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Suboxone Side Effects and Withdrawal: Trading One Problem For Another?

July 3, 2022

Table of Contents

Suboxone is an FDA-approved medication used to treat opioid use disorder that contains buprenorphine and naloxone. The drug is most effective when combined with Medication for Addiction Treatment.[1]

Buprenorphine is a long-acting partial opioid agonist that attaches to the opioid receptors in your body and stays there for a long time.[2,3] 

Since buprenorphine produces a smaller opioid effect than full agonists like fentanyl or heroin, the result is a reduction in cravings, withdrawal symptoms, and the potential for drug abuse. 

Naloxone is an opioid antagonist that binds to opioid receptors and blocks other opioids if they were to be injected or inhaled.[1] Since Suboxone is dissolved under the tongue, naloxone will not block buprenorphine from having its effect.

Suboxone Side Effects

Suboxone Side Effects

Even though Suboxone is a safe and effective treatment for opioid use disorder (OUD), it is still possible to experience side effects. 

Multiple factors determine what side effects and their severity may be experienced by individuals taking Suboxone, such as:[5]

  • Age
  • Drug dose
  • Drug frequency
  • Organ health
  • Gender
  • Race
  • Other medications taken simultaneously 

Different people may develop different reactions to Suboxone. Here’s a list of common and serious side effects.[1]

Common Side Effects

  • Headache
  • Nausea
  • Vomiting
  • Drowsiness
  • Sweating
  • Sexual side effects
  • Urinary retention 
  • Dizziness
  • Irregular heartbeat 
  • Constipation 
  • Problems with concentration

Serious Side Effects

  • Respiratory depression
  • Difficulty breathing 
  • Liver damage 
  • Low blood pressure 
  • Allergic reactions
  • Difficulty driving or operating heavy machinery 

Contact your healthcare provider immediately if you experience any severe side effects of Suboxone or if any of the common side effects become severe and interfere with your daily life.

Does Suboxone Cause Mental Health Side Effects?

Side Effects of Suboxone Withdrawal

Some clinical trials suggest that Suboxone therapy can cause anxiety, depression, and nervousness. However, the frequency is not well defined.[1] 

If Suboxone treatment is stopped “cold turkey” or is not taken as prescribed, it can lead to withdrawal symptoms. Remember, the buprenorphine component is still an opioid and, as such, can cause withdrawal.[4] 

Symptoms of withdrawal include:

  • Pain
  • Cramps
  • Anxiety
  • Changes in mood
  • Sleep problems
  • Cravings 

The mental health side effects of withdrawal can be misinterpreted and lead people to think it was Suboxone that caused the side effects.[9] 

It is vital to take Suboxone precisely as prescribed and not stop without consulting your MAT healthcare provider first.

However, if you desire to wean off Suboxone, consult with your medical provider in order to slowly taper your dose, as this will help prevent Suboxone withdrawal symptoms.

From experience, patients who have been on Suboxone effectively in the past with no intolerance will almost always continue to tolerate the medication well when there's a need to resume it.

Brian Clear, MD, FASAM, Medical Director at Bicycle Health

Can You Overdose on Suboxone?

You can overdose on Suboxone since it still has some activity on the opioid receptors in the body. 

Respiratory depression is likely the most severe side effect of Suboxone and a major warning sign that a possible overdose is occurring. Respiratory depression is when the lungs can no longer exchange oxygen and carbon dioxide efficiently, leading to a buildup of toxins in the body. 

The most well-known symptom of respiratory depression is slower and shallower breathing than normal.[6]

Situations where someone may overdose on Suboxone include:

  • Older age.
  • Opioid naïve patients whose body has not been exposed to any opioids in the past 30 days.
  • Patients who are taking other substances at the same time that also cause respiratory depression, such as alcohol, other opioids, and benzodiazepines.

Steps for Preventing a Suboxone Overdose

If someone has overdosed on Suboxone, knowing the right steps to take can help save their life. 

  • Call 911. 
  • Administer naloxone (Narcan) within 2-3 minutes, if available. Remember, naloxone can bind to the opioid receptors and kick off the buprenorphine, which will block the effects of opioids in the brain. 
  • Keep the person awake and breathing. 
  • Lay the person on their side to prevent choking. 
  • Stay at the scene until emergency help arrives.[8]

Suboxone Overdose Symptoms 

Overdose symptoms include confusion, dizziness, hallucinations, low blood pressure, difficulty breathing, and seizures. 

