Information about buprenorphine: pill, liquid, patch, implant

Many people get confused about the difference between Suboxone and Subutex. They are both used sublingually (under the tongue), and are two brand names of the drug buprenorphine are approved to treat addiction. Suboxone, besides containing the active drug buprenorphine, also contains a small dose of naloxone, which is an opioid antagonist, or blocker. Subutex contains only buprenorphine.

When Suboxone is taken in the proper way, dissolved under the tongue, the naloxone is not absorbed and is inactive. But if the Suboxone pill is inappropriately crushed and injected, the naloxone will be active and will put the addict into immediate withdrawal. If the naloxone weren’t in the drug, the buprenorphine alone could still be abused, to produce a high, or euphoria. In other words, naloxone is a safety feature, to discourage injection of the medication. The naloxone will not affect patients, if Suboxone is used correctly.

I’ve heard of addicts crushing Suboxone to snort, but since it gets absorbed as quickly through the membranes of the mouth as through the nose, it seems unlikely snorting would cause a high. There are some addicts who actually get a sort of a high from the act of snorting a pill, if that’s what they’re accustomed to.

 In the U.S, doctors are encouraged to prescribe Suboxone, rather than Subutex, because it’s safer. In some European countries where buprenorphine was used to treat opioid addiction, it was commonly misused by injection, and turned into a major drug of abuse. In Europe, a Suboxone-type medication with both buprenorphine and naloxone wasn’t available.

Buprenorphine is also marketed under one other brand name in the U.S., Buprenex. This liquid brand contains only buprenorphine (no naloxone) and is intended solely for intravenous or intramuscular injection. This form of the drug is not approved for the treatment of opioid addiction, but only for treatment of acute pain. Buprenex has been used in the U.S. for relief of acute pain since the 1980s. Relative to morphine, it is a fairly good analgesic. There hasn’t been much diversion of this drug to the black market in the U.S., though other countries, such as Scotland, have had large numbers of intravenous buprenorhpine addicts in the past.

To further confuse things, generic buprenorphine has recently come onto the market, though it’s still not much cheaper than the brand name Suboxone. One patient complained the generic was too hard to dissolve, and tasted so bad, that she was willing to pay the extra for the name brand.

Doctors are now conducting studies on other delivery forms of buprenorphine. Probuphine is a brand name of buprenorphine, which is contained in small cylindrical pellets, a little less than an inch long. These pellets can be implanted just under the skin, to release buprenorphine over time, in a similar way Norplant delivers its medication for birth control. Around four pellets are implanted, and the medication is delivered in continuous low levels for up to six months.

Studies have shown that Probuphine is more effective than placebo, but the real question is how it compares to standard therapy with sublingual buprenorphine tablets. The big advantage of implantable pellets is compliance, since the patient is obviously getting the medication if the pellets are in place. In this form, it’s highly unlikely to be diverted.

Buprenorphine is also marketed overseas in a patch form, for pain, but at present it isn’t marketed or approved in the U.S.

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18 responses to this post.

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  11. Posted by Rhonda Sibley on March 17, 2014 at 4:01 am

    I have a question. Can you use the liquid form with insulin needle? My daughter is says she is doing this to get drugs out of her system

    Reply

    • There is a liquid form that is meant to be used by injection – usually only stocked by hospitals. It’s not something a doctor would prescribe. I don’t understand your daughter saying she’s injecting buprenorphine to get drugs out of her system??

      Reply

      • Posted by Dana on July 7, 2015 at 4:11 pm

        From a addict in suboxone treatment for 4 yrs now, I would assume your daughter is buying or getting prescribed suboxone or subutex and is injecting it hunny.. intravenous addiction is very very hard to stop.. I hope she is doing better. BUT her injecting it is NOT going to get the drugs out of her system OR it’s not going to work for her for maintenance etc.. she is abusing the drug, not taking it to help.. sorry hunny

  12. Posted by Linda Juarez on March 5, 2016 at 2:40 am

    I’ve been on Subs for almost 5 yrs as addiction treatment and to control long-term chronic pain. In my opinion, anything that can be done to increase compliance and reduce misdirection of the drug is worth every effort. I just found out about Probuphine and would really like to pursue this avenue of treatment. As a long time opiod addict, I find the films far too easy to skip if I’m in the mood to use. The implants would alleviate that temptation, address my addiction issues and control my chronic pain; win-win-win!!! Keep working on alternatives to Subs film and encourage more doctors to train to use this treatment…for the good of all of the people like me that have no quality of life without pain management but hate being junkies!

    Reply

  13. Posted by Brent on August 19, 2016 at 2:13 pm

    Jana,
    It is definitely possible to get high by snorting Suboxone and even by injection as well. When I was younger and was not quite far into my addiction to opiates, I snorted Suboxone all the time and got high; I also knew people who injected it as well. After your tolerance is high enough Suboxone doesn’t get you high anymore, and neither does Subutex. As I’m sure you already know, tolerance builds quickly and you just feel normal, but when you snort or inject the medication it still remains active and prevents withdrawal no matter what. The naloxone in Suboxone is not powerful enough to overcome the buprenorphine. Buprenorphine has a much higher affinity for the mu opioid receptor than naloxone does, so it has no chance to bind at all, the full dose of buprenorphine binds. I’m sure you probably already know this by now since you are a doctor and undoubtedly know much more than I do, I would appreciate your feedback on this particular matter!

    Thank you for your time & for writing this blog. I have opioid use disorder and I’m a longterm MMT patient of almost 7 years. I only go once a week for the last year since I’ve done really well in treatment. I’ve studied medicated assisted treatment extensively for years and I’ve found that your blog is very helpful, compassionate, and guiding. I’ve read so much of it! I appreciste all of what you do for your patients and for all people who have this deadly disease of addiction.

    Reply

  14. Posted by E.k. on November 6, 2016 at 11:27 pm

    Does suboxone show on a hair follicle drug test?

    Reply

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