Quick Answer
Suboxone (buprenorphine/naloxone) has a low misuse potential. This is because the naloxone component is a misuse deterrent, causing precipitated withdrawal if someone injects or snorts Suboxone.
Suboxone contains two ingredients: buprenorphine and naloxone. Some people try to misuse Suboxone to get high, but it’s not easy.
Buprenorphine has a ceiling effect, meaning that after a certain point, taking more won’t have a larger impact. The naloxone inside each dose provides further protection, as it blocks large amounts of opioids like buprenorphine from working.
Suboxone in Opioid Use Disorder Treatment
Suboxone is a prescription medication for treating opioid use disorder (OUD). When used properly, the medication can ease withdrawal symptoms and reduce drug cravings, allowing you to focus on rebuilding your life.
Suboxone contains the following two ingredients:
- Buprenorphine: This medication is a partial opioid agonist, reducing cravings and withdrawal symptoms.
- Naloxone: This medication is inactive unless people inject the drug. Then, it blocks buprenorphine’s action, prevents a high and causes precipitated withdrawal symptoms
How Suboxone Works to Deter Misuse
Because buprenorphine is an opioid, buprenorphine-only medications have a potential for misuse. People may use it to feel relaxed or get high.
Adding naloxone to buprenorphine to create Suboxone dramatically reduces the abuse potential. This is because naloxone is an opioid antagonist that blocks opioids at the receptor site. It is inactive if you take your Suboxone pill or strip as prescribed (sublingually). However, if you misuse Suboxone by injecting it or snorting it, the naloxone becomes active and it kicks the buprenorphine off the opioid receptor, leading to precipitated withdrawal.
Precipitated withdrawal is characterized by the immediate development of opioid withdrawal symptoms, such as: [1]
- Nausea and vomiting
- Diarrhea
- Stomach cramps
- Anxiety
- Muscle aches and joint pain
- Sweating
- Runny nose and tearing eyes
- Yawning
- Goosebumps
Knowing that misusing Suboxone will cause uncomfortable withdrawal symptoms can deter misuse of this medication.
Suboxone Uses
Suboxone is a critical part of Medication for Addiction Treatment (MAT) programs. The U.S. Food and Drug Administration (FDA) has only approved Suboxone for opioid addiction treatment.[3] It has no other approved purpose.
Suboxone comes in strips and tablets. Both dissolve within the mouth, as active ingredients don’t become absorbed by the body easily via the digestive tract. Most people take doses just once per day, but some people need their medications two or three times daily.
About 75% of people using buprenorphine products like Suboxone do not misuse them.[2, 7] They take the medication as directed by their doctors.
Is Suboxone Safe?
All drugs have side effects. While Suboxone causes some health effects, it is generally safe if prescribed.
Some common side effects associated with Suboxone include the following:[4]
- Headaches
- Back pain
- Stomach pain
- Constipation
- Trouble sleeping
- Mouth numbness
- Blurred vision
When considering if a drug is “safe,” the real question is, “safe compared to what?” Suboxone is safer than taking full opioids, such as prescription painkillers or other illicit opioids like heroin or fentanyl. If you have any concerns about the health effects or safety of Suboxone, talk openly with your doctor about your concerns and ensure your questions are answered.
Know that research suggests Suboxone is safe. The FDA administered studies including thousands of people and determined that the medication is both effective and safe.[3] Long-term Suboxone use is also considered safe.
What Constitutes Suboxone Misuse?
Suboxone misuse involves using this medication in any other way than prescribed by a doctor. Misuse may include:
- Using Suboxone without a prescription
- Using higher or more frequent doses than directed
- Using Suboxone to try and get high or experience euphoria
- Mixing Suboxone with alcohol or other drugs
- Using Suboxone in a way other than directed (e.g. snorting or injecting)
To prevent Suboxone misuse, make sure you follow your doctor’s instructions very carefully and reach out to them if you have any questions.
Suboxone Misuse Potential
While rare, buprenorphine and buprenorphine/naloxone misuse does occur.[5] Some patients, particularly those who are opioid naïve and not used to taking opioids, may get a mild euphoria or high after taking the medication.
Suboxone’s formulation is hard to misuse. Some people resort to snorting Suboxone or shooting Suboxone to ensure it delivers the response they want. This is rare.
Who Might Misuse Suboxone?
Studies show that the majority of patients misusing the drug are not taking Suboxone for euphoria.[6, 7] Instead, they are trying to prevent the crippling withdrawal symptoms and cravings that create a cycle of returning to opioid use.
A small subset of people might misuse Suboxone because they’ve never taken an opioid before. They find it in a medicine cabinet or a loved one’s purse, and they use the drug to get high. Again, this is rare.
Risk Factors for Suboxone Misuse
Many different risk factors can increase the likelihood of someone misusing Suboxone. Several of these factors are related to barriers to quality care while others are influenced by withdrawal symptoms or a desire to get high. Here are some risk factors for Suboxone misuse: [9]
- Unable to access timely OUD treatment
- Lack of health insurance
- Unable to afford Suboxone
- Self-medicate withdrawal symptoms
- Easy access because friends have a prescription
- To experience euphoria or relaxation
One study found that over 63% of people who misused Suboxone or buprenorphine reported receiving it from friends. [9]
Patient Reasons for Diversion and Misuse
Research indicates that there are several reasons patients in OUD treatment may divert or misuse their Suboxone, including: [9]
| Reasons for diverting Suboxone | Reasons for misusing Suboxone |
| Make money to pay off debt, buy preferred opioid for misuse or pay for medical fees or living expenses | Self-medicate negative states, like depression, anxiety or pain |
| Assist friend or family member with OUD | Experience positive effects, like euphoria |
| Pressure from friends to share Suboxone | Alleviate opioid withdrawal or cravings |
| Perceived under-dosing | |
| History of intranasal or intravenous drug use |
Suboxone Misuse Statistics
Digging into Suboxone misuse statistics can help you understand how few people misuse this drug.
