Mixing Suboxone With Other Drugs
What Is Suboxone?
Suboxone is a prescription-only addiction treatment medication approved for use in managing opioid use disorders. Comprised of buprenorphine and naloxone, Suboxone is available in sublingual tablets and sublingual film strips.
Designed to both suppress cravings and manage the symptoms of acute withdrawal in those recovering from heroin and/or prescription opioid dependencies, Suboxone has helped many individuals struggling with opioid addiction as they readjust to their newly drug-free lives.
What Does Suboxone Do?
Suboxone rose to prominence during the early 2000s as an alternative to the singular drug buprenorphine. Suboxone was formulated by combining buprenorphine with another drug called naloxone—an opioid antagonist used as an overdose preventative. The presence of naloxone helps dissuade individuals from using Suboxone via medically unintended routes like injection or snorting. With the addition of naloxone, Suboxone provides individuals with a form of buprenorphine that can easily and safely be administered in outpatient and private settings. With the addition of naloxone, Suboxone provides individuals with a form of buprenorphine that can easily be administered in outpatient and private settings.
Suboxone was formulated by combining buprenorphine with another drug called naloxone—an opioid antagonist used as an overdose preventative.
While buprenorphine alone is used for various clinical applications—as both an analgesic for severe or chronic pain as well as for treating opioid dependence—the combination formulation of Suboxone functions primarily for stabilization and/or opioid replacement in individuals needing help first withdrawing from then tapering off an opioid addiction.
What Are the Dangers of Suboxone?
Though dispensed as an anti-addiction medication, Suboxone can still pose dangers when misused. The FDA has compiled a guide on Suboxone with the following warnings:1,2
- Sudden discontinuance of Suboxone can lead to painful withdrawal symptoms.
- Overdoses can lead to dizziness and breathing problems.
- Suboxone can be lethal when consumed by children.
- Suboxone poses even greater risks when taken together with alcohol, sedatives, or tranquilizers.
What Happens When Suboxone Is Mixed with Other Drugs?
While Suboxone poses enough dangers to those who would abuse it, combining Suboxone with other drugs can pose even more drastic health risks.
Alcohol and Suboxone Interactions
As mentioned above, the FDA has boldly warned against the combination of Suboxone and alcoholic beverages. Both alcohol and buprenorphine (one of Suboxone’s two drug components) are central nervous system (CNS) depressants. By consuming both alcohol and Suboxone together, the risk of CNS depression can markedly increase.
Classic CNS depression from alcohol clouds judgment and lowers inhibitions, which can result in an intoxicated individual engaging in risky and sometimes death-defying behaviors.
Consequences of the CNS depression that can result from mixing both alcohol and Suboxone can include:2-4
- Lowered blood pressure.
- Respiratory depression.
- Deep sedation.
Cocaine and Suboxone Interactions
Unlike the depressant Suboxone, cocaine is a stimulant drug. It’s effects tend to be quite opposite in nature to those of opioid medications and may include:
- Elevated heart rate.
- Elevated blood pressure.
- Increased body temperature.
- Erratic, violent behavior.
Combining Suboxone with cocaine can result in the following:11
- Multi-drug addiction
- Reduced effects of Suboxone
- Increased heart rate
- Masked effects of cocaine
- Increased risk of overdose and possible death
Since, to some extent, the effects of Suboxone oppose those of cocaine, abusing both may motivate you to ill-advisedly increase your dose of cocaine so as to better experience its stimulant effects. Doing so, however, places you at heightened risk of unwittingly overdosing on cocaine.
Heroin and Suboxone Interactions
The purpose behind Suboxone usage is to manage cases of severe opioid dependence, but some individuals with opioid addiction use it to achieve a euphoric effect. Should Suboxone be mixed with another opioid, their mutual depressant qualities may exacerbate one another, which can prove fatal, especially in users with respiratory problems.
The key difference between Suboxone and other opioids is the added naloxone component, which serves to counter the actions of opioid drugs.
If a heroin dependent person were to take Suboxone simultaneously with heroin, or shortly after using heroin, the body’s strong preference for Suboxone will counter the non-specific actions of the more potent heroin, sending the user into an immediate withdrawal. Such predicaments can be very dangerous, and they defeat the purpose of Suboxone as a remedial drug.
Heroin: The Queen Mother of Opioid Addiction
Of all the commonly abused addictive opioids, few are more dangerous than heroin. Users become fast addicted to heroin both mentally and physically as they seek to experience the unique sensations provided by the drug, which can include transcendent euphoria and blissful, mellow states.
Once the drug begins to clear from a dependent person’s system, however, the pains of withdrawal set in, often provoking feelings of fear, anxiety, and depression. Preventing the onset of withdrawal can fuel ongoing, compulsive heroin abuse. As this heroin abuse spirals out of hand, users typically suffer a range of adverse health consequences, including:
- Severe constipation.
- Sudden, uncontrollable vomiting.
- Cold sweats.
- Involuntary, jerky muscle movements.
- Respiratory depression.
Heroin abusers who’ve shared needles also face greater risks of coming into contact with serious and sometimes life-threatening infectious diseases, including hepatitis and HIV.
