Most people with a Suboxone prescription don’t misuse their medication. Researchers say three-quarters of adults with prescriptions for drugs like Suboxone take them as directed.  That being said, some people who are prescribed suboxone, or those who obtain it illicit – may try to misuse it.
In order to prevent misuse, Suboxone contains both the active ingredient Buprenorphine and an anti-misuse ingredient – Naloxone.
Suboxone’s Ceiling Effect Explained
The term ceiling effect applies to drugs like buprenorphine that don’t intoxicate people even when taken in large doses.
The ceiling effect means that Suboxone will produce a certain degree of euphoria and pain relief when used in moderation. Taking more won’t deliver a larger change.
People are less likely to take more and more of the medication as they can’t get more intoxicated with each dose. They’re less likely to overdose as a result.
However, using other opioids or sedating medications combined with Suboxone can still put you at risk for intoxication and even overdose. At very high doses of Suboxone, or particularly in combination with other sedating medications, the ceiling effect of Suboxone can be overcome, which puts the individual at high risk of respiratory suppression, and overdose.
Dangers of Mixing Suboxone With Other Drugs
Suboxone is a powerful medication, meant to be used carefully and under the supervision of a doctor. Before you take anything else with your Suboxone, you should discuss your plans with your doctor first.
Suboxone is a sedative/respiratory suppressant. Combining it with other sedating drugs can lead to severe problems. Most overdose deaths associated with buprenorphine occurred only when Suboxone was mixed with other sedating drugs, including: 
Central nervous system depressants slow down brain activity, relax muscles, and allow for deeper sleep. Medications in this class include sedatives, barbiturates, and sleep aids. Alcohol is another form of CNS depressant. Mixing two or more depressant drugs can lead to life-threatening respiratory depression.
Combining opioids with Suboxone also increases risk of overdosing. Conversely, taking Suboxone shortly after taking an opioid can accidentally precipitate withdrawal.
- Overdose: If you take Suboxone and then take an opioid, the Suboxone blocks the other drug from latching, preventing you from becoming too high or overdosing. However, overdose is still possible on very high doses of opioids.
- Precipitated withdrawal: If you take an opioid and then Suboxone, the Suboxone will remove opioids from receptors and cause immediate withdrawal. You’ll feel sick, and you might be tempted to use more opioids to relieve the symptoms, which can cause relapse and the risk of overdose once again.
If you need to take an opioid with Suboxone (for a surgery or procedure that requires opioids for pain control, for example), talk with your doctor beforehand. Together, you can come up with a plan to make sure you do not accidentally precipitate withdrawal.
Like other CNS depressants, benzodiazepines slow down breathing and heart rates. Benzodiazepines deserve their own mention, as they’re commonly misused along with drugs like Suboxone. In 2020, 16% of overdose deaths involving opioids also involved benzodiazepines. Commonly used benzodiazepines include the following:
Don’t mix these medications. If you’re tempted to misuse benzos with your Suboxone, talk with your doctor first.
How to Use Suboxone Safely
The bottom line is that Suboxone, if used properly and without other substances, is a very safe and potentially life-saving medication. If you have an OUD and are interested in using Suboxone to get well, talk with your doctor.
What does Suboxone do?
Suboxone is a prescription medication used to decrease opioid withdrawal symptoms and ease cravings. When used as directed by a doctor, this medication can help people to overcome long-lasting OUDs.
Is Suboxone a controlled narcotic?
Buprenorphine inside Suboxone is a Schedule III narcotic. It’s legal to use with a prescription from a doctor, but it’s not legal to use without a prescription.
Is Suboxone the same as methadone?
No. Both Suboxone and methadone are used to address opioid use disorders. But they are different medications with different active ingredients.
What does Suboxone do to you mentally?
People in recovery from opioid use disorder often feel more in control while on Suboxone. Their cravings and withdrawal symptoms fade, so they can focus on recovery. At very high doses, Suboxone can cause sedation. However, at the right dose, the patient should not notice it at all. They should simply feel “normal” on a daily basis.
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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