Suboxone (Buprenorphine/Naloxone)

People with opioid use disorder (OUD) have more options than ever when seeking treatment for their condition. In the past several decades, new medications called medication-assisted treatment (MAT) have been approved to treat this condition. Suboxone belongs to this group of drugs. Even though it’s a very effective medication, Suboxone has the potential for addiction and abuse. It must be used carefully and responsibly for this reason.

What Is Suboxone?

Suboxone is the brand name for the combination of buprenorphine and naloxone. These two substances work together to treat the cravings associated with OUD and help reduce the number and severity of withdrawal symptoms. Suboxone is formulated in a film that is placed under the tongue or a sublingual tablet. The film is usually cut into multiple doses, and the dose is administered once daily.

The two substances work in different ways to treat OUD. Buprenorphine is an opioid that targets the body’s opioid receptors. By targeting these receptors, buprenorphine “mimics” the effects of illicit opioids without providing as much euphoria or abuse potential. Naloxone is added to the film to curb abuse. If someone tries to tamper with Suboxone or takes more than directed, the naloxone will block the actions of buprenorphine or other opioids.

What Is Suboxone Used For?

Suboxone is used to treat opioid use disorder and has been shown to be safe and effective. Opioid use disorder can have a significantly negative impact on a person’s life. When treating a person for opioid addiction, the end goal is to allow them to return to a normal life. If they are experiencing persistent withdrawal symptoms, this can impact their ability to function. Suboxone and similar treatments can provide relief in as little as 45 minutes and be continued for as long as needed.

When used appropriately, Suboxone provides critical relief to those in need. Contrary to what some people may think, MAT is not just “trading one addiction for another.” Opioid addiction changes the receptors in the brain into an unnatural state. After using opioids for long enough, addiction becomes a chronic disease and is no longer a choice.

How Does Suboxone Work?

Suboxone contains two different drugs. The buprenorphine component is a partial mu-opioid agonist, meaning it binds to the same opioid receptors as other opioids like hydrocodone, oxycodone, heroin and fentanyl. However, it does not bind as tightly, so it will not cause the same levels of euphoria, and there is a lower risk of abuse.

Suboxone also contains naloxone, which works against other opioid drugs. It blocks the opioid receptors and prevents opioids from working. It can also “bump” opioids off the opioid receptor and reverse intoxication. This is why naloxone is used as a rescue drug for opioid overdose.

Naloxone is added to Suboxone so the film or tablet cannot be tampered with, making it harder to abuse.

Suboxone Dosage

The Suboxone dosage will be different for each person. Treatment includes three different stages: induction, stabilization and maintenance.

During the induction stage, treatment is 4 mg by mouth once daily. Depending on the patient’s response, the dose may be repeated to a target dose of 8–12 mg.

The maintenance dose is determined after the induction phase. Suboxone is increased in increments of 2–8 mg until the target dose is reached. The usual maintenance dose is 12–16 mg once daily, with a maximum dose of 24 mg daily.

Suboxone Tablet

Suboxone sublingual tablets are available in the following dosages:

• Buprenorphine/naloxone 2–0.5 mg
• Buprenorphine/naloxone 8–2 mg
• Buprenorphine/naloxone 0.7–0.18 mg [Zubsolv]
• Buprenorphine/naloxone 1.4–0.36 mg [Zubsolv]
• Buprenorphine/naloxone 2.9–0.71 mg [Zubsolv]
• Buprenorphine/naloxone 5.7–1.4 mg [Zubsolv]
• Buprenorphine/naloxone 8.6–2.1 mg [Zubsolv]
• Buprenorphine/naloxone 11.4–2.9 mg [Zubsolv]

Suboxone Film

Suboxone film is available in the following strengths:

• Buprenorphine/naloxone 2–0.5 mg
• Buprenorphine/naloxone 4–1 mg
• Buprenorphine/naloxone 8–2 mg
• Buprenorphine/naloxone 12–3 mg

Can You Overdose on Suboxone?

Yes, but it is much harder to overdose on Suboxone than other types of opioids. Buprenorphine is a partial opioid agonist, which means it does not completely block opioid receptors like other opioids. It also contains naloxone, meaning if someone tries to abuse Suboxone, then naloxone will work to reverse the effects.

Symptoms of Suboxone overdose may include:

• Decreased level of consciousness
• Pinpoint pupils
• Respiratory depression

Suboxone Side Effects

Like all opioid medications, Suboxone has several possible side effects. Side effects are more common when starting the medication and when changing dosages. Suboxone side effects might not be noticeable when used for OUD because the person has been using more potent opioids. Common side effects may include:

• Abdominal pain
• Blurred vision
• Constipation
• Headache
• Nausea
• Pain
• Palpitations
• Sweating
• Vomiting

Suboxone, like other opioids, carries a risk of overdose. No matter how long a person has been using Suboxone, they are at risk of opioid overdose. Your prescriber should offer you the reversal agent naloxone (Narcan) to reverse an overdose in an emergency.

Long-term use can be hard on the liver. The prescriber should regularly monitor your liver function to identify and treat this if it occurs.

Suboxone can also have effects on blood pressure. Specifically, it can lower blood pressure, and caution should be used if you have heart disease. You are at a higher risk of low blood pressure if you take other medications for hypertension.

Long-term Side Effects of Suboxone

In general, Suboxone is considered safe for long-term use in people with a history of opioid use disorder. However, anyone taking this drug long-term should be aware of the potential side effects, including:

• Edema (swelling)
• Liver problems
• Low blood pressure
• Overdose
• Physical dependence
• Withdrawal symptoms

Suboxone Withdrawal

Withdrawal is a set of symptoms that happens when a person is physically dependent on a drug. After taking Suboxone for long enough at a high enough dose, it can begin to change how the nervous system functions. Suboxone activates mu-opioid receptors, and the body eventually adjusts to the “overexcitement” of the opioid receptors by making less of them.

