What Happens if You Take Opioids While on Suboxone?

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If you take opioids 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 Mixing Suboxone & Opioids 

Precipitated Withdrawal

If an individual takes a full agonist opioid (such as fentanyl, oxycodone, 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 all the full opioid off the receptors. This can cause the acute onset of withdrawal symptoms. This can feel like a flu like illness, including headaches, chills, nausea, vomiting and diarrhea. While precipitated withdrawal is never dangerous or life threatening, it can be extremely unpleasant, and can be a trigger to push people to return to illicit drug use.

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 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 is called the “ceiling effect” of Suboxone.

However, at high enough doses, even this ceiling effect can be overcome, and the combination of multiple sedating medications, Suboxone and other opioids, can lead to overdose, respiratory depression and even death. 

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.

For example, if you're using 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.

Sources

  1. Emergency Department Buprenorphine/Naloxone (Suboxone): Home Dosing Information. Government of Alberta. https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=custom.ab_suboxone_homedosing_ac_adult. March 2021. Accessed September 2022. 
  2. Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed September 2022.

Medically Reviewed By 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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