Category: Suboxone Doctors

Despite some pretty major similarities, including sharing the same first syllable, Subutex and Suboxone are not the same drug. They cannot be used interchangeably or substituted for one another (unless designated by a medical professional). Join us as we dive into the differences between Subutex and Suboxone, how they work, and which one is better to use for opioid addiction.

What is Subutex?

Subutex is the brand name of a prescription medication used in the treatment of opioid use disorder. Its active ingredient is buprenorphine, a very weak opioid, which is used as a pain reliever and to reduce the intensity of withdrawal symptoms.

Subutex is typically prescribed during the induction phase of treatment (i.e. the beginning of treatment), but after they have already gone through the initial withdrawal phase from other opioids. It may not be suitable for long-term maintenance therapy for some individuals

What is Suboxone?

Suboxone, on the other hand, is a combination medication. It too contains buprenorphine (though it is not the same as buprenorphine), which means suboxone is able to safely activate opioid receptors and make opioid withdrawal a lot less uncomfortable. However, the key to suboxone’s success is its other active ingredient: naloxone, an opioid antagonist. 

Opioid antagonists are the opposite of opioid agonists and prevent opioid receptors from being activated. Suboxone has both, which makes it uniquely equipped to deal with some of the key challenges that can occur in medically assisted opioid addiction treatment.

Suboxone is used during both the induction stages of treatment as well as ongoing maintenance phases. 

How Subutex and Suboxone are similar

Both Subutex and Suboxone are FDA-approved medications used in opioid addiction treatment. They belong to a class of drugs known as partial opioid agonists which means that they’re technically opioids, but extremely weak ones — a key factor to why they’re so effective and their use is so widespread. 

Being opioids, Subutex and Suboxone are able to bind to opioid receptors in the brain, fulfilling the body’s physical dependence on opioids and thereby reducing cravings and withdrawal symptoms. And since they’re only partial opioids, they don’t cause euphoric highs like their predecessor, methadone, which is a full opioid agonist. As partial opioid agonists, these drugs carry a low risk of abuse or addiction.

The biggest difference between Subutex and Suboxone

The main difference between Subutex and Suboxone comes down to what they’re made of: Subutex’s only active ingredient is buprenorphine while Suboxone is a combination of buprenorphine and naloxone. 

Buprenorphine is a key ingredient in both Subutex and Suboxone which enables both medications to be so effective at treating opioid addiction, and the presence of naloxone in Suboxone doesn’t change that. What it does affect is the potential for long-term use of a buprenorphine-based medicine and that is why suboxone is preferred for the long-term maintenance treatment of opioid dependence over Subutex.

What does naloxone do?

Naloxone is an opioid antagonist that blocks the effects of opioids at the receptor level. It’s the same active ingredient in the brand name medication, Narcan, that’s used to reverse an opioid overdose quickly. 

Its purpose as part of a buprenorphine duo is to discourage misuse of the medication. If Suboxone is taken sublingually (placed under the tongue) as it’s supposed to be, the naloxone component has little to no effect. However, if someone tries to misuse Suboxone by injecting it, the naloxone becomes active and initiates some very unpleasant withdrawal symptoms very quickly. This makes suboxone much better equipped to deter misuse than subutex, which has no chemical safeguard. 

What does buprenorphine do?

Buprenorphine is the key component in medication-assisted treatment (MAT) for opioid dependence and opioid use disorder. It’s a partial opioid agonist that activates opioid receptors enough to alleviate withdrawal discomfort without producing intense euphoria. In addition to being an effective treatment for opioid addiction, buprenorphine is also used for pain relief and as an anesthetic.

Buprenorphine is a controlled substance due to its opioid nature. It should always be used under the supervision and guidance of a qualified healthcare provider. While the potential for abuse and addiction is low, all opioids carry some risk and should be used cautiously.

Even though it’s only a partial opioid, buprenorphine has a long duration of action and half-life (between 25 to 70 hours). This is great for addiction recovery patients because it means that the medication’s effects provide relief for a long time and don’t require frequent dosages. 

If you or a loved one are looking for relief from opioid dependence, you can talk to someone for free at an NA meeting near you. 

Buprenorphine is one of the most effective medications for treating opioid use disorder (OUD). When combined with counseling and behavioral therapies, buprenorphine can help people with opioid addiction achieve and sustain long-term recovery.

However, the FDA recently released a warning about dental problems, especially tooth decay, in patients with buprenorphine treatments. This warning is specifically for buprenorphine oral tablets and films that are placed under the tongue or on the inside of the cheek.

