Suboxone for opioid addiction is a prescription medication that combines buprenorphine and naloxone. Buprenorphine eases withdrawal and cravings by partly activating the same brain receptors that opioids do, while naloxone is added to discourage misuse. Used as part of a full treatment plan, it is one of three FDA-approved medications for opioid use disorder.
If you or someone you love is thinking about Suboxone, you probably have questions about how it works, whether it is “just trading one drug for another,” and what treatment looks like. Here is a clear, judgment-free look at the facts.
What Is Suboxone?
Suboxone is a brand-name film that dissolves under the tongue or inside the cheek. It contains two medicines:
- Buprenorphine, which MedlinePlus describes as an opioid partial agonist-antagonist
- Naloxone, an opioid antagonist (a medicine that blocks opioid effects)
According to MedlinePlus, the combination is used to treat opioid addiction by preventing withdrawal symptoms when someone stops using opioids. Suboxone is one of several buprenorphine products. The FDA lists other buprenorphine formulations for opioid use disorder, including Zubsolv tablets, generic buprenorphine and naloxone tablets and films, and the extended-release injections Sublocade and Brixadi.
The FDA has approved three medications for opioid use disorder: buprenorphine, methadone and naltrexone. The agency states that all three have been shown to be safe and effective.
How Buprenorphine Works in the Brain
Opioids like heroin, fentanyl and oxycodone are full agonists. They switch on opioid receptors in the brain as strongly as the dose allows. Buprenorphine is different. StatPearls, a peer-reviewed clinical reference, explains three key features:
- Partial agonist: Buprenorphine turns the receptors on only partway. That is enough to calm withdrawal and cravings without the same intense high.
- Ceiling effect: Past a certain point, taking more does not keep increasing its effect on breathing. This makes it safer than full agonists, and StatPearls notes its overdose risk is substantially lower.
- Strong, long-lasting binding: Buprenorphine attaches tightly to receptors and leaves them slowly. Its effects last a long time, and it can blunt the effect of other opioids taken on top of it.
Why Naloxone Is Added
Naloxone is the same medicine used to reverse overdoses. When Suboxone is taken as directed under the tongue, very little naloxone is absorbed. StatPearls explains that naloxone is included to reduce the potential for misuse when injected. If someone dissolves and injects it, the naloxone becomes active and blocks the high.
Starting Suboxone: What to Expect
Starting buprenorphine is often called induction. Because buprenorphine binds so strongly, taking it while other opioids are still active can push them off the receptors and cause sudden, intense withdrawal. This is called precipitated withdrawal. StatPearls notes that treatment should begin once a person is already in mild to moderate withdrawal.
How long to wait depends on the opioid you were using. Long-acting opioids like methadone, and fentanyl patches, generally require a longer wait than short-acting opioids. Your prescriber will guide the timing and the dose. Please do not try to start buprenorphine on your own. To understand the early stages of withdrawal, see our opioid withdrawal timeline.
Is Suboxone Just Replacing One Drug With Another?
This is one of the most common worries, and it is understandable. The answer is no. Opioid use disorder involves compulsive use, loss of control and harm. Taking a prescribed medication as directed, under medical care, to stabilize your brain and body is treatment. Physical dependence on a medication is not the same as addiction.
The research backs this up. The National Institute on Drug Abuse reports that methadone, buprenorphine and naltrexone reduce the risk of relapse and overdose death and help people stay in treatment and live a normal life. SAMHSA notes that buprenorphine should be prescribed as part of a comprehensive treatment plan that includes counseling and other services.
Side Effects and Safety Warnings
Like any medication, Suboxone has possible side effects and risks. MedlinePlus lists common side effects and warnings, including:
- Constipation, headache and trouble sleeping
- Numbness in the mouth
- Blurred vision and sexual side effects
- Liver problems
- Dental problems, including cavities, infections, tooth fractures and tooth loss
The most serious risk is slowed breathing, especially when buprenorphine is combined with benzodiazepines, alcohol or other sedating drugs. Always tell your provider about everything you take. Other important safety points from MedlinePlus:
- Do not stop suddenly. Stopping too quickly can cause withdrawal.
- If taken during pregnancy, babies may have withdrawal symptoms after birth that need care. Talk with your provider before making any changes.
- Store it safely and out of reach of children and anyone with a history of substance use.
Keep naloxone at home as a backup, and learn how to use Narcan in an emergency.
Who Can Prescribe Suboxone Now?
Getting buprenorphine is easier than it used to be. In the past, doctors needed a special federal waiver, often called the X-waiver. SAMHSA explains that the MAT Act eliminated the DATA-waiver requirement, so any practitioner with a current DEA Schedule III registration can now prescribe buprenorphine for opioid use disorder, and patient limits were removed. SAMHSA also notes that buprenorphine was the first opioid use disorder medication that could be prescribed or dispensed in a doctor’s office.
How long someone stays on Suboxone varies from person to person. It is a decision to make with your prescriber, based on your goals, stability and risk of relapse.
Using Suboxone for Opioid Addiction Within a Full Treatment Plan
Medication works best alongside therapy and support. In an outpatient program, you might combine medication with cognitive behavioral therapy (CBT), group therapy, family therapy and relapse prevention planning. Learn more in our overview of medication-assisted treatment (MAT), or compare options in methadone vs. Suboxone.
Frequently Asked Questions
Can you get high on Suboxone?
Because buprenorphine is a partial agonist with a ceiling effect, it produces much weaker opioid effects than full agonists. It can still be misused, which is one reason naloxone is included.
How long does Suboxone stay in your system?
Buprenorphine is long-acting. StatPearls reports an average half-life of about 38 hours, with a range of roughly 25 to 70 hours.
Can you drink alcohol on Suboxone?
No. Combining buprenorphine with alcohol, benzodiazepines or other sedatives can cause dangerously slowed breathing. Talk with your provider if you are struggling with alcohol too.
Is Suboxone better than methadone?
Neither is better for everyone. Both are effective. The best choice depends on your history, health and needs. Our guide to methadone vs. Suboxone explains the differences.
Get Help With Opioid Addiction Treatment in Lancaster, PA
If you are considering Suboxone for opioid addiction, you do not have to figure it out alone. The Ranch Pennsylvania Outpatient Services offers addiction treatment programs in Lancaster, including a partial hospitalization program (PHP) and an intensive outpatient program (IOP). Medication-assisted treatment may be available when clinically appropriate, along with therapy, psychiatric care and aftercare planning. Visit our opioid addiction page to learn more, or verify your insurance today. Our admissions team is available 24/7, and calls are free and confidential.
