Subutex vs. Suboxone: What is the difference and which is better?

Subutex and Suboxone both contain buprenorphine as their active opioid treatment ingredient. The difference is that Suboxone also contains naloxone. Understanding why this matters — and when it does not — helps you have better conversations with your treatment provider.

The key difference

Subutex contains only buprenorphine. Suboxone contains buprenorphine plus naloxone. The naloxone in Suboxone is included as an abuse deterrent — if Suboxone is injected rather than taken sublingually, the naloxone becomes active and triggers withdrawal. When taken as directed (dissolved under the tongue), the naloxone is poorly absorbed and has minimal effect. In terms of treatment effectiveness, both medications work equally well when taken as prescribed.

When Subutex is prescribed instead of Suboxone

Subutex (buprenorphine alone) is typically prescribed during pregnancy (naloxone's effects on the fetus are not fully studied), for patients with documented allergic reactions to naloxone, and sometimes during the initial induction phase of treatment. Outside of pregnancy, most prescribers prefer Suboxone because the naloxone component adds a layer of abuse deterrence.

Common misconceptions

"Suboxone is just replacing one addiction with another." This is the most common and most damaging misconception about MAT. Suboxone stabilizes brain chemistry without producing the high, impairment, and escalating use that characterize addiction. It is treatment — the same way insulin treats diabetes. "You should get off Suboxone as soon as possible." Research shows that longer duration of MAT is associated with better outcomes. Premature discontinuation is associated with high relapse and overdose rates. The right duration is clinical, not ideological. "Suboxone is weaker than methadone." They work differently, not on a strength hierarchy. Buprenorphine is a partial agonist (ceiling effect on respiratory depression) while methadone is a full agonist. Each has clinical situations where it is the better choice.

Treatment facilities

Authoritative sources

This article references guidelines from: NIDA · SAMHSA · CDC · FDA · ASAM

Frequently asked questions

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.