Used to treat opioid addiction, Suboxone is a combination medication containing both a partial opioid agonist, buprenorphine, and an opioid antagonist, naloxone. Buprenorphine is FDA-approved to help individuals wean off and stop taking opioid drugs, the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes.
How Suboxone is Used
Suboxone is a long-acting opioid that stays in the bloodstream longer than most other opiates, such as heroin or oxycodone. This means that it can be given in lower doses less often to minimize withdrawal symptoms that can occur when opioid drugs are processed out of the body. When someone struggles with physical dependence on an opioid drug, which can occur even with prescription opioids that are taken as intended over a period of time, the brain comes to expect the way that opioids interact with and alter brain chemistry.
For instance, the presence of an opioid drug in the brain causes a flood of the neurotransmitter dopamine, one of the chemical messengers partially responsible for mood regulation, feelings of pleasure, movement, memory formation, and motivation. Opioids also act on the central nervous system, lowering body temperature, minimizing anxiety, enhancing relaxation, and slowing heart rate, breathing functions, and blood pressure.
When someone takes an opioid regularly, the changes in brain chemistry become somewhat ingrained, and physical dependence sets in. Opioids are not drugs that should be stopped “cold turkey.” They should instead be weaned off with a slow and controlled tapering schedule during a detox protocol. Buprenorphine is often helpful for this.
The naloxone component of Suboxone is an opioid antagonist, meaning that it essentially “blocks” opioid receptors in the brain from receiving more opiates. The antagonist typically remains dormant in Suboxone unless the drug is altered for misuse. This means that if the drug is to be broken down and then abused, the naloxone will activate and keep the brain from experiencing the euphoric high that may be desired. The naloxone acts as a deterrent to make it less likely that a person will try and abuse Suboxone. Abuse of the drug can also precipitate, or induce, difficult withdrawal symptoms rapidly, which can be physically and emotionally uncomfortable.
When used as directed and as part of a comprehensive treatment program, Suboxone is considered a beneficial tool for addiction treatment. Suboxone is typically formatted into a sublingual strip that is placed under the tongue to be dissolved. As a medication, Suboxone does have potential side effects.
Potential Short-Term Side Effects of Use
The medication labeling for Suboxone lists the following common side effects of Suboxone use:
- Redness inside the mouth
- Heart palpitations
- Numbness in the mouth
- Trouble paying attention
- Possible intoxication (feeling of being drunk)
- Blurry vision
- Feeling lightheaded
- Back pain
- Withdrawal symptoms
Possible Significant Complications
There are more serious side effects of Suboxone that may be experienced.
- Impairment of coordination, balance, and normal movement abilities
- Liver problems, which can be indicated by loss of appetite, jaundice (yellowing of skin and/or whites of eyes), darker urine, light-colored stools, and/or abdominal pain
- Respiratory problems, which can become life threatening and are compounded if Suboxone is combined with other opioids, benzodiazepine drugs, alcohol, or other substances that depress the central nervous system
- Potential allergic reaction, which can include hives, rash, wheezing, lowered blood pressure, swelling of the face, and/or loss of consciousness
- Decreased blood pressure that can cause a person to feel lightheaded or dizzy when standing up too fast from a prone or seated position
- Abuse, dependence, and possible addiction
- Opioid withdrawal syndrome characterized by sweating, trouble regulating body temperature, shakiness, goosebumps, runny nose, watery eyes, muscle aches, diarrhea, and vomiting
Suboxone, while used to treat opioid addiction, is still a controlled substance with a potential for diversion, abuse, dependence, and addiction. Suboxone has been called “prison heroin,” per The New York Times, and it has been smuggled into jails and prisons on the pages of coloring books and religious texts.
It may be desired as a drug of abuse to combat opioid withdrawal symptoms and less for the euphoric high other opioids can produce. Buprenorphine actually has a “ceiling effect,” which means that after a certain amount is taken, the drug no longer has any pleasurable impact. This is what helps to make it an optimal drug for opioid addiction treatment. As a drug of abuse, it may be used more to keep a person feeling balanced and less to induce a significant high.
Buprenorphine abuse can dangerous. In 2010 the Drug Abuse Warning Network (DAWN) Report indicated that there were over 30,000 visits to emergency departments (EDs) related to adverse reactions involving buprenorphine. Opioid drug abuse can be potentially life-threatening. The National Institute on Drug Abuse (NIDA) publishes that over 115 people die every day in the United States as a result of an opioid overdose.
Suboxone can be particularly dangerous if it is combined with other drugs, such as benzodiazepines. The FDA issued their strongest warning, a black-box warning, in 2016 regarding the possible fatal risks of mixing opioids and benzodiazepines. An opioid overdose is recognizable by trouble breathing or stopping breathing altogether, pinpoint pupils, cold and clammy skin that may turn blue, mental confusion, and a possible loss of consciousness. An opioid overdose is a medical emergency that requires immediate professional attention.
Risk of Dependence and Addiction
As an opioid combination drug, Suboxone still has the potential for physical dependence and addiction. Taking Suboxone for a prolonged period of time can cause a person to become dependent on the drug, and if it is then stopped suddenly and processes out of the bloodstream, withdrawal symptoms can kick in.
Withdrawal symptoms are often similar to those associated with a really bad case of the flu, including nausea, vomiting, diarrhea, muscle aches, stomachaches, loss of appetite, headache, sweating and chills, runny nose, watery eyes, irregular heart rate, and insomnia. Drug cravings, depression, restlessness, anxiety, irritability, dilated pupils, agitation, and cognitive difficulties are further side effects of opioid withdrawal. The longer a person has been taking Suboxone and the higher the dosage, the more significant dependence is likely to be and the more intense the withdrawal symptoms will be. Environmental, genetic, and biological factors can all influence withdrawal as well.
Another possible long-term side effect of Suboxone use is addiction. This is a brain and behavioral disease that is characterized by an inability to control drug dosage and use. Addiction can infiltrate all aspects of a person’s life, interfering with personal relationships, family, work, and school obligations, as well as physical and emotional health and wellbeing.
Someone struggling with addiction likely misuses the drug and is unable to stop taking Suboxone even if they want to. They will keep using the drug, even in risky situations and when they recognize that it is negatively impacting their life.
The American Society of Addiction Medicine (ASAM) reports that in 2015 nearly 2.5 million adults in the United States battled opioid addiction. Addiction is a treatable disease. With professional guidance and supervision, Suboxone can be a helpful medication for the treatment of opioid addiction; however, it must be used as directed and as part of a complete treatment program that also integrates behavioral therapies and other methods of care into the overall plan.