Both are forms of medication-assisted treatment (MAT), helping an individual to stop abusing opioids while managing cravings and limiting the discomfort associated with withdrawal symptoms. Subutex contains only buprenorphine, while Suboxone is a combination of buprenorphine and naloxone. While Subutex is no longer available in the U.S., generic forms of the medication are.
Subutex was often prescribed in the initial phase of detox while the person was under close medical supervision to ensure there was no abuse of the drug. Once stabilized in recovery and illicit opioids were out of the system, the person would generally be transferred Suboxone for long-term maintenance.[2]
Today, Suboxone is often considered the gold standard in treatment for opioid use disorder (OUD). If Suboxone does not work for you, your doctor may discuss generic buprenorphine or other forms of MAT with you.
Understanding Subutex & Suboxone
Subutex and Suboxone are both effective medications for people who are ready to transition out of active addiction and into active recovery. While the medications are similar, there are key variances in their chemical makeup and function.[3]
How Does Subutex Work?
Subutex works by binding to the brain’s opioid receptors, which manage the user’s perception of pain and reward.[4] Its primary active ingredient is buprenorphine, a partial opioid agonist, which has a ceiling effect in place to help people manage the difficult parts of detox but avoid euphoria or overdose if they attempt to abuse the medication.
Opioid Receptors Action
The binding of buprenorphine to the opioid receptors helps to stave off cravings for full opioid agonists, like heroin and morphine, without creating the high that makes these drugs so addictive.[5] It also works to diminish the experience of withdrawal symptoms that someone might experience if they were to stop taking full opioid agonists suddenly without tapering down their dose. This can be the key to a successful detox for those who might otherwise relapse due to the extreme nature of opioid withdrawal symptoms.
Ceiling Effect
With buprenorphine’s ceiling effect, the effects of the drug cease above a certain dose.[6] Essentially, this means that increasing the dose does not increase its effects, which significantly cuts down on the risk of respiratory depression, a common cause of opioid overdose death. This makes it a relatively safe choice for people in early recovery who may be more prone to relapse.
Administration & Use
Subutex was prescribed in the form of a sublingual tablet, which means it was not swallowed but placed under the tongue to dissolve.[2] This method of administration allows for the medication to be absorbed directly into the bloodstream through the tissues under the tongue.
Effectiveness in Treatment
Subutex is most effective when used as a first step in a comprehensive treatment plan that may include other medications as well as therapy and support services.[7] While it addresses the physical issues associated with opioid addiction and helps people to manage withdrawal symptoms and cravings, it essential to also put in the work to address the psychological aspects of addiction through a personalized treatment program.
How Does Suboxone Work?
Suboxone contains both buprenorphine and naloxone, an abuse deterrent.[1] This combination reduces or eliminates the experience of withdrawal symptoms and diminish cravings like Subutex does, but it also blocks the effects of other opioids due to the presence of naloxone.[8] This makes it very difficult to abuse Suboxone.
The Role of Buprenorphine
Buprenorphine is present in Suboxone just as it is in Subutex, and it serves the same purpose. It binds to opioid receptors to help people have a more comfortable detox experience while reducing the risk of overdose due to its ceiling effect.[4]
The Role of Naloxone
Naloxone is an opioid antagonist and what makes Suboxone unique from Subutex and other medications used in opioid addiction treatment. Naloxone blocks the effects of opioids by kicking them off opioid receptors.[9]
Most of the time, naloxone remains dormant in the medication. Buprenorphine, as a partial opioid agonist, stays below the trigger level of opioids that would cause naloxone to activate. But if the person abuses opioids or tries to abuse Suboxone, naloxone will bind to opioid receptors, kicking off all opioids and putting the person into precipitated withdrawal. This is a very uncomfortable experience.
Combined Effect in Treatment
The addiction of naloxone makes Suboxone the most common maintenance medication for people in recovery from opioid addiction. Because full opioid agonists are likely in the system at the beginning of detox at levels that will active the naloxone in Suboxone, doctors generally prescribe buprenorphine only in the first days of treatment and then follow up with Suboxone.[1]
The goal of naloxone is to prevent relapse. The user will not get high and will instead get sick if they abuse Suboxone or try to take other opioids.
Administration & Use
Suboxone is prescribed as a sublingual film or tablet that is either dissolved inside the cheek or under the tongue, respectively.[8] Dose amounts and schedules vary based on personal need and stage of treatment, but most people will take the drug once per day.
Like Subutex, Suboxone is most effective when used as a part of a comprehensive treatment plan that includes behavioral therapy and medical supervision.
Comparing Subutex & Suboxone
There are some key things to keep in mind when considering how and when to use buprenorphine versus Suboxone, as both are appropriate at different times.[10] Since Subutex is not available in the U.S. today, it is highly unlikely that you would be prescribed Subutex as part of MAT.
