Can You Get Buprenorphine Without Naloxone?

Yes, you can get medications that contain only buprenorphine and not naloxone. If you have opioid use disorder (OUD) and you’re not able to take naloxone, other medications are available for you, including pills and injections. 

While buprenorphine is helpful, it can also be abused. Adding naloxone can help reduce the risk of abuse and overdose. This opioid agonist (or blocker) kicks in when oral forms of buprenorphine are injected.[1] 

Formulations without naloxone aren’t inherently more dangerous. Injectable formats, for example, are difficult to abuse as you must get them during a doctor’s appointment.

What Medications for OUD Only Contain Buprenorphine? 

Two forms of medications for OUD contain only buprenorphine. One is a pill, and one is a sustained-release injection. 

The pill version of buprenorphine was once sold under the brand name Subutex. It’s been discontinued as a brand in the United States, but it’s widely available in generic form. Some people still call these generic pills Subutex.[2]

Subutex is typically provided in the early stages of recovery when people may still have some active opioids in their system. People who are allergic or sensitive to naloxone may keep taking these pills over the long term. 

Sublocade is the injectable form of buprenorphine. It’s provided in a gel format that becomes solid when it hits water in the body. The medication is then slowly released into the system and delivers relief for up to 30 days.[3]

People who don’t want to take daily medication for OUD can use Sublocade instead. It’s almost impossible to abuse, as you must go to a doctor’s office to get your medication. It’s not a take-home medication you could crush, snort, or abuse. 

Are There Medical Reasons to Avoid Naloxone? 

Naloxone is considered a safe medication for people with OUD. In fact, spray formats of the drug are often used to reverse overdose symptoms in people who took doses of opioids that were too high and overdosed. 

In rare cases, experts say, naloxone can cause cardiac symptoms. When it’s given in an emergency, some people develop swelling in and around the heart and need medical monitoring and treatment to get better.[4] People with heart conditions may avoid naloxone for that reason. 

Researchers say there’s very little evidence that people have allergic reactions to naloxone.[5] No skin tests or blood tests can diagnose an underlying allergy to the substance. However, some people do feel sick when they use naloxone, and they may avoid it for that reason. 

It’s important to find an OUD therapy that works for you and your body. Treatments that work are those you will stay with for a long time. If naloxone makes you feel sick or upset, your doctor should help you find a therapy that works better. 

Prescribing Buprenorphine Without Naloxone 

Every person is different, and so are the therapies they need for OUD. In general, if your team determines that buprenorphine without naloxone is best, your treatment program might look like the following. 

Subutex is typically provided in the early stages of recovery. People may still have active opioids in their bodies, but they’re hoping to get and stay sober. 

Doctors wait until patients have subtle signs of withdrawal (like goosebumps or a runny nose), and then provide a small dose. They watch for symptoms to disappear, and then taper the dose to find a balance between feeling few withdrawal symptoms without grogginess.[2]

Once people have a stable buprenorphine dose, doctors can shift to the injectable form of the drug. Typically, patients get two monthly doses of 300 mg, and then they use 100 mg monthly doses in the maintenance phase. You will always go to the doctor to get your injections, as you can’t give them to yourself at home.[3]

Potential Risks & Considerations 

Two very important risks are involved in using buprenorphine without naloxone. If your doctor decides this is the right treatment for you, it’s important to understand these risks and do your part to avoid them. 

The first involves overdose. Buprenorphine is classified as a Schedule III drug, meaning it has a moderate-to-low potential for physical dependence. If people who aren’t accustomed to opioids take the drug, they can experience a life-threatening overdose.[1] 

People who use buprenorphine for long periods can develop a reduced opioid tolerance. If they take the same drug dose they took before they entered treatment, they can overdose and die.[1] 

Pill formats of buprenorphine can be abused, even by people in treatment for OUD. Some people crush their pills and snort, smoke, or inject the powder. Doing so can also lead to an opioid overdose, which isn’t as likely in formulations that also include naloxone. 

Essentially, naloxone serves as a solid deterrent to abuse buprenorphine-based medications. This can be important in preventing relapse and encouraging long-term recovery.

It’s important to follow your doctor’s instructions about your medications in the letter. If you’re ever tempted to abuse your drugs, talk to your doctor. 

Do You Know How Your Medications Work?

Patient education is an important part of your OUD treatment. Your doctor should verbally explain how your medications work, and you should be given handouts that you can study at home. Before you take your very first dose, you should understand how the therapy works and what you should do to take it correctly. 

While buprenorphine is safe for OUD treatment, oral formulations without naloxone come with higher risks than injectable forms and oral forms with naloxone. If your doctor chooses buprenorphine-only pills, take them exactly as instructed. Talk to your doctor if this isn’t working for you.