Subutex: definition, side effects, use, administration, and interaction

Subutex is a medicine approved by the U.S. Food and Drug Administration to treat opioid use disorder. Its only active ingredient is buprenorphine, which is a synthetic opioid that works by blocking the effects of illicit opioids, reducing cravings, and preventing withdrawal symptoms.

The side effects of Subutex include constipation, drowsiness, headaches, abdominal pain, nausea and/or vomiting, fatigue, anxiety, depression, increased sweating, diarrhea, indigestion, cough, and an increased risk of infection.

Subutex is used to treat addiction in individuals who abuse illicit opioids, such as heroin and/or opioid-containing painkillers like fentanyl, oxycodone, and codeine, during the induction phase of the treatment program. It is also prescribed as maintenance therapy to individuals who cannot tolerate Suboxone.

Subutex is administered as a sublingual tablet that must be placed under the tongue and allowed to dissolve completely before taking any food or drink.

The medications that interact with Subutex include benzodiazepines and other CNS depressants like non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, general anesthetics, antipsychotics, and other opioids; CYP3A4 inhibitors and inducers; antiretrovirals; serotonergic drugs; muscle relaxants; diuretics; and anticholinergic drugs.

What is Subutex?

Subutex contains buprenorphine, a partial opioid agonist, and is approved by the U.S. Food and Drug Administration (FDA) to treat opioid addiction, according to this 2022 article by Poliwoda et al., titled “Buprenorphine and its formulations: a comprehensive review” published in the journal Health Psychology Research. It is available as a sublingual tablet. Subutex is prescribed as part of a holistic opioid addiction treatment program that comprises other modalities like counseling, compliance monitoring, and behavioral and lifestyle alterations. It is available for purchase upon producing a valid prescription from a physician who is certified to prescribe buprenorphine therapy.

Although it is used to treat opiate addiction, Subutex has abuse potential. Buprenorphine is classified as a Schedule III controlled substance, meaning that it has a high potential for psychological dependence and a moderate-to-low potential for physical dependence, per this StatPearls [Internet] release titled “Buprenorphine” by Kumar et al., and last updated in June 2024.

Possessing Subutex without a valid prescription or diverting it by selling or distributing it is illegal and attracts penalties. The brand name Subutex was discontinued in the U.S. after concerns arose about its abuse potential, but generic buprenorphine formulations are available. Subutex is available elsewhere in the world.

What is the generic name for Subutex?

The generic name for Subutex is buprenorphine. Buprenorphine is a synthetic opioid that was developed in the late 1960s as a medicine to treat opioid use disorder (OUD). Its various formulations are approved by the FDA to be used for treating OUD and acute and chronic pain, according to this StatPearls [Internet] release titled “Buprenorphine” by Kumar et al., and last updated in June 2024.

What is Subutex used for?

Subutex is used for treating dependence on opiates or narcotics, such as morphine and heroin, in addicts who have consented to treatment, according to this package leaflet published on the website of the Electronic Medicines Compendium (eMC), a database of medicines licensed in the U.K., titled “Subutex 0.4 mg, 2 mg and 8 mg sublingual tablets: buprenorphine” and last revised in October 2020. According to this medication guide approved by the FDA titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration” that was revised in February 2018, Subutex must be administered under supervision only during the induction phase of an opioid addiction treatment program, following which Suboxone (containing buprenorphine and naloxone) should be used.

FDA’s guidelines state that Subutex must be used as a part of a holistic opioid addiction treatment plan that also includes psychosocial support and counseling. Following the induction phase, Subutex should be administered unsupervised only to those patients who cannot tolerate Suboxone, such as individuals who are hypersensitive to naloxone, an active ingredient in Suboxone.

Subutex is also used to treat opioid addiction in pregnant women who do not want their fetuses to be exposed to naloxone, according to this 2019 article by Shulman et al., titled “Buprenorphine Treatment for Opioid Use Disorder: An Overview” published in the journal CNS Drugs.

Can Subutex be used for pain?

No, Subutex cannot be used for pain, as clarified by this medication guide approved by the FDA titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration” that was revised in February 2018. Rather, it is used for treating addiction to opioid pain medicines like hydrocodone, oxycodone, codeine, and morphine.

