As patients begin to explore buprenorphine/naloxone (Suboxone) as an option to treat opioid use disorder, they may hear many different things from friends, family, or online. It is important to separate facts from myths about Suboxone.
We address some of the common myths or misconceptions about Suboxone and set the record straight, so you can make an informed decision about whether Suboxone is right for you.
Myth 1: Patients May Misuse Suboxone to get high
People prescribed buprenorphine as a treatment for opioid use disorder rarely misuse their prescriptions for the purpose of trying to “get high”. In 2019, one study found that three-fourths of adults using buprenorphine products for addiction treatment reported taking the medication exactly as prescribed. Most people who do misuse their prescriptions don’t do so to get high. Instead, many take higher doses to ease physical pain or because their addiction is being under-treated and they are experiencing insufficient control of their cravings. If this is the case for you, talk to your doctor about adjusting your dose.
Myth 2: You Can Easily Overdose on Suboxone
In fact, It is very difficult to overdose on Suboxone due to what is called the “ceiling effect”:
Buprenorphine/naloxone (Suboxone) is a partial agonist at opioid receptors in the body. Most opioid medications (like oxycodone, hydromorphone, heroin, and fentanyl) are full agonists. This makes its opioid effect lesser than that of full opioids.
Suboxone will bind to opioid receptors and turn them on, but not to the extent that full agonists will. This is called the ceiling effect. There is a ceiling, or limit, to the euphoric effects of Suboxone and the extent to which it can cause respiratory suppression and overdose.
While it is possible to overdose on Suboxone, it is a lot harder to do so than with other full agonist medications because of this ceiling effect. The vast majority of Suboxone related overdose deaths involved the use of multiple other substances, making it very unusual for Suboxone alone to be the cause of an overdose.
Myth 3: Suboxone Isn’t a Standalone Treatment for Opioid Use Disorder
In Medication for Addiction Treatment (MAT) programs, teams combine prescriptions and therapy to help people recover from opioid use disorder. Both parts of MAT are important, but some people don’t need formal therapy, and actually do quite well with Suboxone alone.
Therapy can help some people to do the following:
- Change thought patterns: Addressing negative thinking and recognizing that drugs don’t solve problems could lower relapse risks.
- Amend destructive patterns: Destructive relationships, poor employment opportunities, and harmful friendships could keep people using drugs. Therapy could help you spot and fix these problems.
- Recognize helpful allies: Spending time with other people who use drugs increases your relapse risks. Therapy could help you learn how to connect with others who don’t misuse drugs.
Therapy like this works, but it’s time-intensive. And some people don’t need this type of treatment. If you have adequate support systems,. medication alone may be enough for you to help you avoid opioid misuse.
In general, it’s best to use therapy in conjunction with medication. Changing your life isn’t easy, and your team could help you make meaningful adjustments.
But if you can’t get therapy, or the idea of using therapy keeps you from considering sobriety at all, Suboxone medication alone may be enough for you to maintain abstinence from opioids.
Myth 4: Long-Term Suboxone Therapy Is Harmful
Some people stay on Suboxone for months or even years. Their doses keep them from relapsing. Since a return to drug use can result in an overdose death, their Suboxone prescription may keep them alive. For some people who fear returning to opioid use, it is appropriate to offer Suboxone medication lifelong.  In fact, most doctors who prescribe Suboxone frequently support its use indefinitely in patients when they feel that is appropriate to prevent them returning to opioid use.
Medically Reviewed By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
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