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What is the Suboxone ‘Ceiling Effect’?

The “ceiling effect” means that its effects plateau at moderate doses. If you take more of the medication, it won’t bring a greater effect.

What Is the Ceiling Effect?

The buprenorphine component of Suboxone is a partial opioid agonist. While it activates the opioid receptors in the brain, it does not do so to the same extent that full opioid agonists do.

The analgesic, euphoric, and respiratory depression effects plateau at high doses. This is what is called the buprenorphine “ceiling effect.”[4]

The ceiling effect means that Suboxone will produce a certain degree of euphoria and pain relief but that effect will be maximized at a moderate dose and will not continue to increase at higher and higher doses. This minimizes the utility of taking more and more of the medication and dissuades any potential to overdose on the medication. 

Is It Dangerous to Reach the Ceiling Effect?

Not usually. Due to the ceiling effect, it is nearly impossible to overdose on Suboxone, making buprenorphine less dangerous than other opioids. Let’s see why:

If Suboxone is taken at appropriate doses, it does produce a certain degree of euphoria and pain relief, in the same way that a full opioid agonist would. In this way, it acts as a substitute for full opioid agonists and prevents cravings. This is the way it works to treat opioid use disorder.

However, if abused or taken in doses higher than prescribed or in a method other than intended, the patient will not continue to “get more and more high” as they would with a full opioid agonist. This prevents a patient getting so high that they have an accidental overdose. This ceiling effect is part of what makes Suboxone so safe.

When taken as medically directed, Suboxone is a safe and effective treatment for opioid use disorder.

Suboxone for MAT

Suboxone is a sublingual film that you place under your tongue and let dissolve in your mouth. It generally comes in the following dosage strengths:[1]

  • Buprenorphine 2 mg and naloxone 0.5 mg
  • Buprenorphine 4 mg and naloxone 1 mg
  • Buprenorphine 8 mg and naloxone 2 mg
  • Buprenorphine 12 mg and naloxone 3 mg

Suboxone is prescribed as a Medication for Addiction Treatment (MAT) for opioid use disorder (OUD). Suboxone contains both the partial opioid agonist buprenorphine and the abuse-deterrent component naloxone, which can precipitate withdrawal symptoms and prevent overdose if the medication is misused through injection. 

It is important to start taking Suboxone after opioid withdrawal symptoms have already started. For short-acting opioids like heroin or oxycodone, this usually means no sooner than 12 to 24 hours after the last use of opioids. You may need to wait longer before taking Suboxone if you have been using longer-acting opioids, including methadone — closer to 48 to 72 hours.

After initiation, Suboxone is generally taken as a single daily dose although can sometimes be dosed two or even three times a day depending on the needs of the patient. The dose range is highly variable between patients, sometimes as low as 2 mg of buprenorphine daily to as high as 24 mg of buprenorphine daily. It sometimes takes a few days to slowly adjust the dose to what is right for you, which is why it is important to work closer with a medical prescriber as you first begin to take Suboxone.

What Does It Feel Like When You Take Suboxone?

Suboxone generally takes about 20 to 45 minutes to take effect.[3] Buprenorphine is a long-acting partial opioid agonist that binds to the same opioid receptors in the brain as full opioid agonists like heroin, fentanyl, or prescription painkillers.

As a partial agonist, it does create some euphoria and pain relief, but it does not produce the same degree of euphoric effect as other full agonist opioids. This means that you will not feel “high” if you overdose on Suboxone.

Suboxone will make you feel better and help to keep you from craving opioid drugs or experiencing withdrawal symptoms. Suboxone can block pain receptors, having an analgesic effect, and create a mild sense of euphoria or “feeling good” when you take it as medically directed. 

Suboxone can also make you sleepy and create some slight nausea, dizziness, slowed breathing, and coordination issues. These side effects may be stronger at first as the body adjusts to the new medication, but often dissipate once a person is accustomed to taking daily Suboxone.

If you try to inject Suboxone, the naloxone component of the medication will bind to the receptors in the body instead of the buprenorphine. This can make you sick and experience opioid withdrawal symptoms. This is one way the manufacturers created a deterrent for the misuse of the medication, and therefore has a greater safety profile and a lower abuse potential. 

SOURCES

  1. Suboxone Prescribing Information. U.S. Food and Drug Administration (FDA). https://www.suboxone.com/pdfs/prescribing-information.pdf. Accessed January 2022.
  2. MAT Medications, Counseling, and Related Conditions. Substance Abuse and Mental Health Services Administration (SAMHSA). November 2021. Available at: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions#medications-used-in-mat. Accessed January 2022.
  3. A Patient’s Guide to Starting Buprenorphine at Home. It Matters. https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed January 2022.
  4. Clinical Pharmacology of Buprenorphine: Ceiling Effects at High Doses. Clinical Pharmacology and Therapeutics. https://pubmed.ncbi.nlm.nih.gov/8181201/. May 1994. Accessed January 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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