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Can Subutex Be Used for Chronic Pain (Safely)?

Can you use Subutex for pain? Only if your doctor says it’s safe to do so and provides you with instructions you follow to the letter.

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The U.S. Food and Drug Administration (FDA) has only approved Subutex as a treatment for opioid use disorder (OUD). Typically, the medication is provided in the induction phase of treatment, when people are transitioning from taking hard drugs (like heroin) to medication-assisted treatment (MAT) in a medical detox program.[1]

The brand-name version of Subutex was discontinued. In 2015, the FDA determined that it wasn’t pulled due to safety reasons.[2] As a result, generic forms of the medication are still available. However, they’re not FDA-approved for pain either. 

Is Subutex Typically Used for Chronic Pain?

Doctors typically don’t use Subutex for pain. The reasons are complex and varied, but in most cases, this isn’t the first choice when medical professionals are trying to help people struggling with long-term pain. 

Subutex contains buprenorphine in a dissolving tablet format. People with OUD can place these tablets below their tongues once per day and get relief from opioid cravings for about 24 hours.[1]

Other buprenorphine formats are FDA-approved for chronic pain. They include Belbuca (a dissolving strip for the cheek) and Butrans (a skin patch).[3] These buprenorphine formats are harder to abuse. People can’t crush dissolving strips or skin patches as easily as they can pills. They might be chosen for chronic pain instead of Subutex as a result. 

Doctors do have a lot of leeway in using FDA-approved medications. They can use these therapies off-label for any indication they think is necessary.[4] Technically, this means doctors could use Subutex for pain, even if it’s chronic. 

In surveys of medical professionals, doctors with experience prescribing buprenorphine were more likely to use it for pain therapies. Doctors who have never prescribed buprenorphine are less likely to do so.[5] 

Understanding the Research 

Why do some doctors use Subutex for pain? Digging into the research about buprenorphine and how it works might help you understand the risks and benefits. 

In one study, researchers wrote that buprenorphine was a safer option for chronic pain when compared to full opioid medications. They pointed out that buprenorphine, as opposed to other opioids, latches only partially to opioid receptors. That partial linking means buprenorphine could provide pain relief with a smaller risk of issues like respiratory depression.[6]

In a study of sublingual buprenorphine products (like Subutex) in the treatment of chronic pain, researchers examined the evidence from 10 patient trials. The researchers found the medication was 100% effective. Researchers found that people had less pain, improved sleep, and an improved sense of well-being.[3] 

In a final study that involved a review of 33 clinical studies, each of them demonstrated the efficacy of buprenorphine in pain control. However, these studies involved films and skin patches. They did not deal with dissolving pills.[7]

What Should You Do? 

The evidence suggests that buprenorphine is an effective therapy for all kinds of pain, including chronic versions. However, you’re not stuck with Subutex. The FDA has approved patches and strips for people with chronic pain. If you want to use buprenorphine, these might be good options. 

However, some people don’t react well to the current forms of buprenorphine available. They can’t tolerate the ingredients in the melting strips, or they can’t handle the adhesive in the skin patches. In these cases, your doctor might explore other solutions, such as Subutex. 
It’s critical to work with your doctor on effective solutions for pain relief. Take any medications exactly as they’re prescribed, and go back to your doctor for help if the solutions aren’t working. 

Updated March 18, 2024
Resources
  1. Subutex prescribing information. U.S. Food and Drug Administration. Published February 2018. Accessed February 28, 2024.
  2. Determination that Subutex (buprenorphine hydrochloride) sublingual tablets, equivalent 2 milligrams base, and equivalent 8 milligrams base, were not withdrawn from sale for reasons of safety or effectiveness. Federal Register. Published February 13, 2015. Accessed February 28, 2024.
  3. Hale M, Garofoli M, Raffa R. Benefit-risk analysis of buprenorphine for pain management. Journal of Pain Research. 2021;14:1359-1369.
  4. Wittich C, Burkle C, Lanier W. Ten common questions (and their answers) about off-label drug use. Mayo Clinic Proceedings. 2012;87(10):982-990.
  5. Wesolowicz D, Spelman J, Edmond S, et al. Increasing buprenorphine access for patients with chronic pain: A quality improvement initiative. Pain Medicine. 2023.
  6. Dalal S, Chitneni A, Berger A, et al. Buprenorphine for chronic pain: A safer alternative to traditional opioids. Health Psychology Research. 2021;9(1):27241.
  7. Pergolizzi J. Safety and efficacy of the unique opioid buprenorphine for the treatment of chronic pain. Journal of Pain Research. 2019;12:3299-3317.
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