If you or someone you know is taking buprenorphine, here’s what you need to know about the FDA warning about related dental problems.

What is Buprenorphine?

Buprenorphine is a partial opioid agonist derived from opioids that alters the brain and nervous system’s reaction to pain. It produces euphoria at low to moderate doses, weaker than full opioids like methadone and heroin. 

When taken as prescribed, buprenorphine can help diminish the effects of opioid dependency, including withdrawal symptoms and cravings. It increases safety in case of overdose to potentially prevent death. And can lower the potential for opioid misuse.

Buprenorphine is FDA-approved for the treatment of opioid abuse in multiple products, including:

• Buprenorphine/Naloxone sublingual tablets
• Subutex (buprenorphine sublingual tablets)
• Suboxone (buprenorphine/naloxone sublingual films)
• Zubsolv (buprenorphine/naloxone sublingual tablets)
• Bunavail (buprenorphine/naloxone buccal film)
• Probuphine (buprenorphine implants)
• Sublocade (buprenorphine extended-release injection)

Buprenorphine and Tooth Decay

According to the 2022 FDA warning, medications that include buprenorphine, such as Suboxone, could cause tooth decay due to acid exposure to teeth and gums.

In their communication, the organization identified 305 cases of dental problems related to dissolved-in-the-mouth buprenorphine medicines. Remember, these were only directly reported and published in medical literature cases; there could be more that they’re unaware of.

The most common symptoms include: 

• Tooth decay
• Cavities
• Bad breath
• Oral infections
• Tooth fracture
• Loss of teeth

Most of them were using buprenorphine for OUD, but 28 were using it for pain treatment. In at least 26 cases, patients had no prior history of dental problems. Some cases reported dental issues as soon as two weeks after treatment began. 

It’s important to note that the buprenorphine medicines associated with dental problems are only tablets and films dissolved under the tongue or placed against the cheek. 

Unfortunately, the FDA didn’t pinpoint any risk factors for dental problems in people who use buprenorphine medicines. And they also noted that the benefits of buprenorphine far outweigh the potential risks. The comprehensive approach of using buprenorphine combined with counseling is still one of the most effective ways to treat OUD and help people sustain addiction recovery. 

Connection Between Buprenorphine Treatment and Dental Health

In one study of patients taking buprenorphine for over 45 months, researchers found many reported dental issues, including caries, fillings, cracked teeth, crown placements, root canal treatments, and tooth extractions. More than half of the participants reported toothache pain. 

These dental issues mirror findings from previous reports; a significant percentage of the patients wanted dental treatment, indicating a perceived decline in oral health. Although the reasons for this decline are not clear, several factors like cigarette smoking, bruxism, regular soda consumption, moderate dental hygiene practices, and use of other psychotropic medications that can negatively impact oral health were reported by patients. 

The way buprenorphine/naloxone treatment is used may also play a role in the patient’s dental issues. As the treatment is given sublingually and has an acidic pH, keeping the tablet and saliva in the oral cavity to enhance absorption can lead to a low pH environment. This and the medication frequency can alter the tooth surface microbial profile and promote dental caries.

However, the study acknowledges limitations such as a small sample size, potential confounding factors that might contribute to the development of caries, and the lack of a control group which makes it impossible to ascertain if dental issues predated the use of buprenorphine or were related to other lifestyle or biological factors.

How to Treat Buprenorphine-Induced Tooth Decay?

It’s important to remember that experiencing dental health issues is a common effect of drug abuse. Poor hygiene, poor nutrition, tobacco use, and opioid abuse can all contribute to tooth decay. 

Also, dental problems tend to be side effects of mouth-dissolving medications. However, you can maintain your buprenorphine treatment while protecting your oral health.

If you want to avoid your teeth rotting because of the use of buprenorphine, the FDA recommends some extra steps in your treatment:

• Gently rinse your teeth and gums with water after the sublingual tablet or the film is completely dissolved. Swish the water around your mouth to remove any remaining medication, then swallow.
• Brush your teeth after an hour of taking the tablet or film. 
• Schedule a dental checkup, inform the dentist about your buprenorphine treatment, and have regular follow-up appointments. 

However, if you are already experiencing dental problems due to buprenorphine oral administration, you will need dental treatment. Some reported cases required:

• Tooth extraction/removal
• Root canals
• Dental surgery
• Crowns or implants

Should I Be Worried If I’m Taking Buprenorphine?

