If you’re exploring treatment options for opioid use disorder (OUD), you may have come across buprenorphine (Brixadi) and buprenorphine/naloxone (Suboxone, Zubsolv).

These two drugs are Food and Drug Administration (FDA) approved for opioid use disorder. They’re both used in medication-assisted treatment (MAT). This approach helps people manage substance use disorders, decrease cravings, and prevent withdrawal symptoms.

Read on to find out more about these drugs, how they differ, and which may be preferred in certain instances.

Opioid Use Disorder and MAT

Opioid use disorder is a lifelong medical condition that changes your brain’s reward system. Opioids trigger your brain to release chemicals that decrease the feeling of pain and create a feeling of euphoria.

OUD occurs when you have a strong desire to take more opioids to maintain this feeling, despite the risks. OUD can also include having withdrawal symptoms when you stop taking the opioid.

One of the biggest challenges people face when stopping opioids is coping with the withdrawal symptoms. Some common withdrawal symptoms can include:

• Tremors and muscle pain or aches
• Sweating
• Nausea and vomiting
• Anxiety and depression
• Dilated pupils

Withdrawal symptoms can start as soon as eight hours after taking a short-acting opioid and can last up to 10 days. Withdrawal symptoms are usually not life-threatening. But they can make recovery very hard without MAT.

What Is Buprenorphine and How Does It Work?

Buprenorphine is a drug that blocks the effects of opioids and reduces withdrawal symptoms. It’s used to treat opioid use disorder to help people achieve and maintain long-term recovery from substance use disorders.

Buprenorphine is a partial opioid agonist. This means it attaches to opioid receptors in the brain in a similar way to other opioids, but only partially activates them.

Think of opioid receptors as light switches. Opioids like morphine, oxycodone, heroin, and fentanyl turn the switch fully on. This causes strong opioid effects.

Buprenorphine turns the switch on just enough to reduce withdrawal symptoms and cravings. But it doesn’t cause the same strong euphoria that other opioids do.

Buprenorphine’s Ceiling Effect

Buprenorphine has a built-in limit called the ceiling effect. Once a certain dose is reached, taking more buprenorphine doesn’t keep increasing its opioid effects.

This ceiling effect is especially important because it allows buprenorphine to have a lower risk of causing respiratory depression, which is a life-threatening condition that can cause breathing issues. Full opioid agonists such as methadone, a drug commonly used to treat OUD, may be linked to respiratory depression.

Different Formulations of Buprenorphine

Buprenorphine is available in many formulations:

• Buprenex is an injectable form of buprenorphine that’s used for pain management.
• Butrans is a transdermal patch that releases the medication slowly through the skin. It’s used for chronic pain that doesn’t respond to other treatment options.
• Other formulations, such as sublingual tablets and films, are used for opioid use disorder.

The brand name medication, Subutex, has been discontinued in the United States. But generic formulations of buprenorphine tablets are still available by prescription. For this reason, people may still refer to buprenorphine-only treatment as Subutex, even though they’re often taking a generic formulation.

What Is Buprenorphine/Naloxone?

Buprenorphine/naloxone is also used to treat OUD. It has the same active ingredient, buprenorphine, along with naloxone.

Naloxone is an opioid antagonist that blocks other opioids from binding to opioid receptors. Many people know naloxone as the medication found in Narcan, a nasal spray used to quickly reverse opioid overdose. However, the naloxone included in buprenorphine/naloxone has a different purpose.

When buprenorphine/naloxone is taken as prescribed — under the tongue as a sublingual film or inside the cheek as a buccal film — very little of it is absorbed into the bloodstream. This allows the buprenorphine to work normally. The naloxone is included as a safety mechanism against misuse and diversion.

If someone tries to inject the medication instead of taking it as prescribed, the naloxone becomes active. This can trigger withdrawal symptoms in those with an opioid dependence, which may help reduce the risk of misuse and diversion.

Key Similarities and Differences

Buprenorphine-only and buprenorphine/naloxone formulations are more similar than they are different. Both medications:

• Treat opioid use disorder
• Work on opioid receptors to decrease cravings and help manage withdrawal symptoms
• Support long-term recovery

Both buprenorphine-only and buprenorphine/naloxone formulations work because of the buprenorphine ingredient. The biggest difference is the presence of naloxone in the combination product.

Naloxone can discourage injection misuse, which may lead many healthcare providers to prefer buprenorphine/naloxone for treatment over buprenorphine-only. But there are some situations where buprenorphine-only may be used.

When Might One Medication Be Preferred Over the Other?

There isn’t a one-size-fits-all approach to treating opioid use disorder. Your healthcare provider will consider your medical history, current health, and personal goals when suggesting a treatment option. For many people, buprenorphine/naloxone is preferred because of the naloxone component that helps discourage misuse.

For some situations, like in people with opioid use disorder who are pregnant or planning to become pregnant, some providers may prescribe buprenorphine without naloxone.

Current research suggests that buprenorphine/naloxone may be safe during pregnancy. But buprenorphine-only formulations have been studied for a much longer time. Some healthcare providers prefer to avoid unnecessary prenatal exposure to naloxone until more research is done.

Regardless of which medication is prescribed, it’s also important to know the side effects and safety considerations of treatment.

Side Effects and Safety Considerations

Like all medications, buprenorphine and buprenorphine/naloxone can cause side effects. Common side effects may include:

• Gastrointestinal (GI) issues, such as nausea, vomiting, and constipation
• Headache
• Increased sweating and dizziness
• Trouble sleeping
• Redness or numbness inside your mouth

Since buprenorphine is the active ingredient in both drugs, their side effects are similar. Buprenorphine should only be taken as prescribed. Serious risks, such as increased sedation and breathing problems, can occur if buprenorphine is used with alcohol or benzodiazepines.

Additionally, people considering using buprenorphine to transition from methadone or other long-acting opioids need to be aware of the risk of precipitated withdrawal (withdrawal symptoms caused by medications used to treat OUD).

The risk of precipitated withdrawal is primarily caused by buprenorphine itself. However, FDA labeling for buprenorphine/naloxone notes that small amounts of sublingually absorbed naloxone may worsen withdrawal. It’s important to talk with your healthcare provider to carefully plan when you start buprenorphine or buprenorphine/naloxone.

Both buprenorphine and buprenorphine/naloxone can play an important role in MAT for opioid use disorder. Discussing the similarities and differences with your healthcare provider can help you choose the medication that best fits your needs and recovery goals.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

Are you on buprenorphine without naloxone or buprenorphine with naloxone? Let others know in the comments below.