According to this publication by the National Institute on Drug Abuse (NIDA) titled “What are prescription opioids?” released in June 2021, Subutex prevents withdrawal symptoms in people undergoing treatment for addiction to opioid pain medication. Other formulations of buprenorphine, the active ingredient of Subutex, are used for treating chronic and acute pain, as noted by Poliwoda et al., in their 2022 article titled “Buprenorphine and its formulations: a comprehensive review” published in the journal Health Psychology Research.

Can Subutex treat addiction?

Yes, Subutex can treat addiction to opioids and was approved for this use by the FDA in 2002, according to this 2022 article by Poliwoda et al., titled “Buprenorphine and its formulations: a comprehensive review” published in the journal Health Psychology Research. According to a March 2024 release by the National Institute on Drug Abuse, titled “Opioids,” opioids include opioid painkillers legally available with a prescription, such as oxycodone, hydrocodone, morphine, and codeine; synthetic opioids like fentanyl; and the illegal drug heroin.

What are the side effects of Subutex?

The side effects of Subutex are listed below.

• Constipation
• Sleepiness
• Headaches
• Stomach pain
• Nausea and/or vomiting
• Fatigue
• Chills
• Anxiety
• Depression
• Increased sweating
• Back pain
• Diarrhea
• Indigestion
• Cough
• Watery eyes
• Runny nose
• Increased risk of infection
• Drug withdrawal symptoms, such as restlessness, insomnia, agitation, anxiety, irritability, palpitations, elevated blood pressure, shaking, shivering, sweating, and diarrhea

What are the common doses of Subutex?

The common doses of Subutex are listed below.

• Subutex 2 mg: Each tablet contains 2 mg buprenorphine, which is equivalent to 2.16 mg buprenorphine hydrochloride USP, according to this February 2018 medication guide approved by the FDA titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration.“
• Subutex 8 mg: Each tablet contains 8 mg buprenorphine, which is equivalent to 8.64 mg buprenorphine hydrochloride USP.

When should Subutex be taken?

Subutex should be taken only when objective and clear symptoms of moderate opioid withdrawal manifest during the induction phase of treatment in patients dependent on a short-acting opioid, such as heroin, morphine, oxycodone, or codeine, and not before four hours have elapsed after the patient last used an opioid, according to this February 2018 medication guide approved by the FDA titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration.”

In the case of patients dependent on long-acting opioids like methadone, Subutuex should be administered during the induction stage only when patients begin to show objective and clear signs of moderate opioid withdrawal and generally not before 24 hours have elapsed after they last used a long-acting opioid.

Subutex is used during maintenance treatment if the patient cannot tolerate naloxone, which is the key ingredient of Suboxone, the preferred treatment during this phase, according to this 2022 article by Poliwoda et al., titled “Buprenorphine and its formulations: a comprehensive review” published in the journal Health Psychology Research.

Can Subutex be taken with opioids in the system?

No, Subutex cannot be taken with opioids in the system. It must be initiated at least 6-12 hours, or more, after the patient has taken their last dose of a short-acting opioid like heroin. If taken too soon, it is possible for Subutex to trigger premature withdrawal symptoms by quickly displacing any opioid bound to an opioid receptor site.

Authors Spadaro et al., in their 2023 article titled “Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series” published in the Journal of the American College of Emergency Physicians Opencaution that buprenorphine therapy must be initiated only after individuals addicted to opioids display moderate to severe withdrawal symptoms to prevent precipitated opioid withdrawal (PW). PW is a stage characterized by a rapid worsening of withdrawal symptoms after initiating buprenorphine therapy.

How long does it take for Subutex to work?

It takes about 30-60 minutes for Subutex to work after dosing, according to Amitava Dasgupta in the chapter named “Prescription Opioids: An Overview” in the book Fighting the Opioid Epidemic published in 2020. The peak clinical effects of sublingual buprenorphine are observed 1-4 hours after administration.

How often should Subutex be taken?

Subutex should be taken as a single daily dose during the induction phase of addiction treatment, according to this February 2018 medication guide approved by the FDA titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration.” The initial dose is between 2 mg and 4 mg, according to this StatPearls [Internet] release titled “Buprenorphine” by Kumar et al., and last updated in June 2024. Patients who have a history of opioid abuse with a high risk of relapse but are not dependent on opioids are prescribed 1 mg initially. The dose is increased in increments of 2 mg to 4 mg if patients are able to tolerate the dose and show no signs of precipitated withdrawal.

