Does Suboxone Cause Constipation?

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Buprenorphine is the primary component in  Suboxone that renders it effective for the treatment of opioid use disorder, reducing withdrawal symptoms, craving and the risk of relapse. Although it binds to and activates the opioid receptor in the brain, it does not cause intoxication in the same way that full opioid agonists do, including heroin or fentanyl. However, it does sometimes cause constipation like other opioids do. This is because opioids, including partial opioid agonists like buprenorphine, change the speed of your digestive system, increase fluid absorption, and even delay the release of hormones that begin digestion. 

If you develop constipation while taking Suboxone to overcome opioid use disorder, your doctor can help by prescribing some laxatives, although long-term use of these is not often recommended. You can also make dietary and lifestyle changes to improve your gut health. 

Does Suboxone Cause Constipation?

Suboxone is a lifesaving medication that is one among several Medication for Addiction Treatment (MAT) options. One of the active ingredients, buprenorphine, can potentially cause some side effects while you take it. 

Buprenorphine is a long-acting partial opioid agonist, whereas heroin and fentanyl and other opioids are full agonists. This means that buprenorphine activates the opioid receptors in the brain less robustly reducing the risk of it causing intoxication and overdose compared to other opioids. However, it does have some effects that can be seen with other opioids, including constipation.

Suboxone is a safe medication and many people take it for months or years, when prescribed for maintenance treatment. During this time, you may need to ask your doctor for help managing opioid-induced constipation (OIC). Some over-the-counter remedies, used as needed, are very helpful. You might also benefit from a short-term prescription laxative. 

lifestyle changes to reduce constipation from suboxone

How Buprenorphine in Suboxone Affects the GI Tract

Buprenorphine is not as strong as opioids, but it is in the opioid family, so it can cause constipation as a side effect. Opioids are known to hinder gastric emptying and peristalsis, or the wave-like motions that move food through the gastrointestinal tract.[1] Changes to this process can change how medications are prescribed, which means that Suboxone can interfere with the absorption of some orally taken medicines. 

Slowing in the GI tract also means that more fluid is absorbed during the digestive process. This creates harder stool, which can lead to constipation. 

Opioids increase anal sphincter tone, which means the reflex to defecate is impaired, and this can lead to blockage due to incomplete bowel movements. Finally, opioid medications can reduce emptying of pancreatic juice and bile, so the whole digestive process can be delayed. 

A study surveying patients with cancer who received opioids as part of their treatment plan found that between 40% and 60% of these individuals struggled with constipation due to their prescription painkillers.[2] Opioid-induced constipation reportedly caused the study participants to strain during defecation. 

Although Suboxone is taken sublingually rather than orally, some research suggests that when ultimately swallowed, buprenorphine can bind to opioid receptors in the stomach and lead to constipation.

Other medical studies note that almost everyone who takes prescription opioids for a longer time develops OIC.[3] Unmanaged constipation can cause damage to the sphincter, bowel, intestine, and stomach, so it is important to get help from your doctor if you do not experience relief from constipation. 

Symptoms of Constipation 

Typical constipation symptoms include the following:

  • Feeling bloated
  • Being unable to complete a bowel movement
  • Stomach upset, nausea, or vomiting
  • Alternating episodes of diarrhea and constipation
  • Fecal impaction
  • Pain during attempted bowel movements
  • Bleeding after bowel movements

Your doctor may discuss your history of Suboxone treatment to understand how this might impact your digestion and overall health. They may also perform a physical exam, which could include a rectal exam, especially if you have more serious symptoms like pain or bleeding. 

In most cases, your doctor will recommend some steps to improve gut health. They may prescribe laxatives for as-needed use.

Medications You Might Receive to Manage Constipation From Suboxone

Since opioid-induced constipation is a common problem, not only among those taking Suboxone but also among those taking other opioids for chronic pain, doctors understand the best laxatives to prescribe, how to direct their use, and how to oversee their efficacy. 

  • Senna: This is a laxative taken once per day, which may contain stool softener. This is often prescribed to older adults who are taking opioids for long-term pain management, as it reduces the risk of constipation, but it does not alleviate existing constipation. If you have a history of constipation problems, your Suboxone physician might recommend this. 
  • Saline laxatives with magnesium citrate: These have an onset of action about 30 to 180 minutes after they are taken. They are good for short-term relief.

  • Relistor: This brand name for methylnaltrexone bromide is one of the few opioid antagonists prescribed to alleviate constipation. It does not cross the blood-brain barrier, so it will not stop your regular Suboxone dose from working. However, it will remove opioids from gut receptors, so any buprenorphine lingering in your gut will be eliminated.
  • Amitiza: This brand name for lubiprostone increases fluid secretion in the GI tract, so there is increased tone and peristalsis. 

There are over-the-counter laxatives that you might also find effective, but ask your doctor before taking these. They are not designed for ongoing use. 

Lifestyle Changes to Reduce Constipation From Suboxone

If you develop mild or moderate constipation, or are concerned about developing constipation, you can take some steps to manage your health while taking Suboxone as directed. 

  • Increase your dietary fiber by eating more whole grains, fruits, and vegetables.
  • Take a supplement with additional dietary fiber.
  • Drink more water.
  • Exercise more, as this can improve gut motility as well as overall fitness.

One estimate suggests that $800 million is spent on laxatives in the United States every year, so finding ways to reduce your reliance on these while taking Suboxone can help you feel healthier. However, do not hesitate to report constipation to your doctor for treatment. 

SOURCES

  1. Peristalsis. MedlinePlus. https://medlineplus.gov/ency/anatomyvideos/000097.htm#:~:text=Peristalsis%20is%20a%20series%20of,swallowed%20food%20to%20the%20stomach.&text=The%20motion%20mixes%20and%20shifts%20the%20chyme%20back%20and%20forth. January 2022. Accessed February 2022. 
  2. Opioid Induced Constipation. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK493184/#:~:text=Opioid%20drugs%20are%20known%20to,hardening%20of%20stool%20and%20constipation. August 2021. Accessed February 2022. 
  3. Opioid-Induced Constipation: Rationale for the Role of Norbuprenorphine in Buprenorphine-Treated Individuals. Substance Abuse and Rehabilitation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913538/. June 2016. Accessed February 2022. 
  4. Opioid-Induced Constipation – A Preventable Problem. Australian Government, Department of Veterans Affairs. https://www.apsoc.org.au/PDF/Publications/Veterans_MATES_27_Managing_Constipation_with_Pain_Medicines_TherBrief_JUN11.pdf. June 2011. Accessed February 2022.

Medically Reviewed By 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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