Butrans vs. Suboxone Film for Pain and Opioid Dependence: Important Differences and Potential Risks.

Buprenorphine patch

(Butrans)

Suboxone film

(buprenorphine / naloxone)

Summary for Butrans

Prescription only

Buprenorphine patch, also known by its brand name Butrans, treats people with severe chronic (long-term) pain that isn't relieved with other treatment options. It works as an opioid partial agonist to help with pain. Buprenorphine patch (Butrans) is applied onto the skin once per week. This transdermal patch comes in many strengths. The pain specialist will decide on the dosage based on how severe your pain is and whether you were taking opioid pain medication before starting buprenorphine patch (Butrans). Side effects include nausea, dizziness, and headache.

Indications for Butrans

Severe chronic pain that isn't relieved with non-opioid pain medications

Pros and Cons for Butrans

Pros

Applied on the skin once per week
An option for people who can't swallow pills

Cons

Has many serious risks, like dangerously slow breathing, misuse, and addiction
Doesn't treat sudden breakthrough pain
Not the best choice for people who need to take large doses of opioids (greater than 80 mg of oral morphine equivalents per day)

Common Side Effects for Butrans

Nausea (21%)
Itching at the application site (15%)
Dizziness (15%)
Headache (14%)
Sleepiness (13%)
Constipation (13%)
Vomiting (9%)

Warnings for Butrans

Potential for addiction and misuse
Dangerously slow breathing (respiratory depression)
Risk for opioid overdose
Difficulty concentrating and extreme sleepiness
Harm to newborns when taken during pregnancy
Serious risks with patch exposure to high temperatures (e.g., heat, high fever)
Low adrenal hormone levels
Low blood pressure
Liver damage
Withdrawal symptoms
Seizures
Life-threatening heart rhythm problems (QT prolongation)

Summary for Suboxone Film

Prescription only

Suboxone film (buprenorphine / naloxone) is used for treating opioid use disorder (OUD) in adults. This medication-assisted treatment is given along with counseling and social and emotional support. Suboxone film is a combination of two medications: buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). The films are dissolved either under the tongue (sublingually) or against the inside of the cheek (buccally). The medication is taken once per day. Side effects include numbness in the mouth and headache. It's a controlled substance because it has a risk of being addictive and being misused.

Indications for Suboxone Film

Treatment of opioid use disorder (OUD) in adults (in addition to counseling and therapy)

Pros and Cons for Suboxone Film

Pros

Comes as a film that's placed under the tongue or against the inside of the cheek and dissolved
Available as a lower-cost generic

Cons

Has a risk of addiction and misuse (even though it helps treat opioid use disorder)
Is a controlled substance, so there are special requirements for filling a prescription

Common Side Effects for Suboxone Film

Headache (36%)
Withdrawal symptoms, such as anxiety, goosebumps, stomach discomfort, irritability, cold sweat, joint pain, and watery eyes (25%)
General pain (22%)
Nausea (15%)
Sweating (14%)
Trouble sleeping (14%)
Constipation (12%)
Stomach pain (11%)