Nikki wrote:

I have only heard of subutex, no personal experience with it, but have been told it's the same situation as suboxone if not worse. The worse part being that subutex can and has potential for abuse, whereas with the suboxone strips (only form that is presently available from actual company, unless you go generic)
is designed so it can't be abused.

As far as I am aware, there is no real in-vivo difference between the two. Although you're right that the pharmaceutical company that holds the patent for suboxone (A mixture of buprenorphine, a long lasting mixed agonist/antagonist opioid, and naloxone, an opioid antagonist,) only produces it in the form of strips currently, which are difficult for patients to abuse by attempting to insufflate it, most well-controlled studies/surveys that I've read suggest that, so long as a patient/user/whatever does not attempt to use either drug too soon after using a full-agonist opioid, which would cause excruciating and possibly even medically dangerous precipitated withdrawal syndrome (instant, untreatable until the buprenorphine wears off, peak-level withdrawal, essentially,) that the dirty little secret of Suboxone is that its intravenous/intramuscular injection does not seem to differ in effect in any significant way from that of Subutex. Buprenorphine, the active opioid agonist/antagonist ingredient (which would only get a user with a tolerance low enough to probably not have bothered seeking to be prescribed the drug in the first place high anyway, because of its ceiling effect) simply has a higher affinity for the opioid receptors, and at least given this, and from numerous reports I've read from IV users of one or both on forums on which their doctor is not likely to identify them, that there is absolutely zero real difference in abuse liability between subutex and suboxone.

[Note:This is where I go a bit off-topic into discussing my personal views on the efficacy {short version: I am a strong advocate} of long-term maintenance treatment for long-term and/or heavy opioid addicts. Skip to the last paragraph if you wish to stay precisely on topic.]

Honestly, with regard to methadone and buprenorphine in whatever flavor-of-the-month form is currently in vogue, I actually believe (and some very recent studies agree) the former superior in many (not all or most, mind you) cases, and find the media's demonizing of it, as well as, for whatever reason, that even some within the medical community have jumped onto this bandwagon, to be an incredibly unfair and dangerous trend. I particularly believe in the use of methadone maintenance treatment in moderately severe to severely-addicted individuals, because users cannot divert it nearly as easily and it seems to provide a better treatment for cravings and has the additional benefit of the practitioner being certain an individual has taken it, and ensuring that the patient gets at least some occasional face-time with a counselor. Additionally, its analgesic effect is a beautiful benefit in those with co-existing chronic pain issues. I believe that most of the negative effects attributed to it come to either a lack of understanding of its pharmacology in the severe addict, or from errors in judgement of those providing treatment - although obviously, some simply come from users who seek treatment for reasons besides being truly ready to quit, which is a shame.

It is my personal belief that in any individual who truly needs these drugs due to opioid addiction, particularly high-dose and/or long-term IV users of pills and/or or street opioids (typically heroin, of course,) it is best that they are prescribed them and slowly adjusted to an appropriate dose which can be further adjusted as needed later on, as an adjunct to cognitive-behavioral therapy and a full psychiatric and medical evaluation (as most users seem to begin/continue abusing opioids at least in part due to some untreated, often for a very long time, and of which the patient may not even be aware, physical or psychiatric ailment, condition, or trauma) as opposed to simply being put through immediate withdrawal under supervision or tapered quickly. Of course, whatever additional forms of psychiatric/medical/psychological treatment/support are beneficial to the individual are also necessary, not just something that I would personally recommend. Also, as for those prescribed buprenorphine-based medications, as (though most don't,) many users do simply stop taking them, selling them to enable purchase of a preferred opioid, inject them despite the dangers of doing so, or take a dose far lower than what they are actually prescribed, stockpiling or selling additional medication and in the process minimizing the efficacy of this component of their treatment regimen. Therefore, those on maintenance treatment of this sort, especially during the critical first 6-12 months of therapy, must be monitored closely to make sure that diversion and/or abuse do not occur, though this seems to be much, much, much less of a problem with methadone than with buprenorphine-based treatments.

I'm very sorry to have gotten off on a tangent there. This is a topic about which I personally am fairly passionate, as I believe that the current system could stand significant improvement. Getting back to the portion of your post to which I was initially responding, bottom-line, there is no clinically significant difference between the abuse liability via IV/IM injection in those prescribed Suboxone vs. Subutex, regardless of what a certain company would have use believe. Also, it is my belief after quite a few years of observing these issues from a clinical and, in some cases, observational/empirical standpoint, that individuals who are prescribed maintenance treatment and are provided these drugs by a doctor/clinic that gives enough of a damn about their well-being/understands how these drugs work enough to follow proper protocal, as the author certainly seems to, that these individuals would more often than not, provided a desire to do so, eventually find themselves able to adjust back to a normal, productive life, and eventually, to get clean even of maintenance medications, however long this may take, without suffering any really significant discomfort. It is also my belief that, were this kind of thorough treatment the standard, that 99% of the horror stories we hear about potential problems associated with these drugs would disappear immediately.

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