Suboxone is a popular, prescription-only drug that effectively suppresses opioid cravings and reduces the symptoms of opioid withdrawal. Although Suboxone has assisted thousands of individuals struggling with opioid addiction, the drug is not without its risks. While critics express concerns over the long-term risks of Suboxone, namely dependency, there is also a more immediate risk of Suboxone use — the drug’s dangerous interactions with other substances.

According to statistics gathered by the Substance Abuse and Mental Health Services Association (SAMHSA), there were 30,135 buprenorphine-related emergency room visits in 2010. Not surprisingly, 59 percent of these hospitalizations involved additional drugs. As Suboxone’s popularity increases, it’s crucial to understand the drug’s risk, especially the dangers of mixing Suboxone with other substances.

How Suboxone Works

A combination of the drugs buprenorphine and naloxone, Suboxone works to satiate the brain’s desire for opioids without offering the rewarding effects. Functioning as a partial opioid agonist, or weak opioid, the drug buprenorphine locks onto the brain’s opioid receptors, which alleviates withdrawal symptoms, diminishes cravings, and prevents other opioids from reacting with the brain’s receptors.

While buprenorphine “tricks” the brain into believing a full dose of an opioid was taken, naloxone then blocks the brain’s opioid receptors, immediately eliminating the pleasurable effects of the buprenorphine.

Since Suboxone does include an opioid, taking other drugs while on Suboxone can be life-threatening. If you are on a Suboxone regimen, it’s vital to avoid the following substances due to their dangerous interactions.

Benzodiazepines (“Benzos”)
Benzodiazepines (Xanax, Valium, Klonopin) are typically prescribed to alleviate anxiety and treat insomnia. Categorized as depressant drugs, or “downers,” benzodiazepines sedate the central nervous system, which slows heart rate, lowers blood pressure, and depresses breathing. The buprenorphine in Suboxone also functions as a depressant drug. When taken together, the effects of each drug are both exacerbated, and the combination can lead to severe lack of coordination, impaired judgement, unconsciousness, respiratory failure, and even death.
Cocaine
By counteracting the effects of the other, combining Suboxone and cocaine produces two dangerous effects for users. As a stimulant, or “upper,” cocaine has shown to reduce the amount of buprenorphine in the bloodstream of a Suboxone user, which may quickly lead to opioid withdrawal symptoms. Combining cocaine and Suboxone also increases the risk of a cocaine overdose. As a depressant, Suboxone reduces the effects of cocaine, giving the false sense to users that their body can handle more cocaine — even when it can’t.
Alcohol
Much like benzodiazepines, alcohol is also classified as a depressant, affecting the body’s central nervous system. Due to its popularity and broad acceptance, alcohol may present the most danger to an uninformed Suboxone user. When someone begins Suboxone, he or she may not consider the risks of drinking alcohol. However, the combination of alcohol and Suboxone can produce the same dangerous (and sometimes fatal) effects as mixing benzodiazepines with Suboxone, including unconsciousness and respiratory failure.

Suboxone is a combination drug comprised of two substances: Buprenorphine & Naloxone

Buprenorphine—a relatively mild opiate analgesic with mixed opioid receptor agonist activity; historically used at low doses to manage mild to moderate levels of pain.
Naloxone—an opiate antagonist used to reverse or eliminate the effects of opiates in someone’s system.
Buprenorphine has been available since 1985, but a major shift happened in 2002 when the trade formulations known as Subutex and Suboxone became approved in the US, and began being marketed for the treatment of narcotic addiction. Subutex contains buprenorphine only while Suboxone contains both buprenorphine and naloxone, also known as Narcan. From this point forward, doctors were permitted to prescribe the substance to individuals that were struggling with opiate addiction.

In a similar way to methadone, the thought is that Suboxone will limit withdrawal symptoms and decrease the frequency and intensity of cravings in the person addicted to opiates, making it a safer alternative. Its levels can be monitored and reduced until the person is no longer addicted.

Suboxone typically comes as a sublingual strip rather than a pill. This means it can be dissolved under the tongue discreetly without water to wash it down.

Suboxone acts as a depressant in the body, which means that it slows down the person rather than speeding them up, as a stimulant would do.

The short-term, desirable effects of Suboxone include:

• A pain relieving effect that is between 20 and 30 times more powerful than morphine.
• A mild euphoria that can lasts for around 8 hours with general effects of the substance lasting for 24 – 72 hours.
• A sense of calm and inflated well-being.
• A perception of fewer worries and lower stress.
  Increased relaxation.

As with other drugs of abuse, taking too much Suboxone in the short-term can lead to unwanted effects including:

• Sleepiness.
• Confusion.
• Nausea.
• Respiratory depression.

