Subutex Treatment for Opioid Use Disorder 

Subutex is a prescription medication containing buprenorphine. The U.S. Food and Drug Administration (FDA) approved Subutex for the treatment of opioid use disorder (OUD).[1] However, the FDA says Subutex should only be used in the early stages of treatment. 

Subutex was discontinued in 2011, but generic forms are still available. People still sometimes refer to these as Subutex. 

Unlike other forms of buprenorphine, Subutex doesn’t include any abuse-prevention guardrails. It doesn’t contain an ingredient like naloxone to keep people from injecting it. And its pill form makes it easy to crush and snort the drug. 

Most treatment teams will use Subutex to help people move through the detoxification stage of care. When that’s done, most people transition to another buprenorphine format, so they can use the drug at home without worrying about its abuse potential. 

The Basics of Subutex

This chart can help you understand what Subutex is and how it’s commonly used:[1-3]

How Does Subutex Work? 

Subutex contains buprenorphine. This medication is a partial agonist at mu receptors, meaning it latches loosely to the same receptors used by drugs like heroin and oxycodone.[3] Its loose latching means it can relieve some of the most significant symptoms associated with drug withdrawal. 

Researchers say opioid withdrawal is difficult for most people. Severe symptoms like nausea and vomiting can lead to dehydration, and overwhelming cravings for drugs make a relapse more likely.[4]

With Subutex, doctors can reduce the signs and symptoms of drug withdrawal, ensuring that people stay in treatment for longer while experiencing fewer side effects. The medication can make a successful detox more likely.[4]

How to Take Subutex Properly 

Subutex pills should be administered whole, meaning you shouldn’t cut, crush, or chew them. Place the tablet under your tongue, and wait for it to dissolve. Don’t eat or drink anything until it has completely melted away.[1]

Some people need bigger doses than one tablet can provide. You can place two or more tablets under your tongue at the same time and let them dissolve. If you need more than two tablets or can’t make them fit, ask your doctor what to do next.[1]

Never swallow your tablets. Buprenorphine doesn’t enter your bloodstream effectively through your digestive system. If you swallow your pills, you won’t get as much help as you will if you let them dissolve.[1]

Pros & Cons of Choosing Subutex 

Like all medications, there are advantages and disadvantages of using Subutex.

Pros of Subutex (Buprenorphine)

• May reduce a patient’s craving for more harmful opioids, including heroin and OxyContin
• May reduce or prevent withdrawal symptoms
• Has a much lower potential for abuse when compared to stronger drugs used to treat opioid abuse, such as methadone
• Is an easily accessible treatment
• General healthcare providers can prescribe buprenorphine or Suboxone, while methadone can only be acquired at methadone clinics

Cons of Subutex (Buprenorphine)

• Has addictive properties, so can be abused by patients who are not using it as prescribed
• Ingesting alcohol or any drugs that slow breathing along with buprenorphine can lead to respiratory problems
• The maximum dosage may not be enough for some patients
• Can cause acute withdrawal if opioids are still in the patient’s bloodstream
• This may cause serious issues if the patient is pregnant
• May have a variety of side effects, ranging from inconvenient to deadly

Side Effects of Subutex 

Typical side effects of Subutex include oral issues, such as numbness, burning sensations, and swelling. If they appear, tell your doctor and ask what to do next.[1]

Other side effects you might experience include the following:[1]

• Headache 
• Nausea
• Vomiting 
• Sweating
• Constipation 
• Insomnia
• Swelling of the hands and feet
• Pain

Things to Consider Before Taking Subutex 

Subutex can be an important part of a treatment program for OUD, but it’s powerful and not right for everyone. These warnings and drug interactions are important to consider:

Warnings 

While Subutex is safe and effective when used as prescribed, it can be dangerous when misused, and some specific populations shouldn’t take the drug.[1]

At high doses, buprenorphine can cause respiratory depression and overdose. This risk is pronounced in children and people who have never used opioids before. Never abuse your medication, and keep it away from anyone who might be tempted to abuse it. 

Your doctor will monitor your health via blood tests to look for problems like liver disease or adrenal insufficiency. If they appear, your dose may need to be adjusted. 

Interactions 

The buprenorphine in your Subutex can interact with other medications, making the drug less effective or even harmful. These are a few of the substances known to react with your Subutex:[1]

• Benzodiazepines: Mixing Subutex with benzos can lead to sedation. 
• CYP3A4 inhibitors: Some types of antibiotics, over-the-counter medications, and antifungal medications impede your body’s ability to make CYP3A4, which is needed to break down buprenorphine. Mixing these medications can lead to an overdose.
• Antiretrovirals: If you’re taking medications in this class, your doctor may need to monitor your doses carefully to ensure they don’t interact.
• Serotonin drugs: Medications like antidepressants can increase serotonin levels, and buprenorphine can do the same. Serotonin syndrome is very dangerous. 

Your doctor should review your medications and ensure you’re not taking anything that might interact. Be sure to talk about any vitamins, herbal supplements, or tinctures you take that your doctor didn’t prescribe, as they might interact too.[1]

How Much Does Subutex Cost?

Online pharmacies charge between about $100 and about $200 for generic Subutex tablets, depending on the strength.[2]

Researchers say that buprenorphine prices have fallen more than 57% in five years, but the price can still be a big barrier for some people.[5]

People with commercial insurance plans tend to pay more for their medication than those who have Medicaid insurance. These plans cover buprenorphine medications, but they often require people to pay small fees (copayments) each time they fill their prescriptions. Since Subutex is a daily medication, those costs can add up.[5]

Even so, the cost associated with treating an addiction is lower than leaving it untreated. The National Institute on Drug Abuse points out that untreated addictions come with costs associated with criminal justice, overdose, lost productivity, and more. An investment in addiction care could make these expenses less likely.[6]

The Role of Subutex in Addiction Treatment 

Subutex is FDA-approved for OUD, but officials say it’s preferred for induction only. That means doctors like to use this medication during the detox portion of care (which is typically performed in a supervised setting, like a clinic).[1] 

The purpose of detox is to help you transition from using drugs like heroin to participating in a treatment program. Detox alone doesn’t generally lead to long-term sobriety, and it can’t address the issues that led to drug abuse.[7] However, medications like Subutex can make you more likely to finish detox. 

In one case study, a patient entered a hospital with severe symptoms of withdrawal that his team gave a severity grade of 26. They provided two doses of buprenorphine, and within 90 minutes, his score was lowered to 15. Over the next 45 minutes, his score lowered to 3.[8]

Studies like this demonstrate how effective Suboxone can be. If you’re feeling incredibly sick, you’re more likely to leave care than you would be if you felt comfortable. 

When it’s time for you to leave detox, your team will likely transition you to another form of buprenorphine that is harder to abuse. 

Subutex Therapy at Boca Recovery Center 

At Boca Recovery Center, we use evidence-based therapies for OUD. That means we use Suboxone in our medical detox programs. We pair the use of medications with evidence-based behavioral therapies to help our clients build solid foundations in recovery. 

We ensure that our patients are good candidates for care, so we ask about other medications and health conditions before we get started. Then, we find the dose that can keep symptoms under control and allow you to safely transition to sobriety. We’re a good choice to start your journey to recovery. 

Frequently Asked Questions About Subutex for OUD

These are the questions we often hear about Subutex treatment for opioid use disorder:

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More