Buprenorphine vs. Suboxone: Similarities & Differences

People with opioid use disorder (OUD), or opioid dependence, have a pattern of using opioids in an addictive fashion that can become potentially life-threatening.

Buprenorphine is a generic prescription drug classified as a partial opioid agonist. It is used along with drug counseling and other measures to treat OUD.

Suboxone is a brand-name drug used alongside counseling to treat OUD. It contains two active ingredients: buprenorphine and naloxone. Naloxone is an opioid antagonist.

These active ingredients help prevent withdrawal symptoms when an individual stops taking an opioid drug. It works by making the person feel a similar effect that the opioid would cause.

Buprenorphine alone may be used, though, in individuals who are starting therapy or who cannot take naloxone for some reason—for example, someone who is allergic to naloxone cannot take Suboxone

This article will provide an in-depth comparison of buprenorphine and Suboxone.

Understanding Opioid Dependence

Opioids, also referred to as narcotics, are a type of strong pain medication. Examples include Xtampza ER (oxycodone) and fentanyl. Heroin is an illegal opioid.

Opioids can cause various side effects, including drowsiness, nausea, and constipation. They can also slow your breathing, leading to death by overdose.

People who misuse opioids, either by taking more medication or more often than prescribed, using opioids to get high, or taking someone else's opioid medicine, have a higher risk of OUD.

Know, however, that OUD is also associated with heroin use.

Treatment Options

Opioid dependence may be treated in various ways, including medications, counseling, behavioral therapy, and residential or hospital-based treatment.

A combination treatment effort for OUD is called psychosocial support, which addresses the psychological and social needs of individuals, families, and the community.

Beyond psychological support, medication-assisted treatment (MAT) uses certain medicines (in combination with therapy) to treat opioid use disorders and help people recover.

Notable Statistics

According to the World Health Organization (WHO), in 2019, approximately 600,000 people died due to drug use, with about 80% of these deaths related to opioids.

Furthermore, according to the Centers for Disease Control and Prevention (CDC), from 1999 until 2021, opioid overdose deaths have increased annually.

Opioid dependence in the United States is highest in West Virginia, Tennessee, Louisiana, Kentucky, and Delaware.

What Is Buprenorphine?

Buprenorphine is Food and Drug Administration (FDA)–approved to treat OUD as part of a treatment plan that includes psychosocial support. Buprenorphine comes as a sublingual tablet (a tablet that is placed under the tongue to dissolve), a subdermal implant, and as extended-release injection. Brand-names include Brixadi and Sublocade, which are injections given weekly or monthly.

Buprenorphine is the preferred medicine for the induction of treatment under the supervision of a healthcare provider.

Buprenorphine reduces withdrawal symptoms (such as hot flashes, restlessness, runny nose, sweating, chills, muscle pain, vomiting, and diarrhea). It works by acting on parts of the brain that opioids act on.

However, buprenorphine does not cause a high. It is a treatment that helps balance parts of the brain affected by addiction, allowing the brain to heal while you work on recovery.

Modes of Administration

Generic buprenorphine used in OUD is given as a sublingual tablet.

Off-Label Uses

Sometimes, healthcare providers prescribe a drug for a use that it was not initially approved for. This is called "off-label" prescribing.

Healthcare providers may prescribe buprenorphine off-label for use in pregnant individuals to prevent neonatal abstinence syndrome (NAS), a group of medical conditions in which a newborn baby withdraws from medications they were exposed to while in the womb before birth.

NAS usually results from a person taking opioids for some time during pregnancy.

Brand-Name Forms

Brand-name forms of buprenorphine used to treat chronic pain (not for OUD) that is severe enough to require opioid pain relief include:

• Belbuca (administered via a film that is placed between the gum and cheek)
• Butrans (administered via a patch that is placed on the skin)

What Is Suboxone?

Like buprenorphine, Suboxone is FDA-approved to treat opioid dependence as part of a treatment plan that includes other measures, such as psychosocial support.

Suboxone contains two medications: buprenorphine and naloxone. It is available as a film dissolved under the tongue or between the gum and cheek.

After initial treatment, healthcare providers generally will switch to Suboxone because the medication will not be taken under direct supervision.

Naloxone is used as a safety feature that helps discourage people from dissolving and injecting the medication.

With Suboxone, naloxone, a medication that treats opioid overdose, is added to buprenorphine, making it less likely to be misused and injected.

The naloxone in Suboxone is only absorbed in the body if an individual injects the medication instead of dissolving it in the mouth as directed. If naloxone is injected, it will cause uncomfortable withdrawal symptoms.

So, this combination is a safety feature that helps discourage people who depend on injected opioids from dissolving and injecting Suboxone.

Modes of Administration

Generic forms of the brand-name Suboxone are administered as sublingual tablets.

Off-Label Uses

Some healthcare providers prescribe Suboxone off-label for chronic pain in people with opioid dependence.

Similar Brand-Name Products

Zubsolv is another brand-name product that contains buprenorphine and naloxone and is also used to treat opioid dependence.

