
• Fever

Severe side effects include:

• Respiratory issues
• Adrenal insufficiency
• Overdose
• Dependence
• Neonatal abstinence syndrome
• Painful or difficult urination
• Allergic reactions
• Liver problems
• Sleepiness, drowsiness, or problems with coordination.

The above list does not include all side effects of Subutex. Patients should consult their healthcare practitioners or pharmacists to get more information. Be sure not to drive or perform any activity that requires your full attention until you know how Subutex affects you.

Both patients and practitioners are also 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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Subutex (Buprenorphine) vs. Suboxone: What’s the Difference? 

The main difference between Suboxone and Subutex medications is that Subutex contains only buprenorphine as the active ingredient, whereas Suboxone is a mixture of naloxone and buprenorphine. 

Naloxone is an FDA-approved addiction medication that works to reverse an opioid overdose by blocking the effects of the drug at the opioid receptors. The reason for mixing Subutex (buprenorphine) and naloxone is to prevent misuse as a result of Subutex’s misuse potential.⁴

Doctors recommend taking either Suboxone or Subutex if you suffer from severe opioid dependence or if you have undergone a relapse after the initial recovery. Although both Subutex and Suboxone are effective, Suboxone is preferred because it is less likely to be abused.

A National Institutes of Health (NIH) research published in the Journal of the American Medical Association also found that extended Suboxone treatment exponentially improved outcomes among young adults with opioid use disorder when compared to those subjected to counseling or short-term detoxification.⁵ However, the medication is more effective when used alongside comprehensive addiction therapy. 

What to Tell Your Doctor Before Taking Subutex

Your doctor or pharmacist knows everything about Subutex usage, dependence, and addiction.

Before starting on this medication, brief your doctor on your medical history, 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
• Addision's disease
• alcohol abuse
• trouble urinating
• problems with your thyroid or adrenal gland
• gallbladder issues
• trouble urinating
• mental health conditions

Also, tell your healthcare provider if you are pregnant or planning to become pregnant so they can provide medical advice.

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, and sweating.

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Dangers of Subutex

Subutex has many dangers, especially if not used as prescribed and under supervision. For instance, if used together with other drugs such as sedatives, alcohol, tranquilizers, muscle relaxants, and other illegal drugs, the drug interactions may be toxic and possibly fatal.

Users who overdose on Subutex are also at risk of brain damage resulting from oxygen deficiency due to slowed breathing, a condition known as hypoxia.⁶

Just like any other opioid, extended Subutex misuse may lead to tolerance, which increases the chances of an overdose or death as the user tries to increase the dosage to achieve a “high.”

Subutex is very dangerous if taken by a child. It can stop their breathing or lower their blood pressure, potentially causing death. For this reason, it’s recommended that Subutex is kept far away from the reach of children. 

Signs of Subutex Overdose

The following are the expected symptoms of 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
• Death

What to do if You Overdose on Subutex

If you or someone you know has overdosed on Subutex, do the following:

• Contact the poison control helpline at 1-800-222-1222
• If the victim is unresponsive, call 911 for further assistance

Based on the SAMHSA Opioid Overdose Prevention Toolkit, first responders should do the following if someone has overdosed on Subutex:⁷

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

Is Subutex Addictive?

Yes, Subutex can be addictive, just like any other opioid. Subutex is a sublingual tablet (placed under the tongue to dissolve). Any other form of administration, such as frequent snorting or injection, can lead to physical dependence. Users who take a higher dosage than prescribed are also at risk of getting addicted to Subutex.

The following are signs of Subutex addiction:

• 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 avoid Subutex addiction is by following the doctor’s instructions carefully.

Can Subutex Cause Withdrawal Symptoms? 

Subutex is a schedule III controlled substance, meaning it’s identified as an addictive substance by federal law, and distribution is restricted. 

Although Subutex is intended to assist patients in overcoming opiate addiction, it has the same effect as other opioids. Users may experience withdrawal symptoms if they stop using. Even those taking it as prescribed can experience withdrawal symptoms after extended use.

While Subutex withdrawal is not as severe as most other opioid withdrawal syndromes, most healthcare professionals recommend reducing Subutex use gradually (tapering) to prevent these unpleasant consequences. It’s also advised to seek medical attention in case of severe withdrawals.

Symptoms of Subutex withdrawal include:

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

Treatment for Subutex Misuse & Addiction

There are many remedies that can be used to treat opioid addiction. If you or someone you know is addicted to Subutex, all you need to do is seek professional help. 

Inpatient and outpatient recovery centers across the country exist and have implemented programs to treat people with opioid use disorder and help them overcome mental and physical dependence.

Inpatient and Outpatient treatment

Inpatient addiction recovery centers allow you to live within the facility for the duration of your recovery process. This is a good option for those suffering from severe opioid addiction and has challenges reducing cravings.

The types of treatments in inpatient facilities are categorized into residential, executive, and luxury, based on the programs and amenities offered.

On the other hand, outpatient programs allow the flexibility of tending to other responsibilities while undergoing rehabilitation. They are a good option for those with mild Subutex addiction. Some of the programs offered in outpatient addiction care facilities include:

Intensive Outpatient: 

This treatment plan provides more organized care than many conventional outpatient programs, and it is often utilized as a bridge between inpatient and outpatient therapy. Individuals will usually spend at least 9 hours per week in therapy, with sessions scheduled around their other commitments.

Individualized Therapy: 

One-on-one counseling aids in the identification and assessment of underlying issues that may have contributed to Subutex misuse. This also enables the development of appropriate coping mechanisms.

Group Counseling: 

In order to encourage sober life, group therapy capitalizes on the social reinforcement that peer discussion offers. Positive outcomes are obtained when group therapy is provided in combination with personalized counseling or is structured to reflect cognitive-behavioral therapy (CBT) or contingency management (CM).

Narcotics Anonymous: 

This is a group of recovering drug users who adhere to the same 12-step program like Alcoholics Anonymous (AA). This social setting provides comfort and support to many individuals needing medical help after addiction.

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