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Can Suboxone cause psychosis?

Psychosis is not listed as a common side effect of Suboxone (buprenorphine/naloxone), and it is unlikely to cause psychosis. 

Buprenorphine-containing medications like Suboxone are effective and well-studied remedies for opioid use disorder (OUD). 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 that others do not). 

Some case reports have found a link between buprenorphine use and psychosis. In one case example, psychotic symptoms increased when taking buprenorphine, and ceased when the medication was stopped. 

In others, the psychotic experiences were greater during periods of buprenorphine withdrawal. In other words, the symptoms arose when buprenorphine was leaving the body – in most cases, days after the last buprenorphine use. In fact, withdrawal from other opioids, like heroin, can also precipitate psychosis.

What else causes psychosis?

Psychosis can be caused by many things. It is a common symptom of some mental illnesses, like bipolar disorder and schizophrenia.

It can also be triggered by the use of some drugs or medications, like stimulants and marijuana, or during withdrawal from alcohol.

Can buprenorphine reduce psychotic symptoms?

It’s possible for buprenorphine to reduce psychotic symptoms. Recall that psychotic symptoms have been rarely reported to occur during withdrawal from buprenorphine. 

In many of these cases, restarting buprenorphine or other opioid resolved the hallucinations or delusions and alleviated psychosis. These cases have led researchers to investigate whether buprenorphine might be used as a therapeutic for people with psychosis. 

However, a randomized controlled trial of buprenorphine for patients with bipolar disorder and OUD found that it had neither positive nor negative effects on psychotic symptoms compared to placebo.

Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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