Safe Usage Guidelines

Buprenorphine and Suboxone carry several vital warnings to be aware of:

• These medications have the potential for abuse, addiction, and misuse.
• Opioids such as buprenorphine and Suboxone can cause life-threatening slowing of breathing, unconsciousness, coma, and death.
• Avoid taking a benzodiazepine drug such as Xanax (alprazolam) with buprenorphine or Suboxone, or any other medications or substances that cause a slowing of the central nervous system, such as medications for sleep, barbiturates; muscle relaxants; or alcohol.
• Store your medication out of reach and sight of children and pets. Keep track of your medication so you know if any is missing.
• Neonatal opioid withdrawal syndrome may occur in babies born to individuals who use opioids for some time during pregnancy. This can be prevented by being treated during pregnancy.
• Opioid withdrawal may occur if the medication is interrupted or stopped. Liver function will be monitored while taking buprenorphine or Suboxone.

Side Effects

Like all drugs, buprenorphine and Suboxone have the potential for adverse effects in users, including mild, common side effects and rare but more severe effects.

Monitor yourself or a loved one carefully for the emergence of side effects. And if side effects worsen or fail to dissipate, contact your healthcare provider immediately.

Common Side Effects

Common side effects of both buprenorphine and Suboxone include:

• Headache
• Back pain
• Constipation
• Insomnia (having trouble falling and/or staying asleep)
• Redness or numbness of the mouth
• Tongue pain
• Blurry vision

Severe Side Effects

Serious side effects and their symptoms can include, but are not limited to, the following:

• Anaphylaxis (severe allergic reaction), seek emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
• Signs of serotonin syndrome (SS, a life-threatening condition due to excess serotonin levels) such as hallucinations (seeing or hearing things that do not exist), fever, sweating, confusion, rapid heartbeat, chills, stiff muscles, loss of coordination, or diarrhea
• Irregular menstrual periods
• Nausea
• Vomiting
• Dysarthria (slurred speech)
• Unusual bleeding or bruising
  
• Signs of liver problems: stomach pain, dark urine, clay-colored stools, or jaundice (yellowing of the skin or whites of the eyes caused by a high bilirubin count)

Additionally, dental problems have been associated with buprenorphine medications that dissolve in the mouth. These dental-related issues may include tooth decay or loss, cavities, and infections and can be severe.

Despite these drawbacks, the FDA notes that buprenorphine is an essential medication for OUD, and the benefits outweigh the risks.

Potential for Interaction

Tell your healthcare provider about all your medicines, including prescription and over-the-counter (OTC) drugs, as well as vitamins or supplements.

While taking buprenorphine or Suboxone, do not start any new medications without approval from your healthcare provider.

Examples of drug interactions include but are not limited to the following:

CNS Depression

Drugs/substances that cause central nervous system (CNS) depression can cause extreme slowed breathing, loss of consciousness, coma, or even death.

Examples include benzodiazepines, such as Valium (diazepam); medications for sleep, such as Ambien (zolpidem); or muscle relaxants, such as Flexeril (cyclobenzaprine).

CYP3A4 Inhibition

Buprenorphine and Suboxone are processed in the body by an enzyme (something that speeds up a process) called cytochrome P450 3A4 (CYP3A4).

Drugs that inhibit this enzyme can increase the levels of buprenorphine or Suboxone in the body, leading to increased opioid effects. These drugs include antifungals such as Nizoral (ketoconazole), and protease inhibitors such as Norvir (ritonavir).

CYP3A4 Induction

Drugs that induce CYP3A4 can decrease the levels of buprenorphine or Suboxone in the body, which could cause withdrawal.

Examples include anticonvulsants, such as Tegretol (carbamazepine) and Dilantin (phenytoin).

Potential for SS

Taking buprenorphine or Suboxone with a medication that increases serotonin levels can lead to a life-threatening condition called serotonin syndrome (SS).

People who take a combination of buprenorphine or Suboxone and one of the following drugs will need to be closely monitored:

• A selective serotonin reuptake inhibitor (SSRI), such as Lexapro (escitalopram)
• A serotonin and norepinephrine reuptake inhibitor (SNRI), such as Cymbalta (duloxetine)
• A tricyclic antidepressant, such as Elavil (amitriptyline)
• A triptan for migraine such as Imitrex (sumatriptan)
• A monoamine oxidase inhibitor (MAOI), such as Nardil (phenelzine) or Parnate (tranylcypromine)

Summary

Buprenorphine and Suboxone are prescription medications for treating OUD alongside other measures, such as counseling.

Buprenorphine, as a single-ingredient drug, is used to start therapy in a supervised environment. It is also sometimes used in individuals who are allergic to naloxone and cannot take Suboxone.

Suboxone contains two ingredients: buprenorphine and naloxone. The naloxone component discourages the drug from being dissolved and injected.

If you are in immediate danger, call 911. The 988 Suicide & Crisis Lifeline is available for people undergoing a mental health crisis.

This lifeline provides free, 24/7 access (via phoning or texting 988 or by chatting) to crisis counselors who can help with substance use problems or other emotional distress.