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Suboxone for Opioid Use Disorder

Medically Reviewed by Jennifer Casarella, MD on April 22, 2022

Suboxone is a combination of two drugs, buprenorphine and naloxone. It’s available by prescription only to treat opioid use disorder, or opioid dependence.

Suboxone is one brand-name version of generic buprenorphine and naloxone combination. Other brands include Bunavail, Zubsolv, and Cassipa.

Who Might Need Suboxone?

Suboxone is one of several drugs that may be prescribed in medication assisted therapy or treatment (MAT) for opioid use disorder. People as young as 16 may use Suboxone.

MAT is treatment for opioid use disorder, or recovery from addiction to opioids, such as heroin, morphine, fentanyl, hydrocodone (Vicodin, Lortab, Lorcet), or oxycodone (OxyContin). MAT combines a medication to ease your opioid cravings and withdrawal symptoms along with behavioral therapy and counseling.

When you’re dependent on an opioid, and then reduce the amount you use or stop taking it, your brain and body go through withdrawal. This can be a life-threatening condition.

Withdrawal symptoms include:

  • Intense cravings for opioids
  • Anxiety and restlessness
  • Stomach upset
  • Heavy sweats
  • Rapid heartbeat
  • Muscle aches
  • Insomnia

Suboxone can keep you stable as you go through withdrawal. This drug eases withdrawal symptoms, so you can continue MAT and get well.

After withdrawal, your doctor may keep you on Suboxone as maintenance treatment. It keeps your opioid cravings at bay as you work on your recovery long term.

How Does Suboxone Work?

Treatment with Suboxone, therapy, and counseling can help you manage your opioid use disorder or dependence.

The active component of Suboxone, buprenorphine, is a partial opioid agonist. Unlike a full opioid agonist (such as those listed above), it blocks and also partially activates the opioid receptor. When you take an opioid, it blocks signals called pain receptors in your brain. Your sense of pain is reduced. Your brain also releases chemicals called endorphins that make you feel pleasure. With Suboxone, side effects tend to be milder and the risk of overdose significantly reduced compared to full agonists. It can block the effect of full opioids to ease cravings and withdrawal symptoms and improve function.

Some people are unable to stop using opioids. You may become addicted to the pleasure the drug causes even when there’s no longer a physical cause of pain. You need more and more opioids to get the same feeling. Your body can also come to depend on opioids. You go into physical withdrawal if you don’t take it.

Suboxone gets in the way of that process. Pain receptors aren’t switched off. Suboxone helps you reduce a craving for the pleasure rush of opioids. It also eases withdrawal symptoms that you have when you stop taking opioids.

What Are the Two Different Drugs in Suboxone?

Suboxone contains two different medicines:

  • Buprenorphine, a partial opioid agonist
  • Naloxone, an opioid antagonist

Buprenorphine is like a weaker version of an opioid. Its effects are limited; you don’t get the same pain relief or pleasure rush of a full-strength opioid. But you may be less likely to want to take a full opioid, because buprenorphine satisfies your cravings and eases withdrawal symptoms.

Even if you take higher doses of buprenorphine, there’s a limit to how much it can tamp down your brain’s pain signals or switch on endorphins. You’re less likely to overdose on buprenorphine than opioids.

Naloxone is an opioid antagonist. It has the opposite effects of opioids and is generally used to treat opioid overdoses by reversing them. It is not well absorbed by mouth and by combining it with buprenorphine, the risks of misusing it or injecting it (in which case it could cause unpleasant withdrawal symptoms) is reduced.

How Is Suboxone Given?

Suboxone comes as either a tablet or small, thin piece of film. Both forms dissolve in your mouth. They also both work the same way.

Because it dissolves inside your mouth, Suboxone is easier to take while you’re in addiction recovery. You just place the tablet or film under your tongue, and it melts on its own. You can also place the film inside your cheek.

Both the tablet and film come in many different dosages or strengths. Usually, you start with a dose of 8 mg of buprenorphine and 2 mg of naloxone. Your doctor will prescribe the best dose for your recovery. They’ll change or taper your dose slowly over time. Never try to taper your dose on your own.

