The opioid crisis has been at the forefront of American media and politics for the last few years.
For many people, that crisis only exists in the abstract. However, for far too many, it is their
daily reality. The Department of Health and Human Services (HHS) reports that overdose deaths
involving opioids increased 519.38% from 1999 to 2019. Along with this increase also comes
sharp increases in cases of Hepatitis C and HIV/AIDS due to intravenous drug use, as well as
instances of babies born with Neonatal Opioid Withdrawal Syndrome (NOW). As such, opioid
addiction is increasingly being looked at as a public health crisis, rather than a criminal activity.
The medical community has been responding by innovating new and better treatments for
opioid addiction. Two widely used medications for mitigating opioid addiction are Subutex and
Suboxone. The main difference between the two of these is that Subutex contains only the drug
Buprenorphine, while Suboxone contains both Buprenorphine and Naloxone.
The Opioid Crisis
Opioids include a wide range of drugs, such as the natural morphine and codeine. They
also include synthetic drugs like oxycodone, hydrocodone, tramadol, and fentanyl, among
others. Many of these drugs are prescribed by doctors for pain. They work on the opioid
receptors in the brain, blocking pain and causing pleasure and, often, euphoria. This is the
reason that they are so addictive. In many cases, a patient is prescribed one of these legal
opioids for a legitimate reason. However, they become addicted and sometimes turn to illegal
heroin when they can no longer get the drugs from their doctor. Heroin can actually be cheaper
to obtain for patients who are uninsured. According to HHS, 68% of all overdose deaths are
attributed to synthetic opioids. Over 48,000 overdosed on opioids in 2020.
From the 1960s, the main medical treatment for opioid addiction was methadone.
Methadone is a schedule II substance, meaning it has a high potential for abuse and addiction.
Because of this, users had to come, daily, to methadone clinics, so that their dosage could be
closely supervised, and misuse could be mitigated. However, clinics could be difficult for some
users to access. As well, it is not very beneficial for one addiction to be replaced by another
addiction. Many users had to enter drug rehab for dependency to methadone.
What is Subutex?
In 2000, buprenorphine, previously used as a pain reliever, was approved for opioid addiction. Buprenorphine, much like methadone, works on the opioid receptors in the brain,
but in a slower-acting way that does not produce the “high” effect of opioids. Long-term opioid
use leaves the user with damage to the brain and a storm of chemical imbalances, so that the
user cannot function without the presence of the drugs. Symptoms of opioid withdrawal can be
severe and may include profuse sweating, extreme sensitivity to pain, insomnia, severe anxiety,
nausea and vomiting, and abdominal cramps. These can be so unpleasant that the addict must
have their drug of choice to stop the symptoms. Opioid antagonists like buprenorphine work on
the opioid receptor sites and help mitigate these withdrawal symptoms, giving the user a
fighting chance to get past the detox stage. Buprenorphine gives the brain the support it needs
to regulate itself and the body in absence of the opioids it is used to. This helps reduce
withdrawal symptoms and cravings that are often the reason for relapse. Once the user gets
past the detox stage, they may be in a much better position, both physically and mentally, to
receive education and therapy for their addiction. Buprenorphine can also be used to replace a
certain portion of a patient’s prescription pain medication, helping them taper off. When part of a larger treatment program including therapy, it can also aid in the treatment of the long-
term effects of opioid abuse such as an inability to feel any form of pleasure that can last months to years
Though it is a schedule III substance, which means it is not as likely to be abused or
create dependency, some patients were still misusing Subutex (buprenorphine only). Many
were attempting to inject the drug in order to receive the “high” effect they were used to,
which worked, in many cases. To help mitigate this trade of one dependency for another,
researchers added Naloxone to the formula, creating Suboxone.
How does Suboxone work?
Naloxone, used alone, is an emergency treatment for opioid overdose. Injecting it rapidly
reverses the effects of the opioids that were used. If the user attempts to inject Suboxone, the
naloxone will cause an immediate onset of severe symptoms called “precipitated withdrawal”.
Addicts know this and avoid it. Because of this, Suboxone may have an even lower potential
than Subutex for misuse and addiction.
Lower risk of abuse is of the highest priority for any medication used to help addicts. Therefore,
though neither Subutex nor Suboxone has been shown to work better than the other,
Suboxone may be a better choice for addicts who have been through treatment and relapsed.
Subutex vs Suboxone: Differences & Their Relation To Buprenorphine (americanaddictioncenters.org)
Methadone Maintenance Treatment Pros & Cons (methadonecenters.com)
How Does Methadone Work? (methadoneclinic.com)
The Pros and Cons of Using Buprenorphine for Drug Addiction | AspenRidge Recovery Lakewood
Opioid Crisis Statistics : Prescription Opiod Abuse (drugabusestatistics.org)