There is a boxed warning about medication interactions with Suboxone, and Xanax is one of the medications that should not be taken at the same time without medical supervision. 
This is because Suboxone, a partial opioid agonist, and Xanax, a benzodiazepine, are both central nervous system (CNS) depressants, and mixing these two drugs can result in severe respiratory depression, overdose, and death.
Dangers & Risks of Mixing Xanax & Suboxone
Mixing opioids like Suboxone with benzodiazepines such as Xanax can increase the risk of a fatal overdose. In 2021, approximately 14% of opioid overdose deaths involved benzodiazepines.
Both of these medications suppress breathing and cause sedation (the main cause of fatal overdose). Moreover, both impair your ability to think clearly and make rational decisions.
When mixed, these Suboxone and Xanax can interact to cause the following:
- Severe drowsiness
- Breathing problems
- Decreased awareness
Both benzodiazepines and opioid medications are also habit-forming, leading to:
- Physiological dependence and potentially dangerous withdrawal symptoms, such as seizures
- Opioid use disorder and/or sedative-hypnotic anxiolytic use disorder
Xanax (alprazolam) is prescribed for the short-term relief of anxiety and panic disorders. Withdrawal from benzos can be potentially life-threatening if the medication is stopped suddenly after physical dependence has formed.
If you are already taking Suboxone for opioid use disorder or Xanax for anxiety and may need to take them together, you should talk to your doctor so you can understand the risks and benefits and make a decision about whether or not to take these medications together.
Alternatives to Xanax for Anxiety and Panic Disorder
Suboxone is a Medication for Addiction Treatment (MAT) for the management of opioid use disorder (OUD). It can help to reduce cravings for opioid drugs, minimize the odds of relapse, and help to manage opioid withdrawal symptoms.
One of the symptoms of opioid withdrawal can be anxiety, and anxiety disorders commonly co-occur with opioid addiction. Xanax is commonly prescribed to help manage anxiety, but if you are taking Suboxone, this may not be a safe option for you. There are alternatives to benzodiazepines that do not cause the same level of sedation and breathing suppression, such as antidepressants. There are also other anxiolytic medications that may be less risky, such as hydroxyzine, or Buspar.
Holistic Treatment Methods for Anxiety
In addition to medications for the treatment of anxiety, behavioral therapies and counseling can help treat anxiety. Holistic interventions can also be beneficial in managing anxiety while taking Suboxone. These may include: 
- Massage therapy
- Mindfulness meditation
Talk to your doctor about your options. If you are using Suboxone as part of a comprehensive MAT program, your treatment team will be able to help you manage anxiety and other issues in a safe way while taking Suboxone.
Reviewed By Peter Manza, PhD
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More
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