Belbuca (buprenorphine) has become an important tool in the battle against opioid addiction. However, it’s important to know the differences between suboxone vs Belbuca.
Buprenorphine has unique characteristics that allow it to deliver analgesia (pain relief) like a normal opioid while reducing the amount of euphoria (the “good feeling”) one can feel upon taking it, making it less likely to trigger the cascade of events that leads so many into opioid use disorder (OUD).
This has caused it to be proven useful to patients trying to stop using more dangerous opioids.
But buprenorphine is also a very effective pain reliever, with fewer negative side effects and a lower risk of tolerance, dependence and addiction than its counterparts, making it an attractive option for patients suffering from chronic pain.
This article discusses and compares two buprenorphine-containing medications: Suboxone (used for OUD) and Belbuca (used for chronic pain).
Key Points
- Suboxone and Belbuca both contain buprenorphine but are FDA-approved for different conditions and are not interchangeable.
- Suboxone (buprenorphine + naloxone) is the standard medication for opioid use disorder (OUD). Belbuca (buprenorphine only) is approved for chronic pain.
- Suboxone doses range from 2 mg to 12 mg of buprenorphine. Belbuca doses are much lower, ranging from 75 mcg to 900 mcg.
- Both medications can cause side effects including nausea, constipation, dizziness, and respiratory depression when combined with other depressants.
- Generic buprenorphine/naloxone (Suboxone equivalent) is widely available and typically covered by insurance. Belbuca has no generic version.
- A trained clinician should guide any decision about starting, switching, or combining these medications.
Table of Contents
- Suboxone vs Belbuca Basics
- Suboxone vs Belbuca at a Glance
- Matching the Medication to Your Needs
- Safety, Side Effects and Long Term Use
- Generic Options and Cost
- FAQs: Suboxone vs Belbuca
- Find Treatment Near You
Suboxone vs Belbuca Basics
Suboxone and Belbuca both contain the partial opioid agonist buprenorphine, but they are FDA-approved for different conditions and are not interchangeable. Suboxone is approved for opioid use disorder (OUD), while Belbuca is approved for chronic pain management.
How Suboxone and Belbuca are Similar and Different
Both Suboxone and Belbuca contain the active ingredient buprenorphine, and both are taken in the form of dissolvable oral films. In these ways, they are similar.
There are significant differences between these two medications, however.
- Primary uses: Suboxone is designed specifically for opioid use disorder (OUD), while Belbuca is designed for chronic pain.
- Patients seeking to use Suboxone for pain or Belbuca for OUD may have difficulty getting insurance to pay for these medications for these off label uses.
- Naloxone: While Belbuca contains only buprenorphine, Suboxone incorporates an additional medicine called Naloxone.
- Naloxone boosts Suboxone’s safety by discouraging opioid dependent patients from accidentally overdosing on other opioids during treatment and also makes Suboxone unsuitable for inappropriate uses (like “snorting” or IV use).
Suboxone vs Belbuca at a Glance
This side-by-side comparison highlights the most important differences between Suboxone and Belbuca, including their approved uses, ingredients, dosing, and availability.
| Suboxone | Belbuca | |
|---|---|---|
| FDA-approved use | Opioid use disorder (OUD) | Chronic pain management |
| Active ingredients | Buprenorphine + naloxone | Buprenorphine only |
| How it’s taken | Sublingual film or tablet (dissolves under the tongue) | Buccal film (dissolves against the inside of the cheek) |
| Dosing range | 2 mg to 12 mg buprenorphine per dose (with naloxone in a 4:1 ratio)<sup>2</sup> | 75 mcg to 900 mcg buprenorphine per dose<sup>3</sup> |
| Misuse deterrent | Yes. Naloxone blocks opioid effects if the medication is injected or misused. | No. Contains buprenorphine only, which carries a higher misuse risk if diverted. |
| Generic available | Yes. FDA-approved generic versions of buprenorphine/naloxone are available. | No. Belbuca is currently available as a brand-name product only. |
| Typical treatment goal | Reduce cravings and withdrawal symptoms during OUD recovery | Provide steady, long-term pain control for people who have not responded to other medications |
Suboxone doses contain 2 mg to 12 mg of buprenorphine. Belbuca doses contain 75 mcg to 900 mcg, roughly 20 to 160 times less per dose.
The dosing difference reflects each medication’s purpose. Suboxone requires higher buprenorphine levels to occupy enough opioid receptors to prevent cravings and withdrawal in people with OUD. Belbuca uses much smaller amounts because its goal is pain relief, not receptor saturation for addiction recovery.
Providers determine the appropriate dose based on the person’s medical history, the condition being treated, and their response during the initial titration period. Neither medication should be adjusted without clinical supervision.
Matching the Medication to Your Needs
The right medication depends on the condition being treated. Suboxone is typically the first-line option for people with moderate to severe opioid use disorder, while Belbuca is a second-line choice for people with chronic pain who have not found relief with other medications.