This chart breaks down how Subutex and Suboxone compare:[3,6-8,10-12]
| Subutex | Suboxone | |
| Use | Treatment of opioid use disorder, primarily during the initial phase of treatment for the purposes of transitioning from active abuse into active recovery | Treatment of opioid use disorder, primarily during the maintenance phase of treatment to continue to decrease cravings, reduce rates of relapse, and prevent overdose in the event of relapse |
| Schedule | Schedule III controlled substance | Schedule III controlled substance |
| Forms | Sublingual tablets | Sublingual films and tablets |
| How They Are Used | Dissolved under the tongue (sublingual administration) | Dissolved under the tongue or inside the cheek (buccal administration) |
| Side Effects | May cause initial nausea, vomiting, constipation, headache, sweating, insomnia, and pain | May cause initial nausea, vomiting, constipation, headache, sweating, insomnia, mouth numbness or redness, and pain |
| Addiction Potential | Lower potential for addiction compared to full opioid agonists because it is a partial opioid agonist | Lower potential for addiction compared to full opioid agonists; contains naloxone to deter intravenous abuse |
| Cost | Generally lower cost than Suboxone, especially if generic buprenorphine is prescribed | Generally higher cost than Subutex, partly because it includes naloxone; less expensive generic versions available |
| Insurance Coverage | Coverage varies by insurance plan and may require prior authorization; generic versions are usually more widely covered | Broadly covered by many insurance plans, including Medicaid; generic versions available and covered by many plans |
| Efficacy & Safety | Effective for reducing opioid cravings and withdrawal symptoms, but less safe for use than Suboxone because it lacks naloxone, the opioid blocker | Effective for reducing opioid cravings and withdrawal symptoms, and safer for use due to the inclusion of naloxone |
Key Differences Between Subutex & Suboxone
There are a handful of key differences between Subutex and Suboxone, which are important to understand prior to beginning a medication regimen.[3]
Active Ingredients
Subutex contains only buprenorphine as its active ingredient. Suboxone contains both buprenorphine and naloxone, which adds an extra layer of protection against overdose. Suboxone cannot be initiated until withdrawal symptoms have started.
Method of Administration
Subutex is prescribed in the form of a sublingual tablet. Suboxone is available in buccal film and as a sublingual tablet.
Relapse Prevention
Subutex is easier to abuse than Suboxone.[7] While Suboxone contains buprenorphine, it also contains naloxone, and the fear of extreme precipitated withdrawal can be enough to help people avoid relapse.[13]
Overdose Prevention
Buprenorphine has a ceiling effect, which makes it very difficult to overdose on Subutex.[6] However, if someone were to take other substances with Subutex (such as alcohol, benzodiazepines, or other opioids), overdose is possible.[14]
Suboxone has that same ceiling effect, but it also contains naloxone, which helps to prevent overdose in the event that someone tries to abuse it or other opioids.
Choosing the Right Medication for Opioid Use Disorder
While Subutex was once prescribed as part of MAT programs, it isn’t today since it was discontinued by its manufacturer in 2011. Generic forms of buprenorphine may still be prescribed, however. If you are using MAT to treat OUD, it’s likely that you’ll be prescribed Suboxone or another form of MAT, such as naltrexone or methadone.
When you enroll in an opioid addiction treatment program, you’ll have an assessment to determine the best medication (if any) to treat your condition. Medication is just one piece of the puzzle, and you’ll also participate in therapy, where you will identify and address root issues that led you to abuse opioids or other substances.
- Information about medication-assisted treatment. U.S. Food and Drug Administration. Published May 23, 2023. Accessed March 22, 2024.
- Buprenorphine quick start guide. Substance Abuse and Mental Health Services Administration. Accessed March 22, 2024.
- Understanding the difference between Subutex and Suboxone. Tennessee Department of Children’s Services. Published April 2017. Accessed March 22, 2024.
- How do medications to treat opioid use disorder work? National Institute on Drug Abuse. Published 2021. Accessed March 22, 2024.
- Virk MS, Arttamangkul S, Birdsong WT, Williams JT. Buprenorphine is a weak partial agonist that inhibits opioid receptor desensitization. Journal of Neuroscience. 2009;29(22):7341-7348.
- Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: Ceiling effects at high doses. Clinical Pharmacology and Therapeutics. 1994;55(5):569-580.
- Lutfy K, Cowan A. Buprenorphine: A unique drug with complex pharmacology. Current Neuropharmacology. 2004;2(4):395-402.
- Velander JR. Suboxone: Rationale, science, misconceptions. The Ochsner Journal. 2018;18(1):23-29.
- A. Yokell M, D. Zaller N, C. Green T, D. Rich J. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: An international review. Current Drug Abuse Reviews. 2011;4(1):28-41.
- Simojoki K, Vorma H, Alho H. A retrospective evaluation of patients switched from buprenorphine (Subutex) to the buprenorphine/naloxone combination (Suboxone). Substance Abuse Treatment, Prevention, and Policy. 2008;3(1):16.
- Medicaid coverage of medication-assisted treatment for alcohol and opioid use disorders and of medication for the reversal of opioid overdose. Substance Abuse and Mental Health Services Administration. Published 2018. Accessed March 22, 2024.
- Chambers LC, Hallowell BD, Zullo AR, et al. Buprenorphine dose and time to discontinuation among patients with opioid use disorder in the era of fentanyl. JAMA Network Open. 2023;6(9):e2334540-e2334540.
- Dunn KE, H. Elizabeth Bird, Bergeria CL, Ware OD, Strain EC, Huhn AS. Operational definition of precipitated opioid withdrawal. 2023;14.
- Tanz LJ, Jones CM, Davis NL, et al. Trends and characteristics of buprenorphine-involved overdose deaths prior to and during the COVID-19 pandemic. JAMA Network Open. 2023;6(1):e2251856.
