Belbuca vs. Suboxone: Are They the Same?

If you’ve been prescribed Belbuca for chronic pain or Suboxone for opioid use disorder, you know they both contain buprenorphine. That may leave you wondering if they work the same.

The short answer is: no, they do not. This article explains how Belbuca and Suboxone compare, why someone may be prescribed one instead of the other, and what to know before making any changes to your medication. 

Belbuca vs. Suboxone at a Glance

Are Belbuca and Suboxone the Same?

Not at all. They may have the same active ingredient, buprenorphine, but they were created for different reasons and made differently. 

Belbuca is a very small amount of buprenorphine in a thin strip of a drug called a buccal film. It was approved by the FDA to help control chronic pain 24 hours a day.[1] Suboxone is a combination of much larger amounts of buprenorphine combined with naloxone, which was specifically designed to help people overcome their addiction to opioids.[2]

They have several key differences:

• Active Opioid Dose: Suboxone has much more than Belbuca.
• Naloxone: Suboxone has Naloxone while Belbuca does not.
• Approved Use: Belbuca is approved to treat chronic pain, while Suboxone is used to treat opioid use disorder.
• Overall Treatment Goal: One helps relieve pain, and the other helps decrease cravings and withdrawal from opioids.

Because of these differences, you should never switch from one to the other without first consulting your healthcare provider. Your healthcare provider will determine when it is best for you to switch medications.

Do Belbuca and Suboxone Have the Same Active Ingredients?

Yes. Both Belbuca and Suboxone contain buprenorphine. It works by activating some of the same opioid receptors in the brain as full agonists such as oxycodone and heroin.[3]  However, instead of producing the same level of “high” as those drugs, it causes a much milder effect. 

There is also a ceiling to how effective buprenorphine can be, regardless of how much of it you take. Once past that ceiling, increasing doses will produce no additional benefits. This is why buprenorphine has a relatively lower risk of causing the life-threatening respiratory depression caused by full agonists, though the risk is not eliminated altogether.[4]

What are the Specific Uses for Belbuca and Suboxone?

Belbuca

Belbuca is indicated for the management of severe, daily chronic pain in patients whose persistent pain will necessitate long-term opioid treatment.[5] In general, this includes:

• Neuropathic pain (pain due to damaged nerves)
• Arthritis
• Chronic lower back pain
• Cancer-related pain 

Belbuca should be used to treat persistent, long-term, chronic pain, and should not be used to provide temporary or infrequent relief from pain.

Suboxone

Suboxone is indicated for opioid use disorder. 

This is to alleviate withdrawal symptoms, reduce cravings for opioids, and provide a stable platform upon which to build long-term recovery.[6]

What Accounts for the Dose Difference?

A major distinction in prescribing Belbuca versus Suboxone can be found in their respective dosing units. Belbuca has been prescribed using a microgram dosage form. Conversely, Suboxone has been prescribed using the milligram dosage form. To put that in perspective, a milligram is 1,000 micrograms.

The reason for the difference in the dosages is directly related to how each drug interacts with the opioid receptors in your body. Belbuca occupies a small percentage of the available opioid receptors in order to effectively control the transmission of chronic pain signals. On the other hand, the dosing of Suboxone is intended to occupy significantly greater percentages of those same opioid receptors in an attempt to block the onset of withdrawal symptoms and also diminish cravings for opioids associated with addiction.

Think of Belbuca as a dimmer switch that turns down the intensity of chronic pain so it’s easier to live with. Suboxone, on the other hand, is more like guardrails on a mountain road—it helps keep someone from sliding into withdrawal and cravings so they can stay on the path to recovery.

Is Belbuca Used as a Drug for the Treatment of Opioid Use Disorder?

No. The reason Belbuca is not FDA-approved for the treatment of opioid use disorders is that it has much too low a dose to help alleviate withdrawal symptoms and cravings that can develop from an opioid use disorder. It also doesn’t contain naloxone. As such, Belbuca will not be used as a replacement for Suboxone, which was designed for the treatment of addiction.

