What Is Subutex?
NOTE: Subutex has been discontinued; however, buprenorphine is still prescribed in combination with naloxone in Suboxone.
Subutex is one brand-name formulation of a medication known as buprenorphine. As a partial opioid agonist-antagonist, buprenorphine shares some properties with other opioid substances such as:
In the early 2000s, buprenorphine was approved to treat opioid addiction and dependence, which means that if someone was physically dependent on an opioid, they could be prescribed buprenorphine to counter the withdrawal symptoms and cravings that can lead to relapse.
Subutex is not to be confused with Suboxone. Both contain buprenorphine, and both are used to treat opioid dependence–the difference is that Subutex is comprised of buprenorphine only, whereas Suboxone is a combination of buprenorphine and naloxone. Naloxone is what’s known as an opioid receptor antagonist—i.e., a substance intended to reverse or block the effects of opioids in the body.
Is It Harmful?
When taken appropriately, Subutex is not harmful. However, it may indeed be harmful and addictive when misused.
Although Subutex is meant to treat opioid dependence, it is an opioid substance itself. Perhaps ironically, it can thus be abused, and its misuse can eventually lead to addiction.Are you unable to control your drug use?
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When used as prescribed, Subutex can:
- Reducing cravings and withdrawal symptoms of someone with an opioid dependency.
- Lower the risk of overdose from opioids.
- Lower the misuse of opioids in the future by blocking their effects.
The final point is important because Subutex has a “ceiling effect.” This means that the desired effects of the substance gradually level off even when the dosing increases. Taking more will not always lead to more positive effects.
Subutex is a substance that gives a partial opioid response in the body, which means it will reproduce many of the same effects of drugs like heroin or prescription painkillers but to a lesser degree. Short-term effects of Subutex include:
- Mild feelings of euphoria.
- Reduced sensations of pain.
- Physical and mental relaxation.
- Slowed breathing.
Subutex is not without its unwanted side effects. Some may present immediately while others may develop over time or when dosing is changed. Side effects from Subutex include:
- Nausea and vomiting.
- Muscle pains and cramping.
- Reduced quality and quantity of sleep.
- Increased cravings for the substance.
Mixing Subutex with Other Drugs
Dangerous situations may arise when Subutex is mixed with other depressant substances that slow down the body, including alcohol or sedative medications like diazepam. The combined effect can lead to negative physical and emotional ramifications like:
- Respiratory depression.
- Cardiovascular collapse.
The long-term health effects of Subutex abuse are relatively mild when compared with full agonist opioids. Some of these dangers are associated with exacerbations of pre-existing health conditions, including reactive airway disease (e.g., asthma) and liver disease. It is in your best interest to disclose a complete medical history prior to being started on a Subutex regimen, to preclude the worsening of these medical conditions. Of course, the abuse of Subutex implies a non-adherence to prescribed Subutex dosing parameters, so the likelihood of health effects or the compounding of pre-existing conditions will be even greater, and dose-dependent.
Certain drug interactions with other prescription medication may also arise–if you are using benzodiazepines or antidepressants while using Subutex, you may subject yourself to life-threatening respiratory depression or cardiovascular collapse.
Additionally, if you take Subutex within 6 hours of taking an opiate drug like heroin, you can go into precipitated withdrawal. This means that you end up suffering a very nasty and unexpectedly abrupt withdrawal process. This is one of the key reasons to listen to your doctor when taking the medication and be honest about your last use of opiate drugs.
Further, if you stop taking Subutex and return to abusing opiates, your body may be hypersensitive to the effects of that opiate—meaning your risk of overdose and death is increased.
Finally, if you inject Subutex instead of taking it sublingually (under the tongue) as directed, you are at risk for abscesses, bloodborne diseases, and other complications associated with injection drug use.
Another long-term effect of Subutex abuse is addiction. Addiction is the process of continuing to acquire and use the substance even when negative repercussions are likely to result. Addiction can take place even when the medication is prescribed to you. Signs of addiction are:
- Taking the substance more often or in larger doses than intended.
- Talking the substance for reasons other than intended.
- Buying, selling, and trading to get more of the substance.
- Taking Subutex that is not prescribed for you.
As addiction escalates, other aspects of life become less important and less desirable as more time and attention are given to the substance. Someone addicted to Subutex may:
- Have financial troubles marked by not being able to pay bills or taking extraordinary measures to make more money.
- Have failing relationships with increased conflict or isolation.
- Miss work or other obligations.
- Have more erratic behaviors with mood swings.
- Show no interest in activities or behaviors that were once pleasurable.
When someone is considering ending their use of Subutex, consulting with a medical or substance use professional is extremely important. Ending use on your own is possible; however, to ensure safety and maximize comfort, medical supervision is often recommended. Additionally, supervised treatment tends to end with better results and prolonged periods of recovery.
Withdrawal Symptoms You May Experience
- Loss of appetite.
- Increased pain.
- Craving for the substance.
People abusing Subutex may begin treatment with a period of detox. During this, the substance will be allowed to clear itself from your body in a safe, systematic way. Supportive measures and, potentially, additional medications may be utilized to manage your withdrawal symptoms. This is done in an inpatient setting, so that your status can be vigilantly monitored.
Following detox, the treatment phase of addiction begins. Some programs will be housed at a residential rehab center—where those in recovery reside for a period between 30 and 90 days. This time will provide some separation from the stresses of their home environment, and afford the recovering individual the time and therapeutic attention needed to begin working on and resolving their problematic relationship with Subutex and other substances. Individual, group, and family therapy will be part of many rehab programs.
Outpatient therapy is an alternative option to rehab, but often occurs in addition to it once the patient completes the rehab program. Outpatient mental health and/ or substance use therapy will continue the process of addressing the triggers and underlying factors that feed into substance use. Plans will be made to prevent relapse by noting cravings and following through with alternative behaviors.
Outpatient treatment can continue for years following last use, as can 12-step and community-based treatments. By joining a 12-step program, someone in recovery can establish a support system based on a substance-free lifestyle. With the use of sponsorship or mentoring, someone new to recovery can gain information useful in recovery from others that have had their own success.
Addiction is a serious disease and one that will follow a different course of development for each person individually. With the proper treatment, though, addiction to Subutex can be effectively managed.
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- Substance Abuse and Mental Health Services Administration. (2016). Buprenorphine.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- News Medical Life Sciences. (2016). Subutex (Buprenorphine Hydrochloride) Drug / Medicine Information.