How Do I Take Suboxone?

Suboxone is designed to melt under your tongue or inside your cheek. Ask your doctor or pharmacist if you’re not sure how to take it. They can explain it to you.

If you take the tablet form:

  • Place the tablet under your tongue. Let it dissolve.
  • Don’t swallow it with water.
  • Don’t eat or drink anything until the tablet is totally dissolved.
  • If each prescribed dose is more than one tablet, put the tablets at different places under your tongue at the same time.

If you take the film form:

  • You can drink a little water first to moisten your mouth.
  • For the first few days of treatment, place the film under your tongue, not inside your cheek.
  • Place the film under your tongue near the base.
  • Don’t move the film until it totally dissolves.
  • Don’t chew, swallow, or cut the film into pieces.
  • If your prescribed dose is two pieces of film, place the first film on one side under the base of your tongue, and let it totally dissolve. Then, place the second film on the opposite side. If there’s a third film, place it on the same side where you put the first film.
  • After a few days, you may choose to put the films on the inside of your cheek or under your tongue.

What’s the Benefit of Combined Buprenorphine/Naloxone Over Other MAT Medications?

Suboxone has been used as part of MAT since the early 2000s. Before that, people with opioid use disorder took a drug called methadone during MAT. Methadone is still available and another effective medication for opioid use disorder. It is available only through registered opioid treatment programs while Suboxone can be prescribed by a doctor or other licensed practitioner.

Methadone is a long-acting, synthetic full opioid drug. It also helps ease withdrawal symptoms and reduce cravings and lessens the euphoria of other shorter acting opioids.

What Are the Possible Side Effects of Suboxone?

The most common side effects of using Suboxone are constipation, diarrhea, headaches, and nausea. You may also start to depend on it too much for relaxation.

Suboxone may cause a severe side effect called respiratory depression. That’s shallow, slowed breathing that drops oxygen levels in your blood.

Anyone who takes Suboxone and has these symptoms of respiratory depression should get emergency medical care right away:

  • Dizzy or lightheaded
  • Slow or labored breathing
  • Extremely sleepy or not responsive

Respiratory depression is rare if you take Suboxone at the prescribed dose. It’s more likely if you inject Suboxone, or take it along with alcohol or drugs called benzodiazepines (sedatives that help you sleep or that relieve anxiety).

Suboxone may also cause these side effects in some people:

People who take Suboxone may also have mental side effects like anxiety, depression, or nervousness. Let your doctor know if you notice any of these mood changes. They may put you at risk to use opioids again as a way to dull these feelings.

What Do I Need to Know About Taking Suboxone?

Only use Suboxone as part of MAT for opioid addiction recovery. Don’t take it for pain relief.

Your doctor will decide when it’s safe and healthy for you to start taking Suboxone as part of your recovery. If you start taking it too soon after you stop using opioids, you can have strong withdrawal symptoms like shaking, sweating, nausea, vomiting, diarrhea, body aches, or mood changes.

Here are a few other important precautions to take when you take Suboxone:

  • Don’t stop taking Suboxone on your own for any reason, even if you start to feel better and think you don’t crave opioids anymore. If you just stop taking Suboxone, you’ll go through withdrawal symptoms too.
  • Try not to miss your regular dose of Suboxone. If you skip or miss doses for any reason, you’re at risk to relapse and want to use opioids. Ask your spouse, family, or friends to remind you to take your dose. Put your pills or film in a container that has a slot for each day’s dose of your medicine. You can also set reminders on your phone or write it on your calendar.
  • If you miss a dose of Suboxone, take it as soon as you remember, unless it’s very close to the time for your next dose. Don’t double your next dose if you miss a dose.
  • Don’t operate heavy machinery or equipment while you take Suboxone until you know how much it affects you.
  • Don’t take anyone else’s Suboxone to relieve or treat pain. If you’ve never taken opioids as a pain reliever, using Suboxone to treat pain on its own can cause death even at low doses.
  • Never misuse, overuse, or inject Suboxone. This can cause withdrawal symptoms, respiratory depression, or death.

