Sublocade vs. Suboxone for Opioid Dependence: Important Differences and Potential Risks.

Key takeaways

Sublocade (buprenorphine) and Suboxone (buprenorphine/naloxone) are both used to treat opioid dependence, but they have some key differences. Sublocade is an injection given once a month by a healthcare provider, while Suboxone is a film or tablet that you dissolve in your mouth daily. Sublocade is only for people who have already been stabilized on another form of buprenorphine, whereas Suboxone can be used as initial treatment for those dependent on short-acting opioids. Sublocade is brand name only, but Suboxone is available in a lower-cost generic form. Sublocade works by slowly releasing medication over a month, while Suboxone combines buprenorphine with naloxone to prevent misuse. Both medications can cause side effects like headache and constipation, but Sublocade also has risks related to its injection site.

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Sublocade

(buprenorphine)

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Suboxone tablets

(buprenorphine / naloxone)

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Summary for Sublocade

Prescription only

Sublocade (buprenorphine) is an injection that's given under the skin by a healthcare provider for moderate-to-severe opioid use disorder. Treatment is given along with counseling and social and emotional support. This medication is convenient because you only need a dosage once a month. But it's only for people who've previously used another form of buprenorphine (e.g., Suboxone, buprenorphine (Subutex)). Side effects of Sublocade (buprenorphine) include headache, constipation, and injection-site reactions (e.g., pain, swelling). This medication is brand name only.

Indications for Sublocade

Moderate-to-severe opioid use disorder in adults who've already started treatment with a buprenorphine-containing medication

Pros and Cons for Sublocade

Pros

Works well to treat moderate-to-severe opioid use disorder
Given just once per month
Injections are given only by trained healthcare providers registered with the Sublocade REMS program to make sure it's as safe for you as possible

Cons

Given as an injection under the skin
Need to go to the provider's office or clinic regularly to get injections
Has serious risks like slow breathing

Common Side Effects for Sublocade

Injection-site reactions (pain, itching, redness, bruising, swelling; 14-19%)
Headache (9%)
Constipation (8-9%)
Nausea (8-9%)
Vomiting (6-9%)

Warnings for Sublocade

Not for intravenous (IV) administration
Risk for addiction and misuse
Dangerously slow breathing (respiratory depression)
Harm to newborns
Low adrenal hormone levels
Risk of withdrawal symptoms
Liver damage
Risks with treatment for pain
Not for use in people who haven't taken opioids before
Life-threatening heart rhythm problems (QT prolongation)

Summary for Suboxone

Prescription only

Suboxone tablets (buprenorphine / naloxone) are used for the maintenance treatment of opioid use disorder (OUD) in adults. This medication-assisted treatment is given along with counseling and social and emotional support. It contains two active ingredients: buprenorphine is a partial opioid agonist, and naloxone is an opioid antagonist. The tablets are taken sublingually once per day (they're placed under the tongue where they dissolve). The dosage depends on each person's situation. Side effects include headache, pain, and nausea. It's a controlled substance because it has a risk of being addictive and being misused.

Note: The Suboxone brand name for the sublingual tablets is discontinued, but there are generic versions available. Buprenorphine/naloxone sublingual tablets are also available under the brand name Zubsolv.

Indications for Suboxone

Maintenance treatment for opioid use disorder (OUD) in adults (together with counseling and therapy)

Pros and Cons for Suboxone

Pros

Available as a lower-cost generic
Comes as a tablet that's dissolved under the tongue
Causes milder withdrawal symptoms than other common opioids if stopped suddenly

Cons

Can cause bothersome side effects, such as headache, trouble sleeping, and nausea
Has a risk for misuse and dependency
Is a controlled substance, so there are special requirements for filling a prescription

Common Side Effects for Suboxone

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%)