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.
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.
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. 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. 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. 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.
Typical constipation symptoms include the following:
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.
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.
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.
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.
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.