In 2019, an estimated 2.4 million adults used buprenorphine in the US. In this period, 0.7 million misused the drug.[7] When asked, people said they misused the drug because they were hooked on opioids or experiencing physical pain. Note that a desire to experience euphoria doesn’t appear here.
Suboxone misuse includes using the drug without a prescription. Anyone self-medicating with the drug is technically misusing it. But they’re not trying to get high. They are just trying to not feel sick.
The Suboxone Ceiling Effects
One of the features of Suboxone that makes it less dangerous than full opioids is its ceiling effect.
The buprenorphine component of Suboxone is a partial opioid agonist. While it activates the opioid receptors in the brain, it does not do so fully, as full opioid agonists do.
The analgesic, euphoric, and respiratory depression effects plateau at high doses. This is what is called the buprenorphine ceiling effect.[8]
The ceiling effect means that Suboxone will produce effects such as mild euphoria and pain relief but they will be maximized at a moderate dose. Euphoria will not intensify at higher doses. Taking more and more of the medication doesn’t work.
Signs of Suboxone Misuse & Withdrawal
Like all medications in the opioid class, Suboxone can cause physical and psychological signs when misused. And if you quit taking the drug abruptly, you may experience opioid withdrawal symptoms.
Common signs of Suboxone misuse include the following:[10]
- Unexplained sedation
- Mood changes
- Impaired cognition and memory
- Increased need for privacy
- Needle marks on the arms and legs (if the drug was injected)
- Money difficulties
- Job loss
- Relationship problems
- Doctor shopping, or receiving several Suboxone prescriptions
- Paraphernalia
- Disinterest in hobbies and previously enjoyed activities
If someone is misusing Suboxone and then suddenly stops due to lack of access, they’ll exhibit withdrawal symptoms, which include flu-like symptoms like:[3]
- Goosebumps
- Nausea and vomiting
- Diarrhea
- Aching muscles and bone pain
- Fever
- Sweating
If someone is using their Suboxone appropriately, they may notice some side effects but for the most part, they will appear clear-headed, free of withdrawal symptoms and cravings, and will be able to function well.
Getting Help for Suboxone Misuse
Misusing or misusing Suboxone isn’t safe. But you can get help. Doctors are adept at treating people who misuse drugs within the opioid class.
Your Suboxone misuse treatment options include tapering your dose slowly to help you stop misusing without experiencing withdrawal symptoms. Or your doctor could use another medication (like methadone) to help manage cravings and withdrawal.
However, if you were misusing Suboxone to self-medicate OUD due to lack of treatment access, Bicycle Health can help close that treatment gap. We offer timely, evidence-based OUD treatment, including same-day Suboxone prescriptions. And if cost is a concern, there are a few ways to get low-cost or free Suboxone.
With more involvement from treatment professionals, including behavioral counseling and therapy, you can stop misusing a medication that is designed to help you get better.
Frequently Asked Questions
We’ve compiled some of the most frequently asked questions about Suboxone’s misuse potential.
Yes. It’s rare for people to misuse the drug to get high. But some people take it without a doctor’s permission as a form of self-medication for opioid misuse.
Suboxone is FDA approved as an opioid use disorder treatment.
Suboxone’s ceiling effect means moderate doses are effective, but the drug stops working at high doses. Taking more doesn’t increase euphoric feelings. This helps to prevent misuse of the medication.
Signs of Suboxone misuse can be physical (such as unexplained sedation) or behavioral (such as an increased need for secrecy or job loss). Other signs include financial problems, relationship issues and missing work or school.
Research suggests that most people who misuse Suboxone are attempting to self-medicate an untreated addiction issue. They aren’t taking the drug in an effort to get high. They are simply trying to escape the discomfort of withdrawal.
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
- Opiate and Opioid Withdrawal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000949.htm. May 2020. Accessed September 2022.
- Buprenorphine Misuse Decreased Among U.S. Adults with Opioid Use Disorder from 2015 to 2019. National Institute on Drug Abuse. https://nida.nih.gov/news-events/news-releases/2021/10/buprenorphine-misuse-decreased-among-us-adults-with-opioid-use-disorder-from-2015-2019. October 2021. Accessed June 2023.
- Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed June 2023.
- Buprenorphine Sublingual and Buccal (Opioid Dependence). National Library of Medicine. https://medlineplus.gov/druginfo/meds/a605002.html. January 2022. Accessed June 2023.
- Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review. Current Drug Abuse Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/. March 2011. Accessed June 2023.
- Buprenorphine in the United States: Motives for Abuse, Misuse, and Diversion. Journal of Substance Abuse Treatment. https://www.sciencedirect.com/science/article/pii/S0740547218304720. September 2019. Accessed June 2023.
- Trends In and Characteristics of Buprenorphine Misuse Among Adults in the U.S. JAMA. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785011. October 2021. Accessed June 2023.
- Clinical Pharmacology of Buprenorphine: Ceiling Effects at High Doses. Clinical Pharmacology and Therapeutics. https://pubmed.ncbi.nlm.nih.gov/8181201/. May 1994. Accessed May 2023.
- Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315-326. doi:10.1097/ADM.0000000000000045
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
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