An estimated 1.7 million people take prescripted buprenorphine, whether for OUD or pain treatment and many report no dental pain or other oral health issues. Incorporating some extra steps in your daily dental care routine can help reduce the chances of dental problems caused by buprenorphine. 

If you are a patient currently on buprenorphine treatment, remember not to stop taking the prescribed medication abruptly. Doing so could lead to relapse, misuse or abuse of other opioids, overdose, and death.

The best thing you can do is contact your healthcare facilitator and explain your concern. They could lower your daily dose or suggest another administration route. They can also help you contact a dental care professional to prepare a tooth decay prevention plan. 

Suboxone, the brand name of a widely used medication for treating opioid addiction, has numerous and significant benefits for those in recovery. It can increase treatment retention rates, decrease rates of overdose and relapse, lower mortality rates, and reduce the need for inpatient detox treatment. However, as is the case with many types of medications, it can take some time before the positive effects take place–time that the nature of addiction may not allow. 

So how long does suboxone take to work? 

In this article, we’ll cover all timely matters related to this popular MAT medication including how long the effects last and how long to wait to take suboxone.

What is suboxone used for?

Not all MAT medications are the same or used for the same purpose. Suboxone is a combination of buprenorphine and naloxone used during the early stage of recovery (detox) as well as the maintenance stages. In addition to being valuable for reducing the likelihood and severity of any experienced withdrawal effects, suboxone can also be used for long-term use to reduce cravings and lower the risk of relapse. 

Suboxone dosage is very likely to vary depending on the stage of a person’s addiction recovery. The strongest doses are used at the beginning of treatment, a stage referred to as ‘induction’. In this stage, suboxone is used to prevent and alleviate opioid withdrawal symptoms as soon as possible. In addition to being potentially dangerous, the discomfort experienced during withdrawal is one of the most common reasons why patients abandon treatment or avoid seeking it altogether.  

How long does it take for suboxone to kick in?

The amount of time it takes for suboxone to start working can vary depending on 1) the dosage and 2) the method of administration (more on that later). Generally, Suboxone reaches its peak within 30 minutes but its effects can last up to 24 hours. 

The sublingual form of suboxone (a thin dissolvable film that’s placed under the tongue) is the most effective and fast-acting. Suboxone is also available in a pill form, however, any medication ingested via the digestive tract will take more time to enter the bloodstream and therefore will be slower acting. Neither form of suboxone should ever be chewed or swallowed whole.

Suboxone’s Half-Life

Even if you no longer feel Suboxone’s effects, it’s important to be mindful that Suboxone also has a considerable half-life of 5 to 8 days–and could be up to 60 hours longer for those with impaired liver function. Why does this matter? Suboxone is a central nervous system depressant and mixing it with other depressants like benzos, can cause life-threatening effects.

How long to wait to take suboxone?

Suboxone offers relief and hope to those struggling with opioid addiction but its effectiveness is affected by the timing of use. First off, suboxone will only work for individuals who have opioid dependence. It will not benefit those who are irregular opioid abusers nor will it have any effect as a precautionary measure to protect against addiction.

Patients must be experiencing at least mild withdrawal in order to experience any of suboxone’s benefits. Determining when you can take suboxone will largely depend on the type of opioids that were used. Short-acting opioids such as heroin, codeine, or fentanyl will have an onset of withdrawal symptoms 8-24 hours after they were last used. Long-acting opioids such as methadone can take between 24 to 48 hours for the onset of withdrawal.

Will I qualify for suboxone?

Medical professionals refer to either the Clinical Opiate Withdrawal Scale (COWS) or the Short Opioid Withdrawal Scare (SOWS) to confirm patients meet the criteria to be eligible for suboxone. These scales rank the severity of various symptoms and tallied to create a score that determines whether an individual is in mild, moderate, or severe withdrawal. The types of MAT medications and their dosage will be prescribed depending on the severity of your withdrawal. 

Is suboxone safe?

A common misconception surrounding suboxone, and medication-assisted treatment in general, is that it’s trading one addiction for another. Even though Suboxone is a very weak form of an opioid that doesn’t provide a high, it does have the potential for abuse–any medication does. Suboxone has minimal risks when taken as directed. Overall, the potential benefits of suboxone far outweigh the potential risks for many people addicted to opioids. If you’re on the fence about taking part in medication-assisted treatment, you’d likely benefit from hearing from others recovering from opioid addiction and their experiences with this medication. Find a Narcotics Anonymous meeting near you, today.