When Suboxone Is Usually Recommended
Suboxone is usually recommended as a preferred initial option for patients with moderate to severe opioid use disorder (OUD).
It has been proven to reduce withdrawal symptoms, cravings and overdose deaths. It is most effective when combined with other treatment modalities, such as individual and group counseling.
When Belbuca (buprenorphine) May Be Appropriate
Belbuca is usually considered a second line treatment for patients with moderate to severe chronic pain who have not achieved adequate pain control with other medications.
The goal with Belbuca treatment is steady pain control, not dependence recovery. Therefore, it is important for providers to carefully establish the prospective patient’s drug use/abuse history and any co-occurring mental health struggles that might increase a patient’s risks.
Safety, Side Effects and Long Term Use of Suboxone vs Belbuca
Both medications carry risks including nausea, constipation, dizziness, and respiratory depression, particularly when combined with alcohol or benzodiazepines. Regular follow-up with a prescribing clinician is essential for safe long-term use of either medication.
Risks, Interactions, and Monitoring
Both Belbuca and Suboxone can cause nausea, constipation, dizziness, headache, sweating, sleep disturbances, liver toxicity and lowered heart rate.
Consistent follow up with the buprenorphine prescriber is essential so that one’s health status can be closely monitored.
The most serious potential side effect of buprenorphine is respiratory depression, which can result in death, especially when buprenorphine is combined with other depressants like alcohol or benzodiazepines.
Another serious potential risk is “precipitated withdrawal,” which can occur when buprenorphine treatment is initiated too soon, while another opioid is still in one’s system.
It is crucial to consult with a trained clinician before starting buprenorphine, especially if one has been taking other opioids or is using alcohol or benzodiazepines.
Generic Options and Cost
Cost and insurance coverage can influence which buprenorphine medication is accessible to a given person. Understanding the availability of generic versions and typical price ranges can help guide conversations with providers and pharmacists.
Generic versions of Suboxone (buprenorphine/naloxone) are widely available from multiple manufacturers. This has made the medication significantly more affordable over the past decade, and most insurance plans, including Medicaid and Medicare Part D, cover buprenorphine/naloxone products for OUD treatment.
Belbuca does not currently have an FDA-approved generic version. As a brand-name-only product, it tends to cost more out of pocket. Insurance coverage for Belbuca can vary, and some plans may require prior authorization or step therapy (trying other pain medications first) before approving it.
For people seeking treatment for opioid use disorder, the availability of affordable generic buprenorphine/naloxone products means that cost is less likely to be a barrier. For people who need Belbuca for chronic pain, it may be worth discussing cost and insurance coverage options with a pharmacist or benefits coordinator.
FAQs: Suboxone vs Belbuca
While Belbuca could, theoretically, be considered for OUD (in very specific cases), it is not the preferred medication for this condition. Suboxone is the standard of care for these individuals.
Yes. Suboxone can provide analgesia to patients with chronic pain. It is likely safer than many of the other options on the market and it is undoubtedly safer than using illicit opioids for this purpose.
It can be safe to switch between Suboxone and Belbuca. However, because of the significant dose differences between the two medications and the complicated insurance coverage issues, this decision should be made with help from a trained provider.
In most cases, no. Both medications contain buprenorphine, and taking them simultaneously could lead to excessive buprenorphine levels in the body. This increases the risk of side effects such as drowsiness, dizziness, nausea, and respiratory depression. Buprenorphine has a ceiling effect, meaning that taking more does not increase its therapeutic benefits but can increase harm.1 If a person receiving medication-assisted treatment for OUD also needs chronic pain management, a provider can help develop a safe plan that does not involve overlapping buprenorphine prescriptions.
Find Treatment Near You
To find an experienced buprenorphine provider near you, please feel free to access the Rehab.com directory. You can filter the results by location, level of care, and even by accepted insurance plans and any special programs to meet your personal needs.
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References
- Substance Abuse and Mental Health Services Administration (SAMHSA). “Buprenorphine.” SAMHSA, 2023. https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine
- Indivior Inc. “Suboxone (buprenorphine and naloxone) sublingual film: Prescribing Information.” FDA, 2023. https://www.suboxone.com/pdfs/prescribing-information.pdf
- BioDelivery Sciences International. “Belbuca (buprenorphine buccal film): Prescribing Information.” FDA, 2023. https://www.belbuca.com/hcp/buprenorphine-dosing-titration
- National Institute on Drug Abuse (NIDA). “Medications to Treat Opioid Use Disorder Research Report.” NIDA, 2024. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction
- Oakley B, et al. “Managing precipitated withdrawal: a review.” PubMed, 2022. https://pubmed.ncbi.nlm.nih.gov/35623179/
- National Institute on Drug Abuse (NIDA). “Overdose deaths involving buprenorphine did not proportionally increase with new flexibilities in prescribing.” NIDA, 2023. https://nida.nih.gov/news-events/news-releases/2023/01/overdose-deaths-involving-buprenorphine-did-not-proportionally-increase-with-new-flexibilities-in-prescribing
