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Can You Take Codeine While on Suboxone?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 13, 2023 • 6 cited sources

Codeine shouldn’t generally be taken if you’re currently on a Suboxone treatment or similar medication regimen. Suboxone can impact the efficacy of the codeine. 

Suboxone is generally prescribed to help with opioid use disorder (OUD), and codeine is a potent opioid. 

To obtain proper guidance about alternative treatments for pain relief while on Suboxone, arrange an appointment with your healthcare provider. They’ll be able to assess the feasibility of different treatments while monitoring you closely for any adverse effects and providing reliable pain management strategies. 

Self-administering opioids without professional guidance can be life-threatening, particularly if you have a history of OUD. You should never use opioids like codeine without being told to do so by a doctor.

What Are the Dangers of Taking Suboxone & Codeine Together?

It is generally not recommended to take codeine while on Suboxone, as both medications are opioids and can interact with each other in potentially harmful ways. 

Taking codeine alongside Suboxone is dangerous because this heightens the likelihood of respiratory depression.[1] Respiratory depression can represent a severe health threat where one’s breathing becomes slow and shallow. This can lead to death if left untreated. 

Other side effects — like dizziness, confusion, sedation and impaired coordination — can also occur from this mixture of drugs. Since codeine is a highly addictive full agonist opioid, it has significant potential for drug misuse, which could seriously complicate OUD treatment involving Suboxone. 

Despite the potential risks, a more likely interaction is that using codeine while on Suboxone will result in the codeine being less effective than normal. The buprenorphine component of Suboxone binds to the same receptors other opioids bind to, but it binds imperfectly.[2] It has a lesser effect than full agonist opioids (including codeine) but also still blocks those receptors, meaning other opioids do not attach to them as easily. 

This property is one reason Suboxone is useful for treating OUD, as it reduces a person’s cravings for opioids and doesn’t produce effects as debilitating as the opioids people typically misuse. This significantly reduces the incentive for a person to misuse other opioids.

If you are taking Suboxone for opioid use disorder, it is important to talk to your doctor or medical professional before taking any other medications, including codeine. They can advise you on the potential risks and benefits of taking codeine and suggest alternative pain management options if needed.

Are There Specific Scenarios When You Could Take Both?

Patients are typically advised to avoid using any opioid pain relief medications like codeine, as it could complicate treatment for OUD. 

When someone decides on using Suboxone for OUD treatment, they need to know about its impact on managing chronic or acute pain. By design, the buprenorphine component of this medication binds onto opioid receptors similarly to how codeine does, but it doesn’t trigger as strong effects as codeine normally would on its own. This means that depending solely on opioids may not provide appropriate relief for certain types of pain. 

Because of this, physicians often recommend non-opioid pain medication for such patients to achieve better outcomes. 

In some cases, such as following surgery, physicians may recommend short-acting opioids to manage acute pain for those on Suboxone.[3] This process should be carefully managed for those with OUD. The goal is to effectively manage pain without compromising addiction recovery.

Alternate Options to Codeine & Other Opioids for Acute Pain

Aspirin, acetaminophen, ibuprofen, and naproxen are all commonly used pain relievers that are generally safe to take while on Suboxone. These medications work by reducing inflammation and blocking pain signals in the body. They are known as non-opioid pain medications.

The use of non-opioid medications is a less risky alternative to opioid use for people prescribed Suboxone. These replacements are commonly used for mild to moderate pain symptom management, even in patients who are not taking Suboxone.

Aspirin works by decreasing inflammation and alleviating pains swiftly. However, long-term use or overdose could raise the chances of developing severe gastric ulcers or excessive bleeding.[4] 

Ibuprofen and naproxen are both NSAIDs that can effectively alleviate pain by blocking prostaglandins. Prescribers and patients need to understand that taking these medications in high doses or over time can result in certain side effects, such as bleeding or stomach ulcers, much like with aspirin.

Similarly, acetaminophen can suppress both fever and pain. There are also long-term risks with acetaminophen use, including liver damage. Ideally, these medications are only used short-term to manage acute pain.[5]

Again, in cases of especially severe pain, opioids may sometimes be needed to provide a patient with meaningful pain relief.[6] While doctors generally try to avoid prescribing opioids to a patient on medications such as Suboxone or methadone, some types of pain require the use of opioids. 

However, prescribing opioids to a patient taking buprenorphine-based medications or methadone is rare. It should only be done with significant caution and for as short a time as possible.

Seek Medical Professionals Before Taking Codeine 

For many people living with chronic or acute pain, finding relief from their symptoms is a top priority. Doctors don’t want their patients to live with unnecessary pain. Your doctor can consider the whole picture, including your OUD, as they help you determine how best to manage your pain.

Although often prescribed by healthcare providers as an effective solution for symptom management, opioids present risks such as OUD and overdose that warrant careful consideration during use. Being on Suboxone only further complicates whether the use of such opioids might be warranted. To safely understand the potential dangers of these potent drugs, it’s necessary to have professional guidance from qualified healthcare providers who can monitor each individual’s particular situation closely.

It’s important to inform your doctor about any health conditions you have before taking opioids, as they can interact negatively with certain underlying issues such as respiratory depression, liver or kidney disease as well as mental health issues. Before prescribing opioids or adjusting your Suboxone dose, your doctor needs to be aware of your medical history and current medication routine.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Codeine. U.S. National Library of Medicine. December 2020. Accessed April 2023.
  2. Buprenorphine. Substance Abuse and Mental Health Services Administration. March 2023. Accessed April 2023.
  3. Treating Perioperative and Acute Pain in Patients on Buprenorphine: Narrative Literature Review and Practice Recommendations. Journal of General Internal Medicine December 2020. Accessed April 2023.
  4. Gastrointestinal Ulcers, Role of Aspirin, and Clinical Outcomes: Pathobiology, Diagnosis, and Treatment. Journal of Multidisciplinary Healthcare March 2014. Accessed April 2023.
  5. Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. Journal of Clinical and Translational Hepatology. June 2016. Accessed April 2023.
  6. Acute Pain Management for Patients Receiving Maintenance Methadone or Buprenorphine Therapy. Annals of Internal Medicine. January 2006. Accessed April 2023.

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