There is no maximum recommended duration of administering Subutex in the maintenance phase of addiction treatment. It should be taken for as long as the patient needs it and benefits from it. The FDA, however, specifies that the target recommended dosage should be 16 mg as a single daily dose because dosages higher than 24 mg have not been proven to provide any clinical benefit. Sublingual buprenorphine is prescribed on alternate days to patients who have stabilized on a daily dose.

How long does the effect of Subutex last?

The effect of Subutex lasts for 6-12 hours at low doses of less than 4 mg and 24-72 hours at high doses of more than 16 mg, as mentioned by Amitava Dasgupta in the chapter named “Prescription Opioids: An Overview” in the book Fighting the Opioid Epidemic published in 2020.

How long does Subutex stay in the body?

Subutex stays in the body for about 5-8 days after it has been administered to healthy people. Buprenorphine has an elimination half-life of 24-42 hours. It usually takes about 4-5 half-lives for drugs to be completely eliminated from the body. So, Subutex cannot be traced in the body of healthy individuals after 120-210 hours from administration. However, sensitive tests are able to detect the presence of Subutex in the body for much longer.

What are the administration routes for Subutex?

The administration route for Subutex is sublingual, which is the only way to take the tablet, according to information published on the website of the Electronic Medicines Compendium (eMC), a database of medicines licensed in the U.K., titled “Subutex 0.4 mg, 2 mg and 8 mg sublingual tablets: buprenorphine” and last revised in October 2020. The tablet must be placed under the tongue and allowed to dissolve. It gets completely dissolved in 5-10 minutes. Until then no food or drink should be consumed. If the patient has been prescribed a dose that requires more than two tablets, they should either place all the tablets at once or two at a time under the tongue. Subutex must not be chewed or swallowed whole.

How does Subutex work?

Subutex works as a partial opioid agonist that binds to the same receptors that full agonist opioids like heroin, hydrocodone, oxycodone, methadone, and morphine activate. It reduces opioid cravings and withdrawal symptoms in an opioid-dependent population that has stopped using their substance of abuse, according to this research report by the National Institute on Drug Abuse (NIDA) titled “How do medications to treat opioid use disorder work?” that was updated in December 2021.

A receptor is a protein molecule inside or on the surface of a cell to which substances like drugs, hormones, and antigens bind. The receptor enables the cell to interact with and receive signals from a substance to perform a specific activity. Opioids bind to their respective receptors and act as agonists, partial agonists, or antagonists, according to this 2012 article by Hasan Pathan and John Williams in the British Journal of Pain, titled “Basic opioid pharmacology: an update.” Full agonist opioids activate the receptors fully and result in the opioids’ effects being expressed to their fullest. These effects include dependence, euphoria, and respiratory depression, according to this 2023 StatPearls [Internet] release by Armaan Dhaliwal and Mohit Gupta, titled “Physiology, Opioid Receptor.”

NIDA’s December 2021 publication explains how the buprenorphine in Subutex works. Buprenorphine binds to the opioid receptors and thereby prevents the full opioid agonists from binding to and interacting with those receptors. Being a partial opioid agonist, buprenorphine activates the receptors less strongly than the full agonists.

However, it has adequate agonist properties to make individuals dependent on opioids experience a reinforcing subjective effect, according to a publication titled “What is Buprenorphine?” published by the Psychiatric Research Institute of the University of Arkansas for Medical Sciences. This limited functional response lessens withdrawal symptoms without producing euphoria. Yip et al., in the chapter titled “Opioids” in the book “Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose (Fourth Edition)” published in 2007 mention that buprenorphine shows little physical dependence and mild withdrawal symptoms after treatment is stopped.

Does Subutex produce a ‘high’ like other opioids?

No, Subutex does not produce a “high” like other opioids. Buprenorphine is a partial opioid agonist. Although it produces effects like euphoria, these are less intense than the effects produced by full opioid agonists. So, individuals addicted to opioids often describe “feeling normal” after taking buprenorphine, but they do not feel a “high.” In addition, buprenorphine has a ceiling effect, meaning that its opioid agonist effects reach a maximum and do not magnify with increased doses, according to a publication titled “What is Buprenorphine?” published by the Psychiatric Research Institute of the University of Arkansas for Medical Sciences.

What are the long-term effects of Subutex?

The long-term effects of Subutex are listed below.

• Reduced libido
• Fertility problems
• Irregular menstruation
• Mood swings
• Loss of appetite
• Reduced motivation

Can Subutex cause dental problems?