Who Should Not Use Suboxone?

People with severe liver disease shouldn’t take Suboxone. It’s rare, but Suboxone could cause liver injury. While you take Suboxone, your doctor will watch for signs of liver disease with regular blood tests. If you notice these signs of liver disease, call your doctor right away:

  • Yellow skin or eyes
  • Sharp pain in your belly
  • Severe nausea or vomiting

Teens in recovery for opioid addiction may be prescribed Suboxone. There isn’t much research on the use of Suboxone in adolescents, but a few studies show that the drug is effective, well tolerated, and only causes mild side effects in teens. No teens in these studies had liver toxicity from Suboxone.

Young children are at risk for respiratory depression and death if they accidentally take Suboxone. Keep your medicine well out of the reach of children in your home.

Can You Use Suboxone if You’re Pregnant?

If you’re pregnant, think you may be pregnant, or plan to get pregnant while you’re in recovery for opioid use disorder, let your doctor know. They can talk with you about the risks of pregnancy while you take Suboxone.

If you abuse opioids while pregnant, these drugs can cause harm to your baby, like low birth weight, premature birth, or death. Treating your opioid use disorder can help you have a safer pregnancy and give birth to a healthy baby.

Suboxone’s effects on human babies are still unknown. Studies in animals show that Suboxone could cause problems with labor and delivery, as well as miscarriage, death of a premature baby, or developmental delays after a baby is born. We don’t know if these risks can happen in humans too.

It may be safer for you to take methadone or buprenorphine on its own to treat opioid use disorder while you’re pregnant.

Buprenorphine used without naloxone doesn’t appear to cause birth defects, but it’s possible that your newborn could go into opioid withdrawal. In some studies, these babies experienced severe symptoms like poor feeding, diarrhea, tremors, breathing problems, low heart rate, stiffness, or seizures.

Can You Use Suboxone While Breastfeeding?

We don’t know if Suboxone is safe to use during breastfeeding. If you use Suboxone while you nurse your baby, watch them for any extra drowsiness or breathing problems. Let your doctor know right away if you notice these signs in your new baby.

Buprenorphine does pass to your baby through breast milk. There are studies that show these babies don’t have any ill effects.

What Else Should I Know About Taking Suboxone?

Don’t take Suboxone along with alcohol, sedatives or sleep medicines, or prescription medicines that contain opioids, like some cough syrups. Don’t use illegal drugs while you take Suboxone. This can cause severe side effects.

Don’t switch from taking Suboxone to another drug that contains buprenorphine unless you talk to your doctor. They need to determine the right dose of medicine for you.

If you think you’ve taken too much Suboxone, or if you think someone has overdosed on Suboxone, call 911. You can be given an injection or nasal spray with naloxone that may save your life.

Is Suboxone Covered by Medical Insurance?

Yes, Suboxone treatment costs are covered by most insurance plans. Your individual plan will determine what form or brand of Suboxone you use, or where you can go for this treatment.

Show Sources

SOURCES:

American Addiction Centers: “Suboxone Uses, Abuse Potential, and Addiction Treatment Near Me,” “Methadone Addiction: Signs, Symptoms, & Treatment Near Me,” “Suboxone Insurance Coverage & Cost Guide (With & Without Insurance),” “Suboxone Side Effects: What Are They & Is It Worth It?”

National Alliance on Mental Illness: “Buprenorphine/Naloxone (Suboxone).”

Recovery Care: “Medication Assisted Treatment.”

Journal of Addiction Medicine: “Buprenorphine treatment for adolescents and young adults with opioid use disorders: a narrative review.”

Substance Abuse and Mental Health Services Administration: “Medication Assisted Treatment (MAT).”

Providers Clinical Support System: “Opioid Use Disorder: What Is Opioid Addiction?”

UpToDate: “Opioid withdrawal in adults: Clinical manifestations, course, assessment, and diagnosis.”

StatPearls: “Opioid Withdrawal.”

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