Alternatives to Suboxone: Comparing OUD Medications

Suboxone is the gold standard in Medication for Addiction Treatment (MAT) programs and is often a physician’s first choice in treating opioid use disorder (OUD).

Suboxone consists of buprenorphine and naloxone. The naloxone in Suboxone remains inactive unless the drug is taken in very high doses or misused, such as by injecting it. Most often, that component will not be activated if Suboxone is taken sublingually as intended.

The best medication for OUD is one you’ll take regularly without feeling too sick, sedated or upset. If Suboxone doesn’t work for you, trying another option could be a wise decision. Your doctor can guide this process.

Key Facts About Suboxone Alternatives

• The brand-name medication Subutex contains pure buprenorphine. The manufacturer voluntarily discontinued the drug in 2011.[1] Generic forms remain available, and some people still refer to them as Subutex.
• Zubsolv is very similar to Suboxone, as it also contains buprenorphine and naloxone. But Zubsolv is only available in pill form, whereas Suboxone is also available in a dissolving strip form.
• People with a long history of OUD may need strong medications to keep cravings at bay. Sometimes, methadone is a good choice for people in that situation.
• Naltrexone is not an opioid, so it doesn’t primarily work to address withdrawal symptoms or cravings. Instead, it prevents someone from getting high if they use an opioid while the medication is active.
• Vivitrol is a form of naltrexone injected once per month. It can increase treatment compliance compared to taking a naltrexone pill daily. For this reason, patients may prefer a long-acting injectable to daily medication.

Buprenorphine (Subutex)

Products containing just buprenorphine were available in the U.S. under the brand name Subutex. The manufacturer discontinued them in 2011, but generic forms are available.

Subutex has many of the same benefits as Suboxone. The buprenorphine mechanism of action eases cravings and reduces withdrawal symptoms. Subutex could be right for people in specific populations.

The benefits of Subutex include the following:[2],[3],[4]

• Strength: Pure buprenorphine products are strong and capable of helping people to overcome withdrawal side effects.[2] But very large doses of Suboxone could trigger naloxone’s protective effect, leaving you open to sickness. Since Subutex doesn’t contain naloxone, that risk is not present in Subutex.
• Customization: Patients may require pure buprenorphine if they cannot tolerate the naloxone component.[3] If you’re allergic or sensitive to naloxone (which is rare), your doctor might choose Subutex instead of Suboxone.
• Safety: Historically, pregnant women were given Subutex instead of Suboxone because the risk of birth defects or other teratogenic effects of naloxone was unknown. However, now that we have more data, naloxone is generally considered safe in pregnancy, so many pregnant women are given Suboxone without concern.[4] Still, some prefer Subutex during pregnancy.

Reduced protection is Subutex’s biggest drawback. Without naloxone, it’s slightly easier to overdose on Subutex when compared to Suboxone. It’s also easier for others to steal and misuse your medication.

Zubsolv

Zubsolv is another brand name for the combination of buprenorphine and naloxone. However, Zubsolv is a tablet instead of a strip. Zubsolv works much like Suboxone, but important differences exist.

Zubsolv’s benefits include the following:[5]

• Smaller doses: Zubsolv may be more bioavailable than Suboxone. A smaller dose will be as effective as a larger dose of Suboxone.
• Different experience: Zubsolv might be an option for a patient who cannot tolerate the strip form of buprenorphine-naloxone for some reason.

Zubsolv’s drawbacks include the following:

• Expense: Zubsolv is newer, and it costs more than Suboxone. As a result, most physicians prefer Suboxone. 
• Different experience: Some people appreciate using medications in dissolving tablet form. But others prefer a strip that melts away with no chalky residue. 

Methadone

Studies have repeatedly shown that methadone is effective at reducing opioid misuse and preventing related overdoses.[6] But it comes with drawbacks.

Methadone’s benefits include the following:[7]

• Strength: People with a long history of OUD may need strong medications to keep cravings at bay. Sometimes, methadone is a good choice for people in this situation. 
• Preference. Some people don’t like take-home medications for OUD. While Suboxone is often easier to obtain logistically, methadone is still very frequently used to treat opioid use disorder and may be the right choice for certain patients, particularly those who can visit a methadone clinic regularly.

Methadone’s drawbacks include the following:

• Misuse potential: Methadone is a pure opioid agonist without built-in misuse deterrents. Misusing methadone is easier than misusing suboxone. Today, Suboxone or buprenorphine is often preferred over methadone by patients for its lower misuse potential.
• Inconvenience: Methadone must be dispensed at a licensed methadone clinic. Patients must visit the methadone clinic daily, at least at first, to get their medication. This poses a major barrier to care for patients, particularly those who must work or have other daily responsibilities that make an everyday clinic visit unrealistic.

While well-established patients may get the privilege of take-home doses, they still probably need to visit the clinic at least weekly or every other week, which can be challenging. Switching from methadone to Suboxone allows for telemedicine management, which is much more convenient.

Naltrexone

Naltrexone is an opioid antagonist and the third FDA-approved medication to treat opioid use disorder, along with methadone and Suboxone. It is not an opioid, unlike Suboxone and methadone. In fact, it is an opioid antagonist, which blocks the effects of opioids, so it works slightly differently in treating OUD than methadone or Suboxone.

Naltrexone’s benefits include the following:

• Different use of action: Naltrexone is ideal for patients who have been stable in their recovery and do not want to be on an opioid agonist MAT. A naltrexone implant offers consistent protection.
• Relapse prevention: If people slip while using naltrexone, the drugs likely won’t get them high.
• Unique ingredients: It may be an option for patients who cannot tolerate methadone or Suboxone.

Naltrexone’s drawbacks include the following:

• Weaker protection: Because it is not an opioid, it does not treat the withdrawal symptoms of opioids. Instead, if taken, it simply prevents a patient from getting high if they subsequently use an opioid.
• Reduced effectiveness: Oral naltrexone is considered less effective overall than Suboxone and methadone for treating OUD.

Vivitrol

Vivitrol is the brand name of injectable naltrexone used to treat opioid use disorder. It works similarly to oral forms, with a few unique benefits and drawbacks.

Vivitrol benefits include the following:

• Compliance: Since Vivitrol is injected once per month, it can increase treatment compliance compared to taking a naltrexone pill daily. For this reason, patients may prefer a long-acting injectable to daily medication.
• Safety: Studies have shown that Vivitrol is as safe as Suboxone. 
• Reduced risks: You must visit a doctor for Vivitrol. You won’t have medications in your home that your children or pets could misuse to take inadvertently. 

However, Vivitrol may be slightly less effective than Suboxone in treating OUD.[8] It doesn’t block cravings or treat withdrawal symptoms in the same way that Suboxone does.

Comparing Suboxone Alternatives

Your doctor can help you decide which version of MAT therapy is right for you. But these core details can help you be an active part of your treatment discussion.

Are Suboxone Alternatives as Effective?

Buprenorphine, Zubsolv, Vivitrol and methadone have all been shown to be effective in treating opioid use disorder, mitigating withdrawal symptoms and reducing cravings for opioids. Your doctor will assess your situation, including the severity of your OUD and medical history, to determine the best choice of medication for you.

How to Determine Which Medication Is Right for You

Your OUD therapy choices are vast, and it can be hard to understand why one might be better than another. This video can help you understand how your doctor will guide your recovery and medication choices.