Subutex, according to the FDA, is a "sublingual tablet... indicated for the treatment of opioid dependence" and addiction. Subutex is part of a complete treatment regimen for addiction and dependence on opioids which plagues many individuals. Whether someone has been addicted to heroin or other opioids (prescription and recreational) or is merely dependent on prescription opioids without addiction as a factor, Subutex can be a beneficial medication, depending on the person's needs and situation.
A similar medication Suboxone is also on the market and can be prescribed to treat the same problems. Both drugs contain buprenorphine, a partial opioid agonist.
The FDA approved two medications, Subutex and Suboxone, for the treatment of opioid dependence and addiction with the drug buprenorphine. According to the FDA, "Subutex contains only buprenorphine hydrochloride." Subutex was the "initial product" and was created to treat these conditions with the use of buprenorphine. It was approved in October of 2002 for this reason and then changes were made.
Suboxone actually contains both buprenorphine and naloxone, which is an opioid antagonist.
Suboxone was created because the initially approved-medication of Subutex can be more easily abused as it only contains buprenorphine. The naloxone guards against misuse and can precipitate withdrawal in those who crush and inject it. Subutex does not have this initial ingredient, thus is more easily abused.
However, this does not mean that Suboxone is a more necessary medication than Subutex. According to the FDA, "Subutex is give during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment" (FDA 2). This means that Subutex is often used to treat opioid withdrawal and to curb its initial symptoms while Suboxone is used in the later stages of treatment.
When Taking the Medication, Make Sure to Follow These Steps:
- Place the tablet under your tongue until it melts.
- You may be prescribed two tablets. If so, take them and place them on either side of the underside of your tongue so that they do not touch.
- The dissolving of the tablets "should take 2 to 10 minutes."
You should be sure not to talk or move your mouth more than necessary while the tablets are dissolving because this may make the medication not work as well. Also, do not chew or swallow the tablets because this may also compromise them.
When Taking Subutex, Make Sure to Follow These Precautions:
- Do not operate heavy machinery, drive, or do other tasks which can require immense concentration as the medication my make you drowsy.
- Do not take Subutex with alcohol or CNS depressants as it could cause extreme respiratory depression (to the point where you stop breathing), coma, and even death.
- Do not take antidepressants while taking Subutex. (Discuss this with your doctor if you are already taking antidepressants.)
- Do not take more than the prescribed dosage of Subutex or take it more frequently than prescribed. This is abuse.
As stated by SAMHSA, "Side effects of buprenorphine are similar to those of other opioids and include nausea, vomiting, and constipation." Because Subutex's main ingredient is buprenorphine, its side effects will be buprenorphine's side effects. Those listed above are the most common side effects caused by opioids, so buprenorphine users will likely be familiar with them.
Other Side Effects of Buprenorphine and Subutex are:
- Stomach Pain
- Difficulty Falling Asleep or Staying Asleep (Insomnia)
These side effects are all very common and not usually a cause for alarm. Someone who experiences them should discuss them with their doctor, especially if they are making it difficult for the person to live their life. Your doctor may prescribe you another medication to help with these side effects.How ever, there are some Subutex side effects that may be cause for alarm and can be dangerous indications of another type of problem.
Dangerous Side Effects of Subutex are:
- Rash on the Skin
- Problems Breathing
- Problems Swallowing
- Severely Slowed Breathing
- Severe Sleepiness or Fatigue
- Upset Stomach
- Unusual Bleeding or Bruising
- Loss of Appetite
- Pain in the Upper Right Part of the Stomach
- Yellowing of the Skin or Eyes (Jaundice)
If you notice hives, a rash, itchiness, or that you are having problems breathing and swallowing, you might be allergic to Subutex. The NLM states that these symptoms "are uncommon," but that if you experience them, you should call your doctor right away.
Another potential issue is liver problems. This is indicated by upset stomach, pain in the stomach, and jaundice. You may also be experiencing a decrease in blood pressure if you become dizzy or fatigued. Any of these signs could be a result of a bad reaction to Subutex.
