Last updated: 09/18/2018
Author: Addictions.com Medical Review
Reading Time: 4 minutes
Subutex is a treatment medication for opiate addiction. It is often used only in the withdrawal and detox stage of treatment, but sometimes is used long-term.
Subutex contains buprenorphine which is a widely used therapeutic agent in patients with opiate addiction. Buprenorphine is the main chemical in Subutex, whereas a similar medication, Suboxone contains both buprenorphine and naloxone. They are both gaining popularity over the well known methadone as medication treatments for opiate addiction.
What Is the Difference between Subutex and Methadone?
- Partial opioid agonist
- Reduces cravings
- Full opioid agonist
- Can activate all receptors, like other opiates
- reduces cravings
Subutex is what is known as a partial opioid agonist. This means that it can attach to the opioid receptors in the brain that other opiates would, although, unlike them, it only activates a few receptors. These receptors help to regulate and reinforce important physiological processes such as hunger, thirst, or the need to care for our offspring. They also help to control motivation, emotions, pain, and other central nervous system responses.
Methadone, on the other hand, is a full opioid agonist like morphine, heroin, and prescriptions painkillers. Although it works very slowly compared to other opiates, it can activate all of the receptors at once and elicit, basically, the same physiological responses including dangerous respiratory depression.
Reduction in Opiate Dependence
The long term effectiveness of relieving cravings and withdrawals while blocking other opiate effects helps to stabilize the brain activities. Typically, the person who develops a tolerance for opioids has to use more of the drugs to get the desired effect. As they continue to do this, the normal productivity of certain neurotransmitters, mostly dopamine, becomes diminished.
Dopamine is the natural chemical that makes us feel pleasure and euphoria and the more reliant the brain becomes on artificial dopamine increases through opiate use, the more dependent on opiates a person becomes. In order for them to feel well, they must continue using opiates regularly or they go into a withdrawal state. Sometimes, this happens several times a day depending on the levels of opiate dependence.
Subutex relieves the opiate dependent person of the continuous need to obtain and use opiates. According to the SAMHSA “Repeated administration of buprenorphine produces or maintains opioid physical dependence; however, because buprenorphine is a partial agonist, the level of physical dependence appears to be less than that produced by full agonists.” By reducing the ups and downs of chronic opiate abuse, the brain is capable of rebalancing itself and reducing tolerance and dependence while using Subutex.
Other Benefits of Subutex
Because the buprenorphine content of Subutex is “sticky” it can occupy the receptors for long periods of time, while blocking out other opiate substances. Buprenorphine has also demonstrated a ceiling effect when it comes to respiratory depression which reduces the risk of respiratory failure in case of overdose.
This ceiling effect also proves beneficial to those who take the Subutex on a daily or less than daily basis because larger doses can be administered with less frequency and although they do not increase buprenorphine’s agonist activity they do lengthen its duration of action.
The safety profile for Subutex makes it a desirable treatment for chronic opiate addiction because it has a lower level of abuse and dependence potential than that of methadone, less withdrawal discomfort when discontinuing use, and less harmful risks if diverted to others.
Subutex is a schedule III substance under the Controlled Substances Act and is available by prescriptions from qualified physicians who are specially trained to provide it for treatment of opiate addiction. The prescriptions, controls, and qualifications are substantially more lax than those of methadone because of its higher degree of safety.
In an effort to bring treatments for opiate addiction closer to the mainstream of medical care, Subutex was approved in 2002 as a medication for opiate addiction treatment which could be prescribed or dispensed in a treatment setting such as a doctor’s office without the provider having to be licensed as an Opioid Treatment Program (OTP).
Subutex for Opiate Addiction Treatment Programs
Subutex can be used to manage long term opiate addiction as well as various detox methods from opiates. According to SAMHSA” In general, buprenorphine has been used in three ways for withdrawal from opioids: long‐period withdrawal (>30 days), usually on an outpatient basis; moderate‐period withdrawal (>3 days but <30 days), again on an outpatient basis; and short‐period withdrawal (<3 days), which often has been conducted on an inpatient basis.”
The medical community recognizes that opiate addiction is a chronic medical disorder that can be treated effectively through a combination of medication, psycho-interventions and psychosocial services.
Subutex OTPs work similarly to methadone maintenance programs by providing the medication along with counseling, behavioral therapies, and supportive services that help the addict improve functionality while their lives become more satisfying and productive. The programs teach coping skills and relapse prevention techniques that are recommended guidelines for sufficient opiate addiction treatment.
Many people are choosing to switch from methadone maintenance programs because of the convenience of obtaining Subutex without having to make daily trips to a clinic which can add up in cost, travel, and time.
For those who obtain Subutex from other medical providers, it is important to engage in self-help programs such as Alcoholics Anonymous or Narcotics Anonymous to increase the outcome of recovery.