Subutex Treatment for Opiate Addiction

Subutex is a buprenorphine-containing sublingual pill for treating withdrawal from opioid use. Learn how Subutex is used to help people struggling with opioid addiction.

Subutex is an opioid replacement option for people who wish to avail themselves of medically-assisted detox and recovery from opioid use disorder (OUD). However, it is important that people understand that the Subutex pill does not constitute treatment for addiction. Rather, Subutex relieves withdrawal symptoms and reduces cravings, allowing individuals to focus on treatment for their addiction.

There is no pill that will cure addiction. The underlying causes and the adverse physical, mental, social and psychological effects of drug use and related behaviors must be identified and addressed. That is the function of addiction treatment programs.

Subutex can be a part of an overall addiction treatment plan, but, like any other medication, it does not treat the addiction itself.

What is Subutex?

Subutex is a brand-name formulation of the semi-synthetic opioid buprenorphine, which is used for the treatment of OUD. Subutex comes as a sublingual tablet, which is dissolved under the tongue. Subutex is a “high-affinity” long-acting partial agonist of opioid receptors, meaning that it attaches aggressively to the opioid receptors in the brain and blocks other opioids from attaching to their receptors. As such, it prevents the effects of opioid use.

Even though it binds strongly to opioid receptors, it has very low activity, so Subutex has a low overdose risk and does not produce much euphoria. It does, however, relieve withdrawal symptoms and cravings in people detoxing from opioid use. Subutex treatment is initiated soon after withdrawal symptoms begin in people detoxing from opioid use.

Subutex vs. Suboxone

The difference between Subutex and Suboxone is that, unlike Suboxone, Subutex does not contain the opioid antagonist (blocker) naloxone.

Other Buprenorphine Medications

Buprenorphine comes in many different brand-name formulations, either alone or in combination with naloxone. These have a variety of routes of administration. These brand names include:

• Bunavail: buprenorphine and naloxone, buccal film (dissolves in the inside of the cheek), used for OUD
• Buprenex: buprenorphine alone, intravenous solution, used for pain management
• Butrans: buprenorphine alone, transdermal patch, used for pain management
• Probuphine: 30-day subcutaneous (under the skin) buprenorphine implant for opioid addiction
• Suboxone: buprenorphine and naloxone, sublingual film, used for OUD
• Zubsolv: buprenorphine and naloxone, sublingual tablet, used for OUD

How Does Subutex Work?

Opioids are psychoactive, meaning that they markedly change the brain’s chemistry, disrupting proper healthy function. To compensate for the constant bombardment of opioids, the brain makes major changes to its usual chemical composition and functions. The sudden removal of the opioids again results in disruption to the brain.

Subutex works by “fooling” the brain into thinking that its owner is still using opioids so that the sudden shock of opioid withdrawal doesn’t cause a sudden disruption in the brain’s function.

Subutex has such a strong attachment to opioid receptors in the brain that it removes other opioids and prevents the attachment of any other opioids that are used. As such, it blocks the effects when people try using opioids while on Subutex therapy.

Induction

Subutex induction (initiation of therapy) is at the time of appearance of withdrawal symptoms, or at least 6 to 12 hours after the last opioid use, for short-acting opioids (such as heroin). Because of Subutex’s high affinity for opioid receptors, it will displace other opioids and may precipitate premature withdrawal symptoms if started too early.

Subutex induction is usually done in an inpatient detox center, but may be done in a physician’s office or even, in select cases, at home.

Stabilization

Subutex is started at a low dose and if withdrawal symptoms are not adequately suppressed the dose is titrated upward to get the desired effect. Once a proper dose has been established and treated individuals are satisfied with the buprenorphine stability, there is no set recommended time limit for the continuation of therapy.

Maintenance

Subutex maintenance programs are individualized because the duration of treatment and decision to taper off the drug depend on having adequate supports in place to ensure ongoing recovery following discontinuation.

The discontinuation of Subutex may result in mild withdrawal symptoms beginning three to five days after the last dose, which may continue for several weeks. Following discontinuation, people can switch to naloxone treatment within a few days, thus reducing the risk of relapse. People who relapse may be restarted on Subutex if deemed appropriate.

Subutex Side Effects

What are the side effects of Subutex? Side effects of Subutex are similar to the side effects of other opioids but are usually somewhat less pronounced because the drug is only a partial opioid agonist. Side effects can include:

• Mild euphoria (warm feelings of well-being)
• Constipation
• Confusion, cognitive impairment
• Insomnia
• Muscle aches
• High body temperature, sweating
• Light-headedness, dizziness
• Nausea
• Headache
• Swelling in the legs
• Urinary retention
• Withdrawal symptoms if drug use is abruptly halted

Effects on Babies

Subutex is a common choice for treating opioid addiction in pregnant women because naloxone-containing products can’t be used due to pregnancy side effects. Subutex appears to have fewer fetus-related effects than methadone does.

Subutex effects on the fetus include:

• Intrauterine growth restriction
• Suppressed fetal heart rate
• Suppressed fetal movement

However, studies have shown overall positive long-term effects of Subutex on babies (compared to untreated opioid addiction):

• Reduced neonatal withdrawal syndrome (i.e., babies born addicted to opioids)
• Improved prenatal care compliance
• Fewer high-risk behaviors during pregnancy and motherhood
• No adverse effects of Subutex use in pregnancy on later infant development
• Subutex is compatible with breastfeeding

Effects of Prolonged Use

What are the long-term effects of Subutex? There are no particular Subutex side effects related to long-term use, beyond the usual side effects of the drug. However, Subutex is not intended for long-term use. People taking the drug should receive treatment for their addiction and have plans for tapering off the drug as soon as they are ready. Remaining on the drug as a crutch instead of focusing on addressing the addiction can lead to inappropriately prolonged use of the drug.

Is Subutex Addictive?

People can become addicted to Subutex and develop tolerance. If this happens they may develop withdrawal symptoms if they stop abruptly. However, Subutex addiction is considered an acceptable aspect of the drug, because it replaces the much more harmful and malignant addiction to opioids that it treats.

Does Subutex Get You High?

Although Subutex is only a partial opioid agonist, it can result in a weak high in individuals who are regular opioid users. As such, there are reports of abuse. This risk is why many buprenorphine products also contain the opioid blocker naloxone. Often, attempts at abuse are based on the mistaken belief that getting high on Subutex is as possible as with other drugs.

Subutex and other buprenorphine products produce a greater high in people who are not opioid dependent and produce the positive reinforcement-reward effect seen in other opioids. However, Subutex has abuse potential in people who are not regular opioid users.

Effectiveness of Subutex Treatment for Opioid Addiction

Data shows that buprenorphine is superior to methadone for tolerability (i.e., people are more likely to remain on buprenorphine than they are with methadone due to its side effects). Buprenorphine has been shown to be far superior to a placebo, with one well-designed study showing a one-year retention rate of 75% and 75% negative urine drug tests in patients taking buprenorphine, compared to 0% on both measures in people taking a placebo.

Other studies showed that buprenorphine is associated with reduced mortality, reduced relapse rates, reduced HIV and Hepatitis C transmission rates, improved outcomes in pregnancy, improved retention within recovery programs and improved quality of life.