Another issue is the possibility for withdrawal symptoms to occur. Mostly, withdrawal will be triggered if a person abuses Suboxone and crushes it, but SAMHSA states, "Additionally, the withdrawal syndrome can be precipitated in individuals maintained on buprenorphine" alone, or Subutex. If this occurs, the user will experience:
- Muscle Aches
- Bone Pain
- Runny Nose and Other Flu-Like Symptoms
If this occurs, get in touch with your doctor as soon as possible.
The FDA states that "Suboxone is the formulation used in the majority of patients." Subutex is not always prescribed first because it isn't always necessary. And patients who are on this treatment plan usually take Suboxone for a longer period of time than they take Subutex.
"From January to March 2013, 2.5 million buprenorphine prescriptions were dispensed," including both Subutex and Suboxone (DOJ).
- Start it as an initial medication in their buprenorphine treatment regimen
- Are serious about quitting opioids and following all the necessary procedures in order to take Subutex safely and effectively
- Are "willing to follow safety precautions for treatment" (SAMHSA)
- Have not experienced multiple relapses after treatment
- Have not been abusing opioids for many years
- Are not severely addicted to opioids
When someone takes Subutex as prescribed, usually in the first few days of dependence treatment and detox, the drug will likely be effective for treating dependence on and addiction to opioids.
It is important to remember, though, that neither Subutex nor Suboxone can fully take the place of long-term maintenance medications like methadone. Suboxone is more often used for longer term maintenance than Subutex is, but patients do not respond to it as well as to methadone over the course of treatment that takes months or even years. Methadone is still the best pharmacological treatment for opioid dependence and addiction for patients who have abused opioids for years and who may need to be on maintenance for a long time or even for the rest of their lives.
Complete treatment for opioid addiction and dependence is not just the prescription of Subutex or of both Subutex and Suboxone. A person normally needs to attend behavioral treatments as well in order to fully recover. According to the NIDA, "Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process," and both elements must be present for a patient to receive full addiction treatment. This is, after all, the most effective treatment regimen for addiction to date.
- The Induction Phase - This is the "medically monitored startup of buprenorphine therapy." A patient must have abstained from opioids for 12-24 hours prior to the start of this phase, and they must be "in the early stages of withdrawal." If this has not already occurred, it could be dangerous as the buprenorphine in Subutex could cause acute withdrawal. This is the point where the patient is most likely to take Subutex as opposed to Suboxone.
- Observed Therapy is often done at this time, usually in the office of the physician, and may be continued afterward.
- The Stabilization Phase - This stage takes place "when a patient has discontinued or greatly reduced the use of his or her drug of abuse, no longer has cravings, and is experiencing few or no side effects." A patient may be switched to Suboxone here or their dose of Subutex may merely be tweaked. The patient is stabilized for the most part and no longer experiencing extreme withdrawal symptoms.
- The Maintenance Phase - This phase consists of "when the patient is doing well on a steady dose of buprenorphine." This phase is a different length of time for every patient and should be carried out depending on their needs. If the maintenance phase is not necessary, or if the patient is ready is ready to stop taking Subutex, they will be slowly put through medically supervised withdrawal instead of maintenance. This is what used to be known as the detox phase.
Subutex treatment can be very beneficial if the patient taking it understands the necessities involved in successful Subutex treatment and recovery from opioid dependence and addiction. Ask yourself these questions to decide if Subutex treatment is right for you:
- Am I dependent on opioids?
- Do I experience withdrawal symptoms if I stop taking them?
- Do I not feel normal unless I am taking opioids?
- Do I need opioids to get through the day
- Am I addicted to opioids?
- Can I not stop taking opioids on my own?
- Have I experienced many problems as a result of my opioid abuse?
- Do I feel a lack of control over my abuse of opioids?
- Am I serious about ending my opioid abuse and dependence?
- Will I take my medication only as prescribed?
- Do I understand all of the necessary actions I must take to insure success in Subutex treatment?
If you answered yes to the above questions, Subutex may be right for you. Discuss the treatment of opioid dependence and addiction with your doctor.