What Happens if You Take Opioids While on Suboxone?

If you take opioids like oxycodone, hydrocodone, heroin, or fentanyl while on Suboxone, you may experience one of two very serious consequences.

• Overdose: Your opioids combine with the buprenorphine in your Suboxone and cause sedation and death. 
• Precipitated withdrawal: The buprenorphine in Suboxone binds preferentially to opioid receptors over the opioids in your system, kicking them off quickly and causing a withdrawal syndrome.

While full opioids can be taken along with Suboxone, this should be done with medical supervision to avoid one or the other of these consequences.

The Consequences of Taking Opioids and Suboxone

The Consequences of Mixing Suboxone & Opioids 

Precipitated Withdrawal

If an individual takes a full agonist opioid (such as fentanyl, oxycodone or heroin) and then takes buprenorphine/naloxone (Suboxone) too soon afterward, the buprenorphine (a partial agonist) will bind preferentially over the full opioid and quickly kick the other opioid off the receptors.

This can cause the acute onset of what is known as precipitated withdrawal symptoms. This can feel like a flu-like illness, including symptoms such as the following:

• Headaches
• Chills
• Nausea
• Vomiting
• Diarrhea
• Muscle aches
• Joint pain
• Fever

Precipitated withdrawal typically occurs within about 30 minutes of administering buprenorphine.[3] If you already have Suboxone in your system, the time frame for problems triggered by opioid drugs (like heroin or fentanyl) can depend on how quickly the opioids you use are metabolized.

Precipitated withdrawal symptoms are typically more severe than natural withdrawal symptoms.[3]

Experts say these episodes, while often mild, can be life-threatening in the most severe cases, especially if symptoms like nausea and diarrhea lead to dehydration.[4]

Extremely unpleasant withdrawal can also be a trigger for illicit drug use to relieve these symptoms. Returning to drug use can increase the risk of overdose, as drug tolerance dips.[5] A dose that seems safe could be too much for a healing body to handle.

If you recently used an opioid and want to quit and take Suboxone for your opioid use disorder (OUD), talk to your doctor about how long you should wait before taking your Suboxone dose. You should already be in opioid withdrawal before you take it.

If you experience signs of precipitated withdrawal, contact your doctor immediately. Explain what happened and how you’re feeling. If you can’t reach your doctor, visit an urgent care clinic or hospital instead.

Opioid Overdose 

Suboxone binds more strongly to receptors in the brain than full opioids, even though it is less potent. This means that if you take a full opioid like oxycodone after already having Suboxone in your system, you probably won’t get much of the effect of the full opioid, including the “high” or euphoric feelings that opioids produce. 

This ability to block other opioids is a protective effect of Suboxone. Some people who relapse while taking Suboxone may misuse high doses of heroin or opioid painkillers in an attempt to overcome these protective effects. And at high doses, especially in combination with buprenorphine, this can lead to an opioid overdose.

An opioid overdose causes the following symptoms:[6]

• Constricted pupils, even in dim light
• Loss of consciousness
• Shallow or slow breathing
• Choking or gurgling sounds
• Pale or blue-tinged skin

If someone is overdosing, follow these steps:[7]

• Call 911 immediately. Stay on the phone and follow instructions until help arrives.
• Administer naloxone per the package instructions.
• Try to keep the person awake and breathing.
• If you can’t wake the person up, turn them on their side to prevent choking.

What if I Need Opioids For Medical Reasons?

Even though you should never take illicit opioids while taking Suboxone, there may be circumstances in which you need prescription opioids for acute pain – for example, after surgery, a dental procedure, an accident, etc.

If you’re taking Suboxone and need surgery, you can receive opioids in addition to your Suboxone. Depending on the situation, your doctor might recommend continuing Suboxone during the procedure versus temporarily stopping Suboxone while you receive opioids and then promptly restarting. 

If you need additional pain control, opioids can be given on top of normal Suboxone therapy. However, make sure this is done under medical supervision to avoid either an overdose or precipitated withdrawal. Speak with your doctor before any planned surgical procedures or anticipated need for pain medications, so you and your medical team can have a plan in place for pain management.

Frequently Asked Questions About Taking Opioids and Suboxone