• No, Subutex should not be initiated with opioids in your system.
• Subutex needs to be initiated at least 6 to 12 hours, or longer, after the last dose of a short-acting opioid, such as heroin.
• If taken too soon, Subutex could precipitate premature withdrawal symptoms, because Subutex will rapidly displace any opioid that is occupying a mu-opioid receptor.
• Subutex has now been discontinued and in most cases, replaced by Suboxone.

Subutex is an oral sublingual medication that contained buprenorphine and was used to treat opioid addiction. Subutex was not approved to relieve pain. Subutex has now been discontinued

Subutex was recommended to be initiated at least 6 to 12 hours after the last opioid use for short-acting opioids such as heroin, or when withdrawal symptoms started.

If Subutex was initiated too soon, it could precipitate premature withdrawal symptoms because it rapidly displaced any opioids that were already present on the mu-opioid receptor. Subutex when taken daily, blocked the effects of any opioids that people tried to take in addition to Subutex.

How did Subutex work?

Subutex contained buprenorphine which is a high-affinity partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor.

Because buprenorphine is a high-affinity partial agonist, it attaches strongly to the mu-opioid receptor but has very low activity, which explains why it does not produce a “high” (euphoria) and has a low overdose risk.

This also explains why it displaces other opioids that are in the bloodstream at the same time, and also prevents other opioids from binding to the mu-opioid receptor if these are given after a dose of buprenorphine has been taken. Subutex “fooled” the brain into thinking opioids were already present in the body.

Subutex was usually started at a low dose and the dose titrated upwards if withdrawal symptoms were not adequately suppressed.