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Can Suboxone Cause Psychosis?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Feb 24, 2024 • 5 cited sources

The U.S. Food and Drug Administration (FDA) doesn’t include psychosis on its list of known Suboxone side effects.[1] But case reports suggest some people get it while taking the drug, and others while they withdraw from it.

Psychosis refers to a mental state where there is a loss of contact with reality. Symptoms can include delusions (false beliefs) and hallucinations (seeing, hearing, or feeling things others do not).

Here’s what you need to know about psychosis as it relates to Suboxone

Can Suboxone Cause Psychosis?

Researchers say that some people using buprenorphine medications (like Suboxone) can experience psychosis, but it’s rare. In fact, in a case study published in 2022, researchers could identify only three other cases of psychosis when people abruptly discontinued Suboxone.[6]

Some patients experience a sudden onset of psychosis when they stop taking Suboxone. Typically, the problem appears when people stop taking their doses abruptly. Returning to their medications makes the issue disappear.[3]

What Else Causes Psychosis?

Many other things can trigger psychosis. If you develop the problem while using Suboxone, one of the following two issues could be the cause.

Underlying Mental Illness

Some case studies describe Suboxone withdrawal psychosis in people with underlying mental health issues, like bipolar disorder.

In one such case study, a woman’s poor mental health contributed to her inability to stick to regular medication routines. When she quit Suboxone abruptly, psychosis appeared. When she restarted her medication, the symptoms stopped.[8]

Researchers theorize that buprenorphine causes glutamate release in the brain, and it works as a kappa-opioid receptor antagonist. These two factors could help the drug to mask psychosis. When it’s removed, those symptoms can appear.[8]

Case studies like this demonstrate the importance of sticking with your medications, especially if you have an underlying health condition that can cause psychosis.

Other Drugs & Medications

Other substances are closely associated with psychosis, including the following:[7]

  • Cannabinoids
  • Stimulants
  • Hallucinogens
  • Alcohol

People who combine substances can also experience psychosis.

Never take a street drug or prescription medication with Suboxone without checking with your doctor first.

Can Buprenorphine Reduce Psychotic Symptoms?

In a 2014 study, researchers said opioids like buprenorphine can sometimes work like antipsychotics, stopping episodes before they start.[7] However, this study is small, and doctors might need to do more work to replicate the results.

In a summary of published case reports of psychosis during Suboxone withdrawal, restarting the medication typically made the symptoms disappear. No published case studies discussed persistent psychosis.[9]

Should You Change Your Approach?

Don’t let fear keep you from getting the addiction help you need. Buprenorphine-containing medications like Suboxone are effective and well-studied remedies for opioid use disorder (OUD). This could be just what you need to get your life back on track.

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. Prescribing Information: Suboxone. U.S. Food and Drug Administration. February 2018. Accessed July 2022. 
  2. Buprenorphine-Induced Psychotic Symptoms: A Case Report. The Primary Care Companion for CNS Disorders. August 2018. Accessed July 2022.
  3. Possible Psychosis Associated with Buprenorphine Withdrawal. Journal of Clinical Psychopharmacology. December 2017. Accessed July 2022. 
  4. Acute Psychosis and Buprenorphine Withdrawal: Abrupt vs. Progressive Could Make a Difference. European Psychiatry. July 2013. Accessed July 2022. 
  5. A Double-Blind Randomized Clinical Trial of Buprenorphine Augmentation for Treatment of Psychotic Symptoms in Opioid-Addicted Bipolar Patients. Journal of Opioid Management. 2019. Accessed July 2022.

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