Alarming Trends in Deadly Heroin Usage
Individuals who are addicted to heroin have a death rate that is 63 times the rate of non-heroin users.5 Heroin abuse in the U.S. has been rising at an alarming pace, and its consequences are staggering:6
- In 2010, there were 3,036 people in the U.S. who died from heroin overdose.
- In 2013, there were 8,257 people in the U.S. who died from heroin overdose.
- In 2017, there were 15,482 people in the U.S. who died from heroin overdose.
Heroin abuse has clearly become a large public health issue in the U.S. and will require continued and growing attention from health professionals and public health authorities.The rise of fentanyl in the last seven years makes the opioid epidemic all the more pressing. In 2017, fentanyl accounted for 28,000 deaths from overdose.
How Do People Start Abusing Suboxone?
Some people begin abusing Suboxone after it’s been prescribed as part of a treatment regimen for opioid dependency. Suboxone is used as a replacement drug that has a safer profile than other opioid drugs. Unfortunately, some who’ve transitioned to Suboxone end up abusing it.
An addiction has likely taken hold when a person continues to use a substance in order to maintain an effect, despite the demonstrable negative impact that the drug is having on their life. Any such drug addiction can be potentially debilitating or even lethal if the problem remains untreated.
Deciding If Suboxone Is Right for You
Suboxone, even as a therapeutic medication, is certainly not without its risks. There are a number of factors to weigh when deciding if Suboxone is right for you. Discussed below are some frequently asked questions about Suboxone.
How Safe Is Suboxone for Personal Use?
As pointed out by the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine can be habit-forming for any individual due to its function as an opioid agonist that elicits many of the same effects as other abused opioids.7
While the buprenorphine portion of Suboxone may result in a similar experience to that of other opioid drugs, the naloxone component helps prevent overdose, rendering the drug relatively safer for use.
For these reasons and more, the buprenorphine/naloxone combination that is most commonly known as Suboxone is one of only two opioid addiction treatment medications—along with its sister drug Subutex—to be approved by the Food and Drug Administration (FDA) for usage outside of licensed opioid treatment facilities.
How Effective Has Suboxone Been for Those Addicted to Opioids?
Studies have demonstrated the following results related to the effectiveness of buprenorphine and Suboxone:8
- About 20.7% of those who undergo buprenorphine treatment for opioid addiction are able to totally quit opioid drug use.
- An additional 17.8% have tested opiate-free following buprenorphine/naloxone-based treatments.
- Since 2002, nearly 100,000 physicians have been trained to prescribe Suboxone and Subutex.
- In that same time span, approximately 69,000 providers have registered to provide the two medications.
Suboxone may indeed be a good solution for some individuals who are trying to get off of opioids.
What Are the Controversies Surrounding Drugs Like Suboxone?
Despite the number of successes from Suboxone prescriptions, controversies still linger regarding the ethics behind opioid replacement.
In an effort to further the discussion about opioid replacement drugs, the Royal College of Physicians of Edinburgh recently summoned two of its local medical advisors, Dr. J. R. Robertson and Dr. A. M. Daniels, to respectively argue the pros and cons of opioid replacement.9
Dr. Robertson argues that opioid replacement is essential for the following reasons:
- Medical professionals are obligated to treat patients with the most effective remedies currently available.
- Regardless of politics or personal biases, the primary business of doctors is to care for patients and manage the medical consequences.
- The failure of a doctor to maximize treatment is an act of negligence tantamount to criminal neglect.
Dr. Daniels counters that opioid replacement is dubious due to the following factors:
- Controlled trials provide insufficient evidence into the overall effectiveness of opioid replacement.
- There is too great a risk of leaking the treatment opioids into the general population by prescribing them to recovering individuals.
- Since 1996, Scotland’s heroin-addicted inmate population has grown in direct proportion to the number of methadone patients.
In the United States, the opioid epidemic of the last several years has swung public opinion sharply toward Dr. Robertson’s arguments. Suboxone, used in a responsible manner, has been a highly effective and imminently necessary treatment for opioid use disorder.
- Food and Drug Administration. (n.d.). Medication Guide: Suboxone.
- Indivior, Inc. (2018). Suboxone: Highlights of Prescribing Information.
- Purdue Pharma, L.P. (2017). Butrans (buprenorphine) Transdermal System.
- Substance Abuse and Mental Health Services Administration. (2004). TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction.
- Gronbladh, L., Ohlund, L. S., Gunne, L. M. (1990). Mortality in heroin addiction: impact of methadone treatment. Acta Psychiatr Scand., 82(3), 223-7.
- Centers for Disease Control and Prevention. (n.d.). About Compressed Mortality, 1999-2016.
- Substance Abuse and Mental Health Services Administration. (2019). Buprenorphine.
- Substance Use and Mental Health Services Administration. (2019). Practitioner and Program Data.
- Robertson, J. R., Daniels, A. M. (2012). Methadone replacement therapy: tried, tested, effective? J R Coll Physicians Edinb, 42, 133-8.
- Chen K.Y., Chen, L., Mao, J. (2014). Buprenorphine-naloxone therapy in pain management. Anesthesiology. 120(5), 1262–1274.
- Copenhaver, M.M., Bruce, R.D., Altice, F.L. (2007). Behavioral counseling content for optimizing the use of buprenorphine for treatment of opioid dependence in community-based settings: a review of the empirical evidence. Am J Drug Alcohol Abuse., 3(5), 643–654 .