Suboxone vs Subutex

I noticed that in the stats area I can see the search terms used by those who found my blog;  I think I will answer some of the ‘questions’ in the search terms now and then.  One person searched for ‘do suboxone and subutex feel the same’?  The answer is that yes, they feel the same for most people.  Some specifics:

The active ingredient in both Suboxone and Subutex is buprenorphine.  Buprenorphine is a ‘partial agonist’ that has a self-limiting effect on opiate receptors.  There is a common misperception that the naloxone in Suboxone is responsible for the ceiling effect or for precipitating withdrawal during inductions;  neither is true.  The naloxone is in there supposedly to prevent injection of dissolved Suboxone, as the naloxone is inactive orally (for the most part) but is active if injected.  I say ‘for the most part’ because there are some situations where the naloxone may make a difference.  I don’t have any data to support what I am about to say– and I don’t know if any data exists.  But I think that my ideas are sound, using some basic knowledge of how the body works.  Some background:  Naloxone is not absorbed well through mucous membranes and buprenorphine IS absorbed well; the naloxone therefore is swallowed, and some is absorbed by the small intestine.  From there it enters the portal vein and goes to the liver.  Some medications are efficiently destroyed by the liver; this is called ‘first pass metabolism’.

Times when I change patients to Subutex: 

-During pregnancy.  Even though little naloxone gets into the circulation, and even less crosses the placenta, and even less survives going through the fetal liver, there is a general principle to expose the fetus to as few drugs as possible.  Suboxone has two, Subutex has one, so Subutex wins.

-After gastric bypass.  In some gastric bypass procedures the distal small intestine is pulled up and attached to the stomach;  I would assume in such cases that the naloxone would then pass from the stomach to the ileum instead of the duodenum, and it would get absorbed by capillaries that do not empty into the portal system.  The result would be that the naloxone would bypass the liver and bypass ‘first pass metabolism’, potentially causing a touch of withdrawal.  So I give the patient Subutex.

-Some people get headaches after taking Suboxone and not after taking Subutex.  Are the headaches from the naloxone?  I don’t know.  Subutex costs considerably more, and some insurers therefore will not cover it… so it may depend on how bad the headaches are as far as making the switch.

-Same thing for the taste– Subutex supposedly doesn’t have the ‘fruity’ flavoring, and some people like it better.  It costs 50% more– is it 50% better tasting? 

Keeping it short tonight… Son back from college and so I want to talk to him a bit.  Hey– I have a radio show about psychiatry… if you want to check it out you can click on it from the Fond du Lac Psychiatry web site.  Thanks for checking it out.

Fond du Lac Psychiatry

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