Is buprenorphine the same as Suboxone (buprenorphine and naloxone)?

From the Guidelines

Buprenorphine and Suboxone are not the same, although they are related, with Suboxone being a formulation that includes buprenorphine and naloxone. Buprenorphine is a partial opioid agonist that activates opioid receptors with less intensity than full opioids like heroin or oxycodone 1. Suboxone, on the other hand, is a brand-name medication that contains two active ingredients: buprenorphine and naloxone, with the naloxone component serving as an abuse deterrent that activates only if someone attempts to inject the medication 1.

Some key points to consider about buprenorphine and Suboxone include:

• Buprenorphine is available alone under brand names like Subutex, Belbuca, or Butrans, while Suboxone is commonly prescribed as sublingual films or tablets in various formulations 1.
• Both medications are used to treat opioid use disorder, but Suboxone is preferred for outpatient treatment due to its abuse-deterrent properties 1.
• It's crucial for patients to understand that these medications must be taken as prescribed, typically placed under the tongue until fully dissolved, and should never be crushed, injected, or shared with others.
• Brief treatment periods with rapid medication tapers are associated with high rates of relapse, making longer-term or maintenance treatment generally indicated for patients with opioid dependence 1.

Given the information from the study published in the American Family Physician in 2013 1, it's clear that while buprenorphine and Suboxone share a common active ingredient, they are distinct in terms of formulation and application in treating opioid use disorder.

From the Research

Buprenorphine and Suboxone: Understanding the Difference

• Buprenorphine is a partial mu-opioid receptor agonist used in the treatment of opioid dependence 2.
• Suboxone is a combination of buprenorphine and naloxone in a 4:1 ratio, where naloxone is an opioid antagonist 2.
• The naloxone component in Suboxone has no significant effect when taken sublingually as prescribed, allowing the opioid agonist effects of buprenorphine to predominate 2.
• However, when Suboxone is administered parenterally in patients physically dependent on full agonist opioids, the naloxone causes withdrawal effects, reducing the abuse potential of the drug combination 2.

Comparison of Buprenorphine Formulations

• Buprenorphine is available in different formulations, including a monoproduct (Subutex) and a buprenorphine/naloxone combination product (Suboxone) 3.
• A study comparing the pharmacokinetics of sublingual tablet versus liquid buprenorphine found differences in trough plasma concentrations between the two formulations across all dose levels 3.
• The bioavailability of the two formulations was found to be equivalent across all dose levels 3.

Treatment of Opioid Use Disorder

• Buprenorphine/naloxone (Suboxone) is an effective maintenance therapy for opioid dependence, with generally similar efficacy to methadone 2, 4.
• Methadone and buprenorphine/naloxone have different effects on patients, with methadone preferred by those seeking sedation and buprenorphine/naloxone preferred by those seeking opioid abstinence 4.
• The choice of medication for opioid use disorder treatment depends on various factors, including patient preferences and treatment expectations 4, 5.
• A review of opioid maintenance therapy highlights the importance of considering patient characteristics and treatment goals when selecting a medication for opioid use disorder treatment 6.