Buprenorphine vs Suboxone: Key Differences & Misconceptions

Buprenorphine vs Suboxone: What Are The Key Differences Between Buprenorphine and Suboxone?

Buprenorphine and Suboxone are both opioid agonists approved by the FDA to treat opioid use disorder. Buprenorphine is a single drug, while suboxone is a combination medication made up of buprenorphine and naloxone. Both medications are effective at treating opioid use disorder.

What is Buprenorphine?

Buprenorphine is a synthetic opioid approved by the U.S. Food and Drug Administration (FDA) to treat pain and opioid use disorder. [1]  Buprenorphine is a Schedule III drug, meaning it has a moderate-to-low potential for physical dependence or a high potential for psychological dependence.

Buprenorphine is a partial opioid agonist. This means that it binds to the same receptors as opioids do, causing the same action as the substance. Since it is only a partial opioid agonist, its opioid effects are limited, and therefore, receptors are not activated in the same way to experience a high or overdose.

It is substituting a potent opioid (fentanyl or heroin)  with a less potent opioid (buprenorphine). Once you are stabilized, the medical professional can taper the buprenorphine. This reduces the uncomfortable experience of withdrawal due to opioid addiction with fewer withdrawal symptoms and less discomfort.

Buprenorphine treatment allows you to focus on treatment and therapy rather than suffering through uncomfortable withdrawals. Buprenorphine has been shown to be an effective drug in treating opioid dependence by decreasing cravings and improving overall quality of life during the addiction treatment process.[2]

By alleviating the uncomfortable symptoms of opioid withdrawal, one is more likely to participate in treatment planning, follow through with the goals of the treatment plan, and reduce their morbidity and mortality rate.

Buprenorphine is marketed under the brand names Subutex, a sublingual tablet, and Probuphine, a 30-day subcutaneous implant.

A warning regarding the prescription of buprenorphine: it does have a high risk for intravenous abuse. It can be prescribed to people who are pregnant or have severe liver impairments, but caution and medical monitoring are advised due to the potential impacts on liver health and fetal development.[3]

What is Suboxone?

Suboxone is a combination medication of buprenorphine and naloxone.[4] Naloxone is an opioid receptor antagonist, meaning it binds to the opioid receptors and can block or reverse the effects of an opioid. Naloxone is combined with buprenorphine to lower its risk for misuse when injected.

If someone were to dissolve the Suboxone tablet and inject it intravenously, the naloxone in the combination would act to block the opioid effects of buprenorphine, potentially triggering withdrawal symptoms in opioid-dependent individuals. There is also the potential for an opioid-dependent person to experience withdrawal if they were to inject buprenorphine; with the addition of naloxone in the suboxone, this risk is eliminated. Because of this, most people will be prescribed suboxone as it does not have to be taken under direct supervision like buprenorphine alone has to be.

Brand names for buprenorphine and naloxone include Suboxone, which is taken as a sublingual film, Zubsolv, which is taken as a sublingual tablet, and Bunavail, which is taken as a buccal film (inside the cheek). [5]

Medication-Assisted Treatment for Opioid Use Disorder

In 2022, the Mainstreaming Addiction Treatment Act aimed to increase access to buprenorphine by eliminating the requirement for providers to obtain a special waiver to prescribe this medication for Opioid Use Disorder. [6] However, providers still need to have appropriate DEA registration and adhere to state laws.

Medication-assisted treatment (MAT) is a combined therapeutic approach of medications to treat opioid use disorder and mental health therapy. Medications can help alleviate cravings, which helps one overcome their physical dependence. It also minimizes withdrawal symptoms.
Common opioid withdrawal symptoms include [7]

• Abdominal pain, cramps, diarrhea, constipation
• Changes in body temperature, feeling hot or cold, goosebumps, sweating
• Nausea and vomiting
• Muscle aches
• Nasal congestion
• Restlessness
• Tremors
• Eyes watering, blurry vision
• Frequent yawning

Research shows buprenorphine lowers mortality and adverse outcomes risk.[7]  It is more successful than detox alone in terms of treatment retention, adverse outcomes, and relapse rates. Research shows lower all-cause and overdose mortality and increased improved quality of life ratings for those on maintenance buprenorphine.

Those on buprenorphine also had lower rates of HIV and hepatitis C transmission when compared to those in abstinence-based programs and detox programs. Buprenorphine has a low overdose rate outside of those who are also using alcohol or other sedative drugs.

Research is expanding in the area of MAT, and new studies are showing that buprenorphine may be able to treat other addiction disorders. One off-label study has found that suboxone has the potential to treat cocaine addiction. The buprenorphine and naltrexone bind to more receptors than just opioid ones, which may reduce the compulsive use that often comes with cocaine addiction without leading to an opioid addiction.[9]

Misconceptions about buprenorphine and suboxone.

There are numerous misconceptions surrounding medication-assisted treatment. The following are frequent misconceptions regarding buprenorphine and suboxone treatment, followed by the facts.[10]

• Medication-assisted treatment is just substituting one drug for another: Suboxone, used as directed in MAT, acts as a medication that facilitates recovery by reducing withdrawal symptoms and cravings, unlike misuse of substances that impair health and function.
• Taking suboxone is a failure: Addiction is a disease, not a personal, moral failure. Partial agonists stabilize the opioid receptors so you can make lifestyle and behavior changes and address psychiatric needs, breaking the relapse cycle.
• People are just getting high on Suboxone: While Suboxone is designed to mitigate opioid cravings without producing a significant ‘high,’ there is still a potential for misuse, particularly in individuals not opioid-dependent. They can get high if they combine suboxone with other drugs, don’t take it as prescribed, or use it to manage withdrawal symptoms while actively using opioids. Treatment programs can address these risks through monitoring, drug testing, and pill/film counting.
• People will just sell their Suboxone: This can also be monitored through pill/film checks and buprenorphine level testing. The rate of someone sharing or selling their buprenorphine is similar to antibiotics – 20%. Most people who were using buprenorphine were doing so to self-medicate their addiction because they were not able to afford treatment – 64%!

Effective Treatment for Opioid Use Disorder

There is significant research that supports the use of buprenorphine and suboxone for the treatment of opioid use disorder. Despite its safety and efficacy, it is an underused treatment for those with an opioid use disorder.

Medications for opioid use disorder are most effective when paired with counselling and psychosocial support. People seeking treatment for OUD should work closely with their healthcare provider to determine what type of treatment will best meet their needs.

Frequently Asked Questions About Buprenorphine vs Suboxone