Side Effects

Suddenly stopping use of Suboxone can elicit unpleasant withdrawal symptoms and prove much more difficult to quit than thought.
While Suboxone is used in the treatment of addiction, the drug itself can lead to tolerance and dependence. Suddenly stopping use of Suboxone can elicit unpleasant withdrawal effects, and prove much more difficult to quit than thought. Other side effects that may occur during a period of active use or withdrawal include:

• Constipation (during use).
• Diarrhea (during withdrawal).
• Arthralgia, or joint pain (during withdrawal).
• Insomnia.
• Irritability.
• Jitteriness.
• Pinpoint pupils (during use).
• Dilated pupils (during withdrawal).

In addition, partial opioid agonists like buprenorphine and, indeed, opioid antagonists like naloxone can send someone addicted to full opioid agonist substances (like heroin or oxycodone) into what is known as precipitated withdrawal—inducing the onset of the unpleasant withdrawal symptoms very rapidly, if not immediately.

Can I Become Addicted to Suboxone?

In 2012, there were more than 9 million prescriptions for buprenorphine written in the US.

While Suboxone is used in the long-term management of opiate abuse to end the pattern of abuse,  it actually can be abused itself. In fact, currently, aside from its prescribed use, Suboxone is a highly sought after drug of abuse. Those abusing Suboxone include:

• People already abusing narcotics—whether or not they are addicted.
• People that are unaware of the drug’s risks.
• People addicted to heroin looking to avoid withdrawals.
• People on a Suboxone program who become dependent on the substance.
• Rather than being addicted to the heroin or prescription pills, people become addicted to the Suboxone. Taking the drug for reasons other than its intended purpose increases the risk of becoming addicted or restarting the cycle of abuse and addiction.

Long-Term Effects of Suboxone

Suboxone abuse both directly and indirectly imparts some serious long-term effects that can affect both mental and physical health.

Negative Health Effects

• Drowsiness.
• Gastrointestinal issues like constipation, nausea and vomiting.
• Disorientation and confusion.
• Decreased pain tolerance.
• Negative Psychological Effects
• Increased incidence of depression.
• Anxiety.
• Isolation.
• Difficulty in social situations.

Extended Issues

• Failing relationships.
• Trouble with responsibilities (e.g. parenting, work, school).
• Financial strain.
• Legal problems associated with addictive behaviors.

Suboxone Dependence

Because Suboxone contains an opioid, it can lead to dependence. This means your body starts to build a tolerance to it and you will feel uncomfortable when you stop using it.

One of the key signs of Suboxone dependence is that you start to suffer from withdrawal around 48 hours after ceasing use of the drug.

Withdrawal symptoms can mimic the flu, but they can last for up to a week. It is a sign that the opioid and its ultimately toxic influences are finally relinquishing their grip on a wide range of the body’s systems and functioning.

Suboxone dependence often requires a medically monitored detox period to keep the user comfortable and helps protect them from continuing their drug use in an attempt to stave off the onset of withdrawal.

Suboxone Addiction Treatment

The full range of Suboxone addiction treatment consists broadly of a detox stage, a therapeutic stage, and a longer-term recovery phase (which frequently consists of a number of post-treatment aftercare efforts). Conceptually, these stages may overlap to some degree.

Detox

Detox means you’ll be withdrawn from the drug. Normally, this happens gradually with your dose slowly being reduced. This can occur over the course of days, weeks, or months and often incurs as part of an inpatient rehab program.

Therapy

Once your withdrawal is progressing, you can start the process of therapy. Whether the therapy is inpatient or outpatient, it will involve understanding the systems in place that triggered the addiction, and what can be done to maintain life without the substance.

You may encounter different therapists with different styles during this process. For example, a therapist trained in cognitive behavioral therapy may ask about your thoughts and feelings to assess how these impact your behaviors. You might also be asked about your family and how you relate to others to identify the problematic relationships in your life. Additionally, a therapist will work to determine if the problematic drug use may have been a means of “self-medication”, or done in an attempt to manage other underlying mental or behavioral health issues.

A referral to a psychiatrist may be done to begin psychiatric medications to any concurrent mental health issues, if indicated. Evaluation by a mental health professional will help to identify any potential factors that may have lead to or reinforced ongoing drug abuse or addiction, as well as outline the therapeutic steps one can take to get off drugs.

Recovery

The last stage is recovery, when the period of active addiction treatment concludes, and you are given the opportunity to move forward in your life. You can use the tools learned and the guidance received to move on from your drug addiction.

Strategic aftercare planning will be implemented as most treatment programs near completion. Post-treatment, many benefit from ongoing counseling that is focused on drug use prevention, improved coping skills, and identifying health supports. It is helpful for those entering the long-term recovery phase to obtain individual counseling or coaching and/or support for a period of time.

Sources: drugabuse.com

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