When a person with fewer opioid receptors stops taking Suboxone, they start getting withdrawal symptoms. Opioid receptors are responsible for controlling pain, mood and digestion. When withdrawal happens, usually the symptoms are related to these body processes.

Suboxone can cause withdrawal as severe and uncomfortable as other opioid drugs, so it is important not to stop taking it suddenly. Withdrawal symptoms are usually worse for people who abuse opioids but can still happen for those taking Suboxone exactly as prescribed.

Suboxone Withdrawal Symptoms

Suboxone withdrawal can include several symptoms ranging from uncomfortable to dangerous. Common symptoms may include:

• Dilated pupils
• Fast breathing
• Fast heart rate
• Yawning
• Goosebumps
• Rhinorrhea (runny nose)
• Hyper reflexes
• Lacrimation (tearing)
• Light sensitivity
• Myalgia (muscle aches)
• Nausea and Vomiting
• High blood pressure
• Insomnia
• Hyperthermia (high body temperature)

Suboxone Interactions

Tell your doctor about all medications you are taking before starting this drug because it can have many interactions with other substances

Suboxone is a central nervous system (CNS) depressant and can increase the depressant effects of other drugs. Use caution when taking other opioids, alcohol, sleep medications, certain anxiety medications, kratom and cannabis. These drugs can also increase the risk of overdose when taking Suboxone.

Do not take naltrexone or use naloxone while taking Suboxone unless you are experiencing an acute opioid overdose. Taking these drugs can cause an immediate and uncomfortable withdrawal and be life-threatening.

Suboxone and Alcohol

Suboxone and alcohol are both CNS depressants. When combined, the risk of overdose from either medication is greatly increased. In the U.S. in 2010, alcohol was involved in 22% of deaths related to prescription opioids like Suboxone.

Both can cause respiratory depression (slowed breathing) and, in high enough amounts, shut down the areas of the brain that control breathing. Suboxone should never be combined with alcohol or other CNS depressants.

Suboxone and Pregnancy

Generally, the risk that Suboxone carries to the developing infant is considered safer than the risk of opioid relapse. All opioids, including Suboxone, carry the risk of Neonatal Opioid Withdrawal Syndrome (NOWS). However, this risk is much easier to manage with a long-acting opioid in a controlled setting like a treatment program.

If you are pregnant or thinking of becoming pregnant while on Suboxone, talk with your doctor. You should work closely with your healthcare provider to ensure your pregnancy is safe for you and your baby.

FAQs About Suboxone

Is Suboxone a Controlled Substance?

Yes, Suboxone in any formulation is a controlled substance. Buprenorphine is a Schedule III drug, according to the Drug Enforcement Agency (DEA). Drugs in this category carry a high risk of psychological dependence and a low-moderate risk of physical dependence.

Suboxone is a Schedule III substance and not Schedule II (like other opioids) because buprenorphine only partially activates opioid receptors. Opioids that fully activate opioid receptors include morphine, heroin and hydrocodone, among others.

Does Suboxone Make You Tired?

Yes, Suboxone can tire a person because it slows down the central nervous system. This side effect is more likely to happen in people using Suboxone for the first time. People develop a “tolerance” to Suboxone quickly and are not likely to feel tired after taking it for 1–2 weeks.

How Long Does It Take for Suboxone to Kick In?

Once placed under the tongue, Suboxone dissolves in about 2–10 minutes. The drug will start working within about 30 minutes for most people.

Does Suboxone Get You High?

When someone takes Suboxone as prescribed for opioid use disorder, they are not likely to get high because their body is used to much stronger opioids. Suboxone is a partial opioid agonist, so it does not bind as tightly to receptors as heroin, morphine or other full opioid agonists.

People who have never used opioids before can get high from Suboxone. Therefore, it is still a controlled substance and should only be used with a valid prescription.

Is Suboxone Addictive?

Yes, Suboxone carries a risk for an addiction like any opioid. The DEA recognizes it as a Schedule II substance because a person can become physically or psychologically addicted to it.

It is important to note that taking Suboxone for medication-assisted treatment (MAT) of OUD is not an addiction and it is not “trading one addiction for another.” People who need Suboxone are not likely to get high from Suboxone because it is not as strong as other opioids they were probably abusing before.

Does Suboxone Show Up on a Drug Test?

Yes, but it usually must be ordered specifically by the physician or treatment facility. Standard 10-panel drug screens will test for opioids, but buprenorphine will not cause a positive result.

A treatment program dispensing Suboxone will probably test for the medication to ensure a person is not selling or giving away their Suboxone. Otherwise, a person would only be tested for Suboxone if there was suspicion of use.

Looking for a Suboxone Clinic in Colorado?

The Recovery Village at Palmer Lake offers medication-assisted treatment (MAT) to those with opioid use disorder as medically appropriate. MAT is a tool to help people quit opioid abuse without the risks of going “cold turkey.” It is generally provided during a medical detox, throughout rehab, and sometimes maintained long-term after a person’s rehab treatment is finished.

If you or a loved one are addicted to Suboxone or other opioids, call The Recovery Village at Palmer Lake. Our compassionate team of licensed medical professionals can develop a personalized addiction treatment plan that works for your situation. You can overcome a dangerous opioid addiction with professifonal help; don’t wait, call us today.