Yes, Subutex can cause dental problems, according to an FDA release titled “FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain” last updated in January 2022. There have been instances of tooth loss, tooth fractures, and dental decay reported by healthcare professionals. Many of the patients who reported the problems had no prior record of dental issues.

Authors Suzuki et al., in their 2013 article titled “Sublingual Buprenorphine and Dental Problems: A Case Series” published in the journal The Primary Care Companion for CNS Disorders suggest that the prolonged contact between Subutex and the tooth surfaces leads to an imbalance in the pH level or alters the microbial profile of the tooth surface.

Who should take Subutex?

Opioid-dependent individuals with a contraindication to methadone should take Subutex to manage withdrawal symptoms during the treatment induction phase, according to this StatPearls [Internet] release titled “Buprenorphine” by Kumar et al., last updated in June 2024. Patients who cannot tolerate methadone, have not responded to its administration in the past, and individuals who live in an area where methadone clinics are either unavailable or the wait time for enrollment in such a clinic exceeds three months should take Subutex. Individuals with a brief history of opioid dependence and/or lower need for opioids should also take Subutex.

Who should not take Subutex?

Subutex should not be taken by children aged less than 16 years, people who are hypersensitive or allergic to buprenorphine or any other ingredient in the drug, or have a serious respiratory or liver disease, according to information published on the website of the Electronic Medicines Compendium (eMC), a database of medicines licensed in the U.K., titled “Subutex 0.4 mg, 2 mg and 8 mg sublingual tablets: buprenorphine” and last revised in October 2020.

Subutex must also not be taken by anyone displaying signs of alcohol intoxication, such as sweating, anxiety, trembling, shaking, confusion, or hallucinations. The FDA, in a February 2018 medication guide titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration,” warns that individuals diagnosed with adrenal insufficiency must be weaned off of Subutex.

Is Subutex safe to take during pregnancy?

Yes, Subutex is safe to take during pregnancy compared to methadone with more favorable neonatal outcomes, according to this 2022 article by Suarez et al., published in The New England Journal of Medicine, titled “Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy.” The American Society of Addiction Medicine (ASAM) in its 2020 publicationtitled “The ASAM National Practice Guideline For the Treatment of Opioid Use Disorder 2020 Focused Update“ recommends initiating buprenorphine treatment as early as possible during pregnancy.

The benefits of administering buprenorphine far outweigh the risks associated with untreated opioid use disorder in this population or relying solely on withdrawal management or psychosocial therapy. The FDA classifies buprenorphine as a pregnancy category C drug with possibly adverse effects on the fetus, according to this StatPearls [Internet] release titled “Buprenorphine” by Kumar et al., last updated in June 2024.

Does Subutex affect a fetus during pregnancy?

Yes, Subutex affects a fetus during pregnancy but to a lesser degree than methadone, according to this 2022 article by Helen Santoro published by the Stanford Medicine News Center, titled “Use of buprenorphine during pregnancy better for infants than methadone, study finds.” Buprenorphine breaches the placenta in pregnant women. Exposure to the substance in the womb increases the likelihood of the infant displaying withdrawal symptoms after birth, according to this StatPearls [Internet] release titled “Buprenorphine” by Kumar et al., and last updated in June 2024. This is known as neonatal abstinence syndrome (NAS) and manifests between the first and eighth day of life. However, the authors note that to date, there is no evidence to suggest that buprenorphine is associated with increased congenital disabilities. There is also only minimal evidence that it causes neurological impairment. The benefits of buprenorphine to treat opioid use disorder in pregnant women far outweigh its risks to the fetus.

What is Subutex made of?

Subutex is made of buprenorphine hydrochloride, lactose, mannitol, cornstarch, citric acid, povidone K30, sodium citrate, and magnesium stearate, according to this February 2018 medication guide approved by the FDA titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration.“

What does a Subutex pill look like?

A Subutex pill looks like a flat, uncoated, and oval-shaped tablet. The pill has beveled edges and an alphanumeric code specifying the product and its strength (“B2” on Subutex 2 mg and “B8” on Subutex 8 mg) is debossed on one side, as described by the FDA in its February 2018 medication guide titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration.“

What precautions should be taken when taking Subutex?

The precautions to be taken when taking Subutex are listed below.