There could be some limited exceptions when a doctor prescribes medications off-label, which means prescribed to treat a condition it is not FDA-approved for. This is a clinical determination made on behalf of the patient and should never be done without consultation with your healthcare provider.

Are There Times When Suboxone is Used to Treat Chronic Pain?

There are instances where doctors will prescribe Suboxone off-label to patients with chronic pain issues.[7] These would typically be people who have a history of substance abuse issues and ongoing chronic pain. 

Doctors feel that because of the ceiling effect of Suboxone and its lower risk of being misused, Suboxone can be an alternative in certain situations. However, Suboxone is generally not viewed as a primary form of pain management. Suboxone was primarily created to address the issue of OUD, and the dosages are based upon addressing OUD and not managing chronic pain. There have been no studies done regarding Suboxone for pain relief. Patients who consider using Suboxone for pain should speak to their healthcare providers about both the potential positives and negatives of Suboxone use as related to their complete medical history.

Belbuca vs. Suboxone Side Effects

Both medications also carry shared opioid-related warnings, including respiratory depression, sedation, and dangerous interactions with alcohol, benzodiazepines, and other central nervous system depressants.[8]

Misuse and Dependence Risks

Buprenorphine has a ceiling effect that may limit some of the dangers associated with full opioid agonist drugs. However, both Belbuca and Suboxone are Schedule III drugs and carry a risk of dependence, misuse, and abrupt withdrawal when abruptly stopped.[9][10]

The absence of naloxone in Belbuca means this drug was developed as a pain management product and does not contain the same type of misuse-deterrent characteristics found in Suboxone. The inclusion of naloxone in Suboxone provides a mechanism to deter intravenous misuse. Additionally, Suboxone contains ingredients specific to addiction treatment.

However, a lower misuse potential does not equate to zero misuse potential. A clinician needs to monitor patients carefully during the duration of treatment using either Belbuca or Suboxone.

Can You Switch Between Belbuca and Suboxone?

There is no direct correlation in switching from Belbuca to Suboxone or vice versa. Both products are chemically different in terms of their formulations, proportion of active ingredients reaching the systemic circulation, and available doses. They were also created to address very different therapeutic objectives.

Due to these variations, there are no reliable conversion charts to convert a dose of one to the other. Only a physician with knowledge of the entire medical history, current dosage regimen, and treatment objectives of a patient can decide how to make a safe transition between these two medications — or if such a transition should occur at all.

Is One More Effective Than the Other?

Neither Belbuca nor Suboxone is more effective than the other. Each is designed for a specific use case, and the best choice will depend completely on what the patient is seeking treatment for.

When the primary issue is chronic pain that has failed to improve through other methods of managing chronic pain, then Belbuca would generally represent the preferred method. Conversely, when the main issues are related to opioid use disorders, cravings, or withdrawal symptoms, Suboxone might be the most suitable course of action.

In conclusion, the best drug is always going to be the one that is consistent with an individual’s diagnosis and treatment objectives, but only after consultation with a qualified healthcare professional.

When To Speak With A Healthcare Professional

A healthcare professional should be consulted when:

• Chronic pain is no longer adequately controlled using current treatments.
• You have concerns about misuse
• Symptoms of withdrawal appear between doses.
• Managing side effects becomes unmanageable.
• You want to switch from one to the other
• Planning for pregnancy or pregnancy at time of treatment.
• You have a history of liver disease or otherwise impaired liver
• Other sedative products, including benzodiazepines, are being used.

Understanding the Difference Between Belbuca and Suboxone

Both Belbuca and Suboxone contain buprenorphine, but that is where many of their similarities end. Belbuca is used for certain types of chronic pain, while Suboxone is used to treat opioid use disorder by reducing withdrawal symptoms and cravings. Because the medications differ in formulation, dosage, and FDA-approved use, they should not be treated as interchangeable. Any changes should be made with guidance from a qualified healthcare provider.

If opioid use has become difficult to control, Marietta Springs provides in-person addiction treatment through PHP, IOP, and outpatient programs, with support for co-occurring mental health concerns. Contact Marietta Springs today to speak with the admissions team and learn what treatment options may fit your needs.