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Can You Overdose on Suboxone?

Suboxone has no overdose potential when taken as prescribed.

When taken as prescribed, Suboxone also does not lead to intoxication since buprenorphine is not as strong as full opioid agonists like heroin.

Why Isn’t Overdose Possible with Suboxone?

Suboxone combines naloxone and buprenorphine to help people overcome dependence on opioids.

Buprenorphine is a partial opioid agonist, unlike heroin, fentanyl, and even methadone, which are full opioid agonists.[2] The main active ingredient in Suboxone creates much weaker ‘opioid effects’ than other drugs in the opioid family.

Some may worry that Suboxone treatment might put one at risk of overdosing on this prescription treatment at some point. However, this is not the case. Even if abused, overdosing on Suboxone by itself is almost impossible.

If alcohol or other sedatives are mixed in at high doses, however, overdose risk increases. This is true for many drugs, including ones like Benadryl.

Suboxone has a ‘ceiling effect’ that prevents opioid effects such as sedation or respiratory depression from increasing beyond a certain level. For this reason, taking Suboxone in large quantities does not carry the overdose risk of many other opioids. Taking Suboxone in large quantities is simply wasting medication.

Suboxone also contains naloxone, a drug that is used to stop opioid overdoses on its own. This was added to Suboxone to stop people from tampering with the medication to get high on buprenorphine. If Suboxone is tampered with and used intravenously, naloxone will be activated, and the user will achieve no desirable effect.

How Buprenorphine Blocks Opioid Receptors

Buprenorphine is also very effective at preventing overdose and relapse from other opioids.

Buprenorphine’s unique properties prevent other opioids from binding to brain receptors since these natural opioid receptors are already occupied. Someone who takes Suboxone but relapses back into heroin use, for example, will not experience a high from heroin since Suboxone is still active in their brain.

Heroin quickly metabolizes out of the body, but buprenorphine remains active due to its long duration. This can help prevent ‘slips’ from progressing to full relapses.

Over time, buprenorphine helps to reduce compulsive behaviors around opioid drugs and allows the brain’s reward center to rewire overtime so that it does not associate ‘feeling good’ with opioids.

The ‘Ceiling Effect’ With Suboxone

Treating opioid use disorder (OUD) with Suboxone works for many people because buprenorphine is safe to use in an outpatient or remote setting. This means that physicians can prescribe it for use at home rather than requiring that their patients come into the office for each dose, which is required for methadone treatment.

Buprenorphine also has a dose ceiling effect.[3] This means that any opioid effects like sedation or euphoria level off after a certain amount is in the body, especially for people who have struggled with OUD for years and have a physical tolerance. This experience reduces the risk of misuse, side effects, and chemical dependency in people who take Suboxone as Medication for Addiction Treatment(MAT).

Rare Cases of Suboxone Overdose Risk

People who are prescribed Suboxone and take it as directed are not at risk of overdose. In fact, when taken as prescribed, Suboxone has no overdose risk.

In rare situations, it is potentially possible that someone may be at risk of overdose involving Suboxone.[4]  However, this is true even for common over-the-counter medications such as Benadryl. These are some of the situations where buprenorphine might contribute to an overdose:

  • People who take multiple drugs, either prescribed or illicit, are at greater risk of overdose. For example, if you take Suboxone and abuse an anti-anxiety medication like Klonopin, these two can enhance each other’s sedative effects which, in large amounts, can lead to overdose.
  • People who drink alcohol while on Suboxone increase their risk of alcohol poisoning or overdose.
  • People who are opioid naïve, or who have never regular taken drugs that are full opioid agonists.

Suboxone is designed to reduce the risk of overdose and intoxication. Previous buprenorphine-based drugs could be tampered with, so a person could abuse the substance to get high. However, Suboxone’s added naloxone should stop this from occurring.

Symptoms of Suboxone Overdose

People who are opioid naïve, or who have never regularly taken drugs that are full opioid agonists, might risk taking too much buprenorphine and overdosing. Symptoms of an overdose include:

  • Pinpoint pupils that are unresponsive to light.
  • Extreme drowsiness.
  • Passing out and not waking up.
  • Blurry vision.
  • Dizziness.
  • Slow or shallow breathing.
  • Irregular breathing.
  • Difficulty breathing.[5]

As with most medications, children are at an increased risk of overdose, so be sure to keep your Suboxone safely stored in a place it cannot be accidentally consumed. If someone does take too much Suboxone, call 911.

SOURCES

  1. Methadone and Buprenorphine Reduce Risk of Death After Opioid Overdose. National Institute on Drug Abuse. https://www.drugabuse.gov/news-events/news-releases/2018/06/methadone-and-buprenorphine-reduce-risk-of-death-after-opioid-overdose. June 2018. Accessed January 2022.
  2. Buprenorphine/Naloxone: What You Need to Know.CA Bridge. https://www.acep.org/globalassets/sites/acep/media/equal-documents/ca-bridge---patient-materials---bup-naloxone---nov-2019.pdf. November 2019. Accessed December 2021.
  3. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness (NAMI). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed December 2021.
  4. Can You Overdose on Suboxone? Drugs.com. https://www.drugs.com/medical-answers/you-overdose-suboxone-3536143/. April 2020. Accessed December 2021.
  5. Buprenorphine Sublingual and Buccal (Opioid Dependence). MedlinePlus. https://medlineplus.gov/druginfo/meds/a605002.html. November 2021. Accessed December 2021.

Brian Clear, MD, FASAM — Medical Director

Brian Clear, MD, FASAM, is board certified in Family Medicine and Addiction Medicine, and he joined Bicycle Health in early 2020 as Medical Director and President of the Medical Provider Group.

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