The scientific literature shows that Suboxone has a lower risk of causing respiratory depression than other opioids. Taking it exactly as prescribed further reduces the likelihood that respiratory depression and overdose will occur.

Suboxone Withdrawal Timeline and Symptoms

Suboxone can cause physical dependence when used for long periods. 

Once it is stopped, whether due to completion of treatment or abrupt discontinuation, withdrawal symptoms can occur. 

Withdrawal symptoms include stomach cramps, anxiety, headache, depression, restlessness, nausea, sweating, tremors, diarrhea, and muscle aches. 

The symptoms will be dependent on how long the person was on Suboxone and the dose they were taking.[9]

The timeline for experiencing withdrawal symptoms is as follows:

  • The first 72 hours: physical symptoms, like vomiting, nausea, and diarrhea, are at their worst
  • After 1 week: body aches and pains, difficulty sleeping, and mood swings start to appear
  • After 2 weeks: people may start to experience depression (timeframe with the greatest potential for relapse)
  • After 1 month: cravings and depression may continue to persist

Suboxone withdrawal can last for several months, but most physical symptoms will end after the first month.

Is Suboxone Trading One Problem for Another?

Suboxone treatment is not trading one problem for another. 

While Suboxone still has an opioid component, it works differently than other opioids in the sense that it does not activate the opioid receptor as strongly. 

As a result, you will be able to satisfy cravings and reduce withdrawal symptoms while having a reduced chance of overdosing. 

The FDA approval process included studies that showed sufficient evidence that OUDs can be adequately treated with Suboxone. 

The buprenorphine part of Suboxone also has something called a “ceiling effect” for respiratory depression. The ceiling effect is where buprenorphine loses its ability to cause respiratory depression after reaching a certain max dose. 

If someone has not overdosed on buprenorphine once they reach their max dose, they are extremely unlikely to overdose even if they try to take more Suboxone. This ultimately reduces the risk of overdose even more.[7] 

Further, when taking Suboxone, healthcare professionals will be helping you on your journey and can provide both medical and emotional support to conquer OUDs.

Typically, this assistance is provided via a Medication for Addiction Treatment (MAT) program, where counseling and behavioral strategies are combined with Suboxone to help improve the success of treatment. 

Research shows that including MAT programs helps treat and maintain recovery in people with OUDs.[10]

Is Suboxone Right for You?

Bicycle Health uses Suboxone as a primary medication for dealing with opioid dependence. To learn more about the benefits and the effects of Suboxone, schedule a time to speak with one of our MAT professionals, or call us today at (844) 943-2514.

Dylan Kakos, PharmD

Dylan Kakos, PharmD, received his Doctor of Pharmacy from the University of Michigan and is a Medical Writer for Banner Medical, LLC.

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Citations

1. U.S. Food and Drug Administration. Drugs@FDA: FDA-Approved Drugs. Revised August 2010. Accessed 29 November 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf

2. Substance Abuse and Mental Health Services Administration. Buprenorphine. Updated May 2021. Accessed 29 November 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine

3. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.

4. Rosoff DB, Smith GD, Lohoff FW. Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders: A Multivariable Mendelian Randomization Analysis. JAMA Psychiatry. 2021;78(2):151–160. doi:10.1001/jamapsychiatry.2020.3554

5. Alomar MJ. Factors affecting the development of adverse drug reactions (Review article). Saudi Pharm J. 2014;22(2):83-94. doi:10.1016/j.jsps.2013.02.003

6. Bateman JT, Saunders SE, Levitt ES. Understanding and countering opioid-induced respiratory depression [published online ahead of print, 2021 Jun 5]. Br J Pharmacol. 2021;10.1111/bph.15580. doi:10.1111/bph.15580

7. Pergolizzi J, Aloisi AM, Dahan A, et al. Current knowledge of buprenorphine and its unique pharmacological profile. Pain Pract. 2010;10(5):428-450. doi:10.1111/j.1533-2500.2010.00378.x

8. Centers for Disease Control and Prevention. Know the Signs. Save a Life. Accessed 29 November 2021. https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-Opioid-Overdose-Tip-Card-a.pdf.  

9. Thomas S. Suboxone Withdrawal: Symptoms, Timeline & Detox Treatment. American Addiction Centers. Updated November 2021. Accessed 29 November 2021.  https://americanaddictioncenters.org/suboxone/withdrawal

10. Substance Abuse and Mental Health Services Administration. Medication-Assisted Treatment (MAT). Updated November 2021. Accessed 1 December 2021. https://www.samhsa.gov/medication-assisted-treatment.

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