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How Does Suboxone Interact With Alcohol?

Patients may choose to drink alcohol while on Suboxone, but doing so does have risks.

Alcohol acts as a central nervous system (CNS) depressant, thereby depressing the body’s respiratory drive. 

Buprenorphine/naloxone (Suboxone) is also considered a CNS (central nervous system) depressant.

When buprenorphine/naloxone (Suboxone) and alcohol are mixed, there is increased risk for sedation, decreased respiratory drive, overdose, and death.

When taken as prescribed and at the appropriate dose, buprenorphine/naloxone (Suboxone) should not make patients feel overly tired or sedated. However, if combined with other CNS depressants — like alcohol or benzodiazepines, AKA “benzos” (like Xanax, Klonopin, Ativan, or Valium) — it can increase the risk of sedation, respiratory depression, overdose and death.

For these reasons, it is recommended that buprenorphine/naloxone (Suboxone) NOT be combined with alcohol or benzos unless done so under the supervision of a medical provider.

risks of drinking alcohol while on suboxone


Side Effects From Mixing Alcohol & Suboxone

Buprenorphine, the active medication in Suboxone, and alcohol are both CNS depressants.[1] There is a risk, when combined, of enhancing each other’s sedative effects. This may include the following:

  • Severe drowsiness
  • Decreased awareness of surroundings
  • Breathing problems 

Although a stable, daily dose of Suboxone should not put you at risk of breathing problems or overdose, alcohol can enhance the sedative qualities in buprenorphine and increase the risk of over-sedation or even overdose.

Alcohol use while taking Suboxone complicates the ability of buprenorphine to help you overcome substance abuse patterns. This is called polysubstance use.[2] While alcohol can be used while on Suboxone, it should be done so sparingly, particularly at first, so that an individual can judge the amount of alcohol that is safe for them to consume while concurrently on Suboxone.

Attending counseling alongside Suboxone treatment is the best approach to overcoming addiction, but your rehabilitation program must know to provide counseling for AUD as well as OUD.

Anyone who struggles with alcohol use disorder or who experiences delirium tremens, a life-threatening form of alcohol withdrawal syndrome, might still be a candidate for Suboxone, and should talk with their doctor openly about the fact that they are using both medications simultaneously.[3]

Does Suboxone Block the Effects of Alcohol?

No, suboxone does not dampen the effects of alcohol. If anything, a person may have more sedation and intoxication with the same amount of alcohol they used to consume once they start taking Suboxone. It is recommended to avoid drinking all together while first starting Suboxone, and then re-initiating alcohol use slowly and carefully once a patient is stable on their Suboxone dose.

Can Suboxone Help Patients with Alcohol Use Disorder in Addition to Opioid Use Disorder?

Strictly speaking, Suboxone is a treatment for opioid use disorder, not alcohol use disorder. However, some limited medical studies suggests that buprenorphine can reduce alcohol drinking through certain brain activity associated with some opioid receptors.[4] In addition, we know that preventing use of one substance also helps prevent the use of others. Many individuals tend to use multiple drugs at the same time. Thus, if an individual is using Suboxone to prevent use of opioids, they may also spend less time drinking alcohol. Thus, Suboxone doesn’t directly treat alcohol use disorder, but may lend itself to preventing individuals from being in situations where they are drinking or consuming other substances.

Is Moderate Drinking While on Suboxone Safe?

Drinking “socially” (in low to moderate amounts) may cause you to feel sleepy or sedated more quickly than normal while on Suboxone. If you have started Suboxone, you should re-initiate drinking slowly to ensure that you do not become overly sedated. Drinking alcohol excessively puts you at greater risk of suppressed or irregular breathing, opioid overdose symptoms, coma, and death, and is never recommended, on or off Suboxone.

There is no amount of alcohol that is considered entirely “safe,” according to the Centers for Disease Control and Prevention (CDC). This is especially true for those taking prescription medications with sedative effects like Suboxone.[6] All prescription guidelines for Suboxone state that you should not drink while taking Suboxone. However, if you do decide to consume low or moderate amounts of alcohol while on Suboxone, alert your doctor so that the two of you can make the best decisions together about your health.

SOURCES

  1. Important Safety Information. Suboxone.com. https://www.suboxone.com/. Accessed February 2022.
  2. Polydrug Use: Health and Social Responsibilities. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). https://www.emcdda.europa.eu/publications/mini-guides/polydrug-use-health-and-social-responses_en. 2021. Accessed February 2022.
  3. Suboxone Sublingual Tablets. Medsafe, Government of New Zealand. https://www.medsafe.govt.nz/Consumers/cmi/s/suboxone.pdf. July 2021. Accessed February 2022.
  4. Buprenorphine Reduces Alcohol Drinking Through Activation of the Nociceptin/Orphanin FQ-NOP Receptor System. Biological Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035814/. February 2011. Accessed February 2022.
  5. Highlights of Prescribing Information: Suboxone. Access Data FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020733s024lbl.pdf. October 2019. Accessed February 2022.
  6. Dietary Guidelines for Alcohol. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm#:~:text=To%20reduce%20the%20risk%20of,days%20when%20alcohol%20is%20consumed. December 2020. Accessed February 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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