• Informing the doctor about existing health conditions: Patients should inform their doctors if they have these conditions: seizures, fits, or convulsions; any respiratory disease; any liver disease; low blood pressure; thyroid problems; any urinary disorder; kidney disease; or an adrenocortical disease. They should also inform their doctor if they have suffered a head injury recently, according to information published on the website of the Electronic Medicines Compendium (eMC), a database of medicines licensed in the U.K., titled “Subutex 0.4 mg, 2 mg and 8 mg sublingual tablets: buprenorphine” and last revised in October 2020. Knowing about their patients’ health issues allows doctors to decide on a safe dose of Subutex and/or monitor them periodically during treatment to ascertain if Subutex is exacerbating a pre-existing health condition.
• Avoiding concomitant use with other drugs and alcohol: Taking Subutex along with other opioids and alcohol is known to cause adverse reactions. For instance, mixing Subutex and alcohol increases the risk of intoxication and overdose because both these substances depress CNS activity, according to this 2019 article by Shulman et al., published in the journal CNS Drugs, titled “Buprenorphine Treatment for Opioid Use Disorder: An Overview.”
• Avoiding concomitant use with other medications: Taking Subutex along with sleep medications, anti-depressants, antiretrovirals, blood pressure-lowering drugs, naltrexone, and medicines that induce drowsiness, such as narcotic painkillers and those used to treat allergic reactions, is known to cause severe and adverse side effects.
• Refraining from misusing and/or diverting the drug: According to SAMHSA’s Buprenorphine Quick Start Guide, diversion is the unauthorized re-routing of prescription medicine, through selling or sharing, to someone for whom the medicine was not intended. The FDA in its February 2018 medication guide titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration” specifies that diversion of Subutex is illegal. Misuse is taking medicine in a way other than what has been prescribed. It means taking more medicine than the recommended dosage or taking it for a condition other than what it was intended for. The FDA advises patients that if they miss a dose, they should take it as soon as they remember. However, if it is almost time for the next dose, they must never take a double dose to compensate for the missed dose. Instead, they should skip the missed dose and take the next one at the usual time.
• Refraining from driving and/or using heavy machinery: The FDA cautions that Subutex has the possibility of causing mental and/or physical impairment of abilities required to drive a vehicle or operate heavy machinery. Patients should be careful when starting treatment with Subutex and during dose adjustment. They must not engage in these activities until they are certain their treatment has not impaired their ability to perform these tasks.
• Consulting a doctor before stopping treatment: Subutex is discontinued gradually by tapering the dosage to minimize the severity of withdrawal symptoms (eMC, 2020). Patients should consult their doctors before stopping treatment. Subutex should not be stopped abruptly.
• Storing the tablets properly: Subutex tablets should be stored at room temperature between 68°F and 77°F (20°C to 25°C). The FDA advises that the tablets should be stored out of reach and sight of children. Dangerous respiratory depression and even death is possible if a child ingests Subutex. Subutex tablets should also be stored in a secure place to prevent theft because it is an opioid that is desirable to people who use street drugs or abuse prescription medicine.
• Disposing of unused tablets safely: Unused Subutex tablets should be disposed of immediately and flushed down the toilet.

Can Subutex be used with other drugs?

No, Subutex cannot be used with other drugs, such as medications for certain diseases and medical conditions, opioid-containing medicines, alcohol, and opioids, according to the FDA in its February 2018 medication guide titled “SUBUTEX (buprenorphine sublingual tablets) for sublingual administration.”

Concomitant use of Subutex and drugs which are CNS depressants, such as opioid-containing medicines, sedatives, certain allergy medications, anti-depressants, barbiturates, alcohol, and illicit opioids like the street drug heroin increases the risk of severe adverse reactions including overdose and death. Certain blood pressure medications, anti-fungal medicines, antibiotics, and antiretrovirals magnify the effects of Subutex if taken together. Medications for tuberculosis and epilepsy decrease the effects of Subutex.

What medications interact with Subutex?

The medications that interact with Subutex are listed below.

• Benzodiazepines and other CNS depressants like non-benzodiazepine sedatives/hypnotics, anxiolytics, tranquilizers, general anesthetics, antipsychotics, and other opioids
• CYP3A4 inhibitors like erythromycin and ketoconazole
• CYP3A4 inducers like rifampin, carbamazepine, and phenytoin
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) like efavirenz, nevirapine, etravirine, and delavirdine
• Certain antiretroviral protease inhibitors (PIs) like atazanavir and atazanavir/ritonavir
• Serotonergic drugs like mirtazapine, trazodone, and tramadol
• Monoamine Oxidase Inhibitors (MAOIs) like phenelzine, tranylcypromine, and linezolid
• Skeletal muscle relaxants
• Diuretics
• Anticholinergic drugs

Can Subutex cause addiction?

