Suboxone / Subutex Difference

I will bop off an easy question before finishing for the night…  again, from the search terms, someone searched ‘Suboxone Subutex difference’.  For those wondering where I am getting the search terms, I’ll explain again– go down the right column of the blog to the list of recent visitors– on a widgent from ‘feedjit’.  Then go to the bottom of that box– above the box that has the map with the red dots– and click on the ‘watch in real time’ link.  You will see visitors come and go, including the site that they arrived from, the site they leave to, and the search terms that were used to find the blog.  I find the ‘real-time’ applications for the internet so interesting– there are sites where you can just watch the world’s searches in real time as they flash across the screen… this is a bit less dramatic, but still pretty cool.  I review the search terms now and then to get an idea of the questions that people have about Suboxone.

There are a few differences between the two drugs;  Suboxone has a fruity taste, and Subutex doesn’t– it is just a bit bitter, or so I have been told.  Subutex is white and shaped different than the orange Suboxone.  The only other difference is that Suboxone has naloxone mixed with the buprenorphine, and Subutex does not.  This means nothing for most patients, but I have had a few patients who didn’t tolerate Suboxone do well with Subutex– one patient who had a rash, presumably from an allergy to naloxone; one patient with GI distress from Suboxone and not from Subutex; and several patients who had headaches taking Suboxone, but no headaches after being changed to Subutex.  Did the Suboxone cause the headaches?  Or would the headaches have gone away in a few days after the patient adjusted to the Suboxone, and the change to Subutex was only a coincidence?  I don’t know which is the case.  The final difference is that Subutex is quite a bit more expensive than Suboxone– making Suboxone the preferred drug in most cases.

There is some confusion out there on other sites;  people have written that the naloxone is responsible for the ‘ceiling effect’… but this is NOT the case.  The ceiling effect is a property of buprenorphine, with or without naloxone added.

The main reason for the addition of naloxone is supposedly to reduce the ability to abuse the drug, as the naloxone is not active orally, but is effective if injected.  But I have seen very little evidence of that type of diversion– mainly, in my opinion, because it is just not practical to use buprenorphine to get high– first, why inject when it is almost as potent to just put it in your mouth?  And second, a person who injects it will get the effects, and then they will be done for the next week– the long half-life and blocking properties of the partial-agonist buprenorphine will prevent repeated injections from having repeated effects.  Instead of injecting, diversion usually provides a way for an addict to avoid using when the supply of oxy is low and the cost is high, or when the addict just is sick and tired and wants a break from using.

I am left, then, with the impression that the naloxone mainly serves political issues– that the addition of naloxone makes the idea of Suboxone programs for opiate addicts more palatable for the people that approved the programs.  Cynical, I suppose.  But I don’t see any other big reason.  And if it worked, and helped launch the program– good deal.