Suboxone vs. Fentanyl for Pain: Important Differences and Potential Risks.

Key takeaways

Buprenorphine/naloxone (Suboxone, Zubsolv, Bunavail) and fentanyl (Duragesic) are both used to manage opioid-related conditions, but they serve different purposes and have distinct characteristics. Buprenorphine/naloxone is a combination medication used to treat opioid dependence. It works by reducing cravings and withdrawal symptoms through a mix of a partial opioid agonist (buprenorphine) and an opioid antagonist (naloxone). This medication is available in various forms, such as sublingual films and tablets, and requires careful dosing adjustments. On the other hand, fentanyl is a potent opioid used to manage severe, long-term pain, especially in individuals who are already opioid-tolerant. It is administered through a transdermal patch that provides continuous pain relief over 72 hours. Fentanyl has a higher risk of addiction, misuse, and overdose compared to buprenorphine/naloxone and is not suitable for short-term or mild pain. Both medications require special monitoring and are part of the REMS program due to their potential for serious side effects and misuse.

Suboxone tablets

(buprenorphine / naloxone)

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fentanyl patch

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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%)

Warnings for Suboxone

Potential for addiction and misuse
Potentially life-threatening slowed breathing (respiratory depression)
Risk for opioid overdose
Difficulty concentrating and extreme sleepiness
Harm to newborn babies
Low adrenal hormone levels
Withdrawal symptoms
Liver damage
Dental problems
Life-threatening heart rhythm problem (QT prolongation)
Low blood pressure
Not for use for pain or for people who haven't taken opioids before

Summary for Fentanyl

Prescription only

The fentanyl transdermal patch, previously known by the brand name Duragesic, is an opioid. It's a patch that's applied on the skin every 3 days to manage severe, long-term or chronic pain. The fentanyl patch is only approved for people who are "opioid tolerant" whose pain isn't controlled well enough with other treatment options. Fentanyl is a very powerful opioid, so the medication can be especially dangerous for those who aren't opioid tolerant because of their high risk for extremely slowed breathing and overdose. Some side effects include nausea, vomiting, and sleepiness.

Indications for Fentanyl

Severe, chronic pain in people who are opioid tolerant

Pros and Cons for Fentanyl

Pros

A possible option for severe, chronic pain if you've already tried other treatments and they don't work well enough for you
A possible choice if you have trouble swallowing pills
Replaced on the skin every 3 days

Cons

Only approved for people who are already taking opioids around-the-clock (opioid tolerant)
High risk for dangerously slow breathing, misuse, and addiction
Not intended to use as needed, for short-term pain, or for mild pain

Common Side Effects for Fentanyl

Nausea (41%)
Vomiting (26%)
Sleepiness (19%)
Dizziness (10%)
Trouble sleeping (10%)
Constipation (9%)
A lot of sweating (6%)
Tiredness (6%)
Feeling cold (6%)

Warnings for Fentanyl

Potential for misuse and addiction
Life-threatening slowed breathing (respiratory depression)
Risk for opioid overdose
Life-threatening risks with accidental exposure
Life-threatening risks with patch exposure to high temperatures (e.g., heat, high fever)
Difficulty concentrating and extreme sleepiness
Physical dependence and withdrawal
Harm to newborn babies
Drug interactions
Serotonin syndrome
Low blood pressure and slow heart rate
Low adrenal hormone levels
Seizures