Yes, Subutex can cause addiction because it has abuse potential as well as addictive properties. Buprenorphine and all products containing buprenorphine, which include Subutex, are classified as schedule III controlled substances, according to this May 2022 release by the Drug Enforcement Administration (U.S. Department of Justice) titled “BUPRENORPHINE (Trade Names: Buprenex®, Suboxone®, Subutex®, Zubsolv®, Sublocade®, Butrans®).”

Buprenorphine has a moderate-to-low likelihood of causing physical dependence or a high risk for psychological dependence. It is a synthetic opioid that produces feelings of euphoria that are desired by opiate users. Hence, it tends to be abused, as noted by the National Drug Intelligence Center of the U.S. Department of Justice in their September 2004 release titled “Intelligence Bulletin: Buprenorphine: Potential for Abuse.”

How is Subutex abused?

Subutex is abused through misuse and criminal diversion, according to a September 2004 document released by the National Drug Intelligence Center of the U.S. Department of Justice titled “Intelligence Bulletin: Buprenorphine: Potential for Abuse.” It is misused by individuals who are dependent on street drugs and/or have a tendency to abuse prescription drugs. These include people who are currently using methadone for opioid addiction treatment. These individuals abuse Subutex and methadone together to enhance the addictive effects of both drugs.

The Subutex tablet is crushed and snorted or injected by individuals who intend to misuse it. Taking more Subutex than the prescribed amount or taking it more frequently than the recommended rate are other examples of Subutex abuse. The FDA also notes that Subutex is widely diverted–shared with or sold or distributed to individuals for whom the drug was originally not prescribed–because the drug is easily accessible.

How long does Subutex withdrawal last?

Subutex withdrawal lasts for several days to a week and sometimes, for months in individuals who experience protracted withdrawal. Withdrawal symptoms appear within 24-48 hours of the last dose. The duration of withdrawal depends on factors like dosage, duration of use, the patient’s health, and whether or not they are undergoing Subutex detox treatment.

What are the differences between Subutex and Suboxone?

The differences between Subutex and Suboxone are based on their chemical composition, the forms in which they are available for delivery, usage, and safety concerns. The differences are described in the table below.

Can Subutex and Suboxone be taken at the same time?

No, Subutex and Suboxone cannot be taken at the same time. By taking Subutex and Suboxone together as sublingual tablets, high amounts of buprenorphine are introduced into the body. Although overdosing on buprenorphine is uncommon in adults, individuals without tolerance or those who take alcohol and/or benzodiazepines along with buprenorphine have an increased risk of being adversely affected by the effects of the overdose, according to SAMHSA’s Buprenorphine Quick Start Guide. There is also the increased possibility of the individual experiencing intense side effects, similar to those caused by full opioid agonists.

According to a publication titled “What is Buprenorphine?” published by the Psychiatric Research Institute of the University of Arkansas for Medical Sciences, high doses of buprenorphine have been known to precipitate acute withdrawal in certain circumstances. For instance, if sublingual Subutex and Suboxone are crushed and injected, the naloxone in the Suboxone tablet is likely to cause opioid withdrawals.

Where can Subutex be purchased?

Subutex can be purchased at retail pharmacies upon producing a prescription from a specially certified physician registered with the SAMHSA, according to a September 2004 document released by the National Drug Intelligence Center of the U.S. Department of Justice titled “Intelligence Bulletin: Buprenorphine: Potential for Abuse.”

Why was Subutex discontinued?

Subutex was discontinued in the U.S. by its manufacturer Reckitt Benckiser Pharmaceuticals Inc. in 2011 after there were reports of individuals misusing the tablets by crushing and injecting or snorting them, according to Poliwoda et al., in their 2022 article titled “Buprenorphine and its formulations: a comprehensive review” published in the journal Health Psychology Research. Reckitt Benckiser subsequently developed another formulation of buprenorphine that contained naloxone, which has the potential to deter intravenous use by blocking the effects of buprenorphine when it is injected. However, generic forms of sublingual buprenorphine are available in the U.S. and Subutex is available in other parts of the world.