Suboxone is a safe prescription drug. While it should only be taken as prescribed and does have some side effects, it is considered to have low misuse and addiction potential. Its use for combating opioid use disorder is strongly supported by evidence.
What Is Suboxone?
Suboxone is a brand name medication that combines the drugs buprenorphine and naloxone. Combination buprenorphine/naloxone drugs are one of two options (the other being methadone) most commonly used as part of medication for opioid use disorder (mOUD) programs. mOUD treatment is considered the gold standard for opioid addiction.
The primary active ingredient in Suboxone is buprenorphine, which is a long-acting, high-affinity partial opioid agonist. This means the drug is technically an opioid, although the opioids most associated with substance use disorders, such as heroin and fentanyl, are typically full agonists. These types of drugs bring more intense effects and generally have significantly higher misuse and addiction potential.
How Does Suboxone Work?
As a partial opioid agonist, buprenorphine attaches to opioid receptors in the brain but, unlike full agonists, it binds imperfectly. This not only produces a less intense effect than if one were to use a full opioid agonist, but it also blocks those receptors, meaning that using opioids with greater misuse potential while under the effects of buprenorphine will generally produce a significantly lessened effect.
While it may seem counterintuitive to use an opioid as part of treatment for opioid use disorder, buprenorphine can greatly reduce cravings for opioids and sharply reduce or outright eliminate withdrawal symptoms. Additionally, while it can in certain situations cause some euphoria and is associated with some side effects, a person taking buprenorphine, especially as recommended, will be able to function normally in their day-to-day life.
Difficult to Misuse
Buprenorphine is also associated with a “ceiling effect” where attempting to use more of the drug than recommended to produce a more intense high is ineffective. The intensity of the drug’s effects levels off with increased use, meaning higher and higher doses will not produce a proportionally higher effect.
The naloxone component of Suboxone helps to further reduce the medication’s misuse potential. In isolation, it is normally possible to inject buprenorphine (rather than take it orally, as is done with Suboxone when taking it correctly) to intensify its effects and produce something approaching a “standard” opioid high. Naloxone makes this method of misuse ineffective.
If someone injects Suboxone or similar combination drugs, the naloxone will activate. Naloxone is an opioid antagonist, meaning it counteracts the effects of opioids. This means that injecting Suboxone will cause naloxone to eliminate any opioid high a person intended to achieve with the injection.
Because it eliminates a significant amount of buprenorphine’s misuse potential, doctors usually only prescribe combination buprenorphine/naloxone medications rather than buprenorphine in isolation.
How Addictive Is Suboxone?
Suboxone and other buprenorphine/naloxone drugs are considered to have very low misuse and addiction potential. While these drugs can be misused, meaning taken in a nonmedically recommended manner, it is difficult to achieve a powerful, and thus desirable, high with Suboxone and similar medication.
This is part of what makes mOUD treatment useful. It can reduce a person’s opioid cravings and withdrawal symptoms without itself representing a major addiction or misuse risk.
As an opioid agonist, buprenorphine can cause physical dependence, meaning a person may experience withdrawal symptoms if they stop taking the drug after an extended period of taking it. However, physical dependence isn’t the same thing as opioid use disorder. OUD includes a compulsion to misuse substances, whereas physical dependence simply means a person’s body has adjusted to the presence of a drug and causes unpleasant symptoms if they suddenly stop taking it.
It’s also important to note that a person taking Suboxone as part of mOUD treatment will almost always be taking it because they’re already physically dependent on more dangerous, powerful opioids. In this context, physical dependence on buprenorphine is a much less significant concern, as it is much safer for a person to be reliant on medical doses of buprenorphine rather than doses of more dangerous opioids.
Understanding Suboxone Misuse, Abuse & Addiction
As touched on above, Suboxone misuse is rare. Furthermore, it seems a significant amount of the misuse of these types of drugs is due to people legitimately attempting to self-medicate OUD. While one should never use prescription medication without first being prescribed that medication by a doctor, many people misusing Suboxone are doing so to try to manage withdrawal symptoms or stop taking more dangerous opioids. This is similar to how one might take the medication as part of a legitimate mOUD process.
This is very different from a person actively misusing a drug. Many experts blame this type of misuse on legitimate treatment paths being unavailable to people with OUD.
While exact data is difficult to find, Suboxone misuse, where one uses Suboxone in an attempt to achieve a euphoric high, is likely quite rare for the simple fact that it isn’t effective. While some misuse certainly occurs, the drug usually doesn’t produce a strong high in isolation.
A person seeking to misuse opioids will likely instead misuse other more powerful, yet often still cheap and widely available, opioids. Notably, Suboxone is a prescription medication, so it also isn’t significantly more accessible than some of the most commonly sold illegal opioids to the average person.
Overall, Suboxone is considered a safe medication that can legitimately help combat OUD and help people to stop taking much more dangerous drugs. When discussing the use of Suboxone and similar drugs, it’s important to remember that full opioid agonists like heroin and fentanyl are highly addictive and can be deadly. The evidence clearly shows that Suboxone is a beneficial medication for people with OUD.
How Effective Is Suboxone for Opioid Use Disorder?
Different people will react to mOUD in different ways, but Suboxone and similar medications have a significant amount of evidence supporting their use. A Swedish study of buprenorphine use for the purpose of treating opioid use disorder, used in combination with psychosocial supports like therapy, showed a treatment failure rate of 25% for buprenorphine against a 100% failure rate for those administered a placebo.
A meta-analysis indicated that people on a standard 16 mg dose of buprenorphine were over 1.82 times more likely to stay in treatment compared to patients on placebos. Buprenorphine has likewise been shown to reduce opioid-positive drug tests by about 14.2%. While buprenorphine isn’t a “miracle cure,” it is genuinely helpful in helping patients stay in treatment and achieve better results from that treatment.
Overall, the only mOUD comparable to drugs like Suboxone is methadone treatment. Evidence suggests methadone and buprenorphine are similarly effective at reducing opioid use.
Buprenorphine-based medications are generally easier to access than methadone. With that said, some patients may react better to one treatment than the other. It makes sense for a patient who doesn’t respond as well as hoped to one treatment to consider switching to the other. In some cases, a different medication can help them more in their recovery.
- Suboxone: Rationale, Science, Misconceptions. The Ochsner Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/. 2018. Accessed February 2023.
- Effect of Buprenorphine Dose on Treatment Outcome. Journal of Addictive Diseases. https://www.mcstap.com/docs/Effect%20of%20Buprenorphine%20Dose%20on%20Treatment%20Outcome.pdf. December 2011. Accessed February 2023.
- An Overview of Abuse-Deterrent Opioids and Recommendations for Practical Patient Care. Journal of Multidisciplinary Healthcare. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045950/. July 2018. Accessed February 2023.
- 5 Myths About Using Suboxone to Treat Opiate Addiction. Harvard Health Publishing. https://www.health.harvard.edu/blog/5-myths-about-using-suboxone-to-treat-opiate-addiction-2018032014496. October 2021. Accessed February 2023.
- How Effective Are Medications to Treat Opioid Use Disorder? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder. December 2021. Accessed February 2023.
By: Peter Manza, PhD
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