While Suboxone is safe when taken correctly, the medication can cause respiratory depression if taken at very high doses or if taken in conjunction with other medications that also cause respiratory depression.
What Is Respiratory Depression?
Our brain has a natural drive to keep us breathing. Respiratory depression, also called hypoventilation, occurs when a person’s brain is not sending a signal to breath. This causes breathing to become slower and less efficient, reducing how effectively their body can cycle oxygen in and carbon dioxide out. Too much respiratory depression can lead to death.
Suboxone is an opioid medication, albeit a “partial opioid”. All opioids can cause respiratory depression. Suboxone tends to cause much less respiratory suppression than “full opioids” like oxycodone, morphine, heroin or fentanyl. Compared to other opioids, Suboxone causes much less respiratory depression.  The few cases of respiratory depression associated with Suboxone use have usually occurred when Suboxone is used in conjunction with other medications that also cause respiratory suppression, such as benzodiazepines or alcohol.
Impacts of Respiratory Depression When Mixing Substances
The real danger regarding buprenorphine/naloxone (Suboxone) and respiratory depression is when a person takes Suboxone in combination with other drugs.
When taking any medication that can cause respiratory depression, including Suboxone, it is critical that you monitor how your medication may interact with other drugs, both recreational and medicinal. It’s also important to watch out for signs of serious respiratory depression.
Mixing Benzodiazepines & Suboxone
Benzodiazepines are a significant contributor to the overdose death toll in the United States, with over 12,000 deaths in 2020 connected to benzodiazepine use. These overdoses are more common when mixing benzodiazepines with other sedating medications such as opioids. 
Mixing Alcohol & Suboxone
Alcohol is also a respiratory depressant that can potentially interact with Suboxone.  Because alcohol is legal, we may not consider it as dangerous. However it certainly can be sedating, particularly when mixed with Suboxone. This is not to say that individuals on Suboxone can’t also drink alcohol occasionally in moderation. However, doing so should be done with caution, and ideally with the advice of a doctor.
Consult a Doctor Before Mixing Drugs
Whether you use drugs recreationally or as prescribed, it’s important to talk to a doctor about what is and isn’t safe to mix with Suboxone. Your doctor can advise you about any medications you are prescribed and whether or not they pose increased risk for patients on Suboxone.
- Opioid-Induced Respiratory Effects: New Data on Buprenorphine. Palliative Medicine. https://pubmed.ncbi.nlm.nih.gov/16764215/. 2006. Accessed November 2022.
- Overdose Death Rates. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. January 2022. Accessed November 2022.
- Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed November 2022.
Medically Reviewed By: Elena Hill, MD, MPH
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