What Are the Dangers of Mixing Suboxone & Cocaine?

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The biggest danger of mixing Suboxone and cocaine is the return to substance use.

Polysubstance use is defined as combining use of multiple illicit drugs at the same time, such as cocaine and opioids like heroin. When an individual is using multiple substances that have different effects in the body, it can complicate the treatment for addiction. It is important for medical providers to diagnose and treat all substance abuse behaviors, because the approach to various substance use treatments is different.

Suboxone is a medication that helps people specifically overcome opioid abuse. Unfortunately, there is not currently a similar medication treatment for cocaine use disorder. Instead, treatments for cocaine addiction focus on behavioral therapy. However, helping people abstain from one substance may also help them abstain from another. Suboxone can benefit people with polysubstance use, including opioids and cocaine.

Suboxone & Addiction Treatment

Suboxone is the brand name combination of buprenorphine-naloxone, and is a first line treatment for opioid use disorder (OUD).[1]

Buprenorphine is a partial opioid agonist which binds with the opioid receptors in the brain but does not cause intoxication. Instead, it alleviates withdrawal symptoms and cravings, helps maintain physical and emotional stability, and allow people to focus on their recovery.

Suboxone is taken once per day, usually as a sublingual dissolving film, but sometimes as a tablet. When taken as directed, buprenorphine reduces cravings for opioids like heroin, and it can block the euphoric effects of these drugs in the event of a relapse.

Suboxone is not indicated as treatment for other substance use disorders, like cocaine. However, taking Suboxone can benefit people who struggle with abusing multiple drugs, including opioids and cocaine, as long as the primary substance of abuse is an opioid drug.

The combination of heroin and cocaine abuse is relatively common, but it is very important for rehabilitation programs and doctors to recognize the use of multiple substances in order to appropriately treat the individual.

Abusing Cocaine & Opioids

While opioids like heroin are central nervous system depressants, cocaine is a stimulant drug.[2] Like many opioids, cocaine is a Schedule II medication in the United States, with very limited application as a local anesthetic for some eye, ear, nose, and throat surgeries. However, it is much more often a drug of abuse, leading to intense euphoric highs with effects like increased physical and mental energy, paranoia, anxiety, and insomnia.

The combination of heroin and cocaine abuse is common in the US. The practice of using both drugs together is sometimes called speedballing.[3] A speedball is typically injected, but it may also be snorted. It is extremely dangerous and can quickly cause an overdose.

For people struggling with polysubstance use, treatment requires a focus on safely withdrawing from both substances.[4] This may involve prescribing buprenorphine medications like Suboxone to manage opioid withdrawal, but cocaine withdrawal has no similar Medication for Addiction Treatment (MAT).

Unfortunately, this means some people may continue to use cocaine during their opioid treatment. One study reported that more than 50 percent of patients receiving Suboxone treatment continued to use cocaine.[5]

The Risks of Combining Cocaine & Suboxone

Using cocaine can make Suboxone less effective. The naloxone present in Suboxone will not block the euphoric effects of cocaine as it does for opioids. However, the real harm of using cocaine while taking Suboxone is the ongoing, unaddressed substance use. People who struggle with polysubstance use need all their substance use behaviors treated at the same time.

A small-scale study examined combining buprenorphine and naltrexone in treating cocaine dependence in people overcoming heroin addiction.[6] Research found that the combination did help some of the study’s participants, although naltrexone theoretically blocks the effects of buprenorphine. However, results were not conclusive enough to use this approach to treatment, so the primary approach to cocaine addiction remains behavioral therapy.

Can You Overdose in Treatment?

When you take Suboxone as directed, even if you use other drugs like cocaine, it is extremely difficult to overdose. However, the use of additional substances always increases the risks of a fatal overdose. If you are using other illicit substances while also undergoing suboxone therapy, please discuss the other substances you are using with your suboxone provider so they can best keep you safe while on Suboxone therapy.

SOURCES

  1. Buprenorphine/Naloxone (Suboxone). National Institute on Mental Illness (NAMI). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed January 2022.
  2. What Is Cocaine? National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/research-reports/cocaine/what-cocaine. May 2016. Accessed January 2022.
  3. “Speedballing”: Mixing Stimulants and Opioids, Micromodule. Florida Alcohol & Drug Abuse Association (FADAA). https://www.training.fadaa.org/Speedballing/Speedballing_PPT.pdf. Accessed January 2022.
  4. What Is Polydrug Use? Alcohol and Drug Foundation (ADF). https://adf.org.au/reducing-risk/polydrug-use/. November 2021. Accessed January 2022.
  5. Behavioral Counseling Content for Optimizing the Use of Buprenorphine for Treatment of Opioid Dependence in Community-BasedSettings: A Review of the Empirical Evidence. American Journal of Alcohol and Drug Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2274830/. March 2008. Accessed January 2022.
  6.  Combination of Buprenorphine and Naltrexone in the Treatment of Cocaine Dependence. National Institute on Drug Abuse (NIDA). https://nida.nih.gov/international/abstracts/combination-buprenorphine-naltrexone-in-treatment-cocaine-dependence.2013. Accessed January 2022.

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 she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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