Suboxone is usually considered to have low, but not zero, “abuse” or misuse potential.
It can cause mild euphoria in people who are opioid naïve, although its high isn’t really comparable to that typically associated with “true” opioids. Suboxone also contains several features that make it less likely to be “abused” or misused as compared with full opioids. These include its “ceiling effect” and the addition of Naloxone, both of which will be discussed here.
Suboxone is a combination of buprenorphine and naloxone that is used to treat opioid use disorder (OUD) [1] It works by acting on opioid receptors in the brain, on the same receptors that opioid full agonists act on. It binds to these receptors and prevents withdrawal symptoms from opioids and reduces cravings to use full opioids. In this way it acts as a treatment for OUD.
Suboxone has some misuse potential since it has the potential to cause some euphoria, particularly in people who are not tolerant to opioids. However, its misuse potential is limited by two features: its nature as a partial opioid agonist and subsequent “ceiling effect”, and the addition of Naloxone.
One of the features of Suboxone that makes it less dangerous than full opioids is its 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 affects plateaus 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.
The addition of Naloxone to Buprenorphine is another safety mechanism to minimize misuse or abuse of this medication.
Naloxone is added to buprenorphine in Suboxone as an additional abuse-deterrent. When Suboxone is dissolved under the tongue, the naloxone component is not readily absorbed because it has a low bioavailability and sublingual absorption rate compared to buprenorphine.[2] Therefore, when taken sublingually as directed, the Naloxone is not absorbed and the patient only experiences the effects of the buprenorphine. However, naloxone is active if injected intravenously. Therefore, if a patient tries to inject Suboxone, the Naloxone will be absorbed along with the buprenorphine, binding preferentially to the body’s opioid receptors and preventing the patient from getting “high” off of the Suboxone. This prevents misuse of the medication and also prevents an overdose. The addition of Naloxone to buprenorphine therefore prevents misuse or abuse of the medication.
All drugs have side effects. While Suboxone causes some health effects, it is generally safe if taken as prescribed, although it's usually recommended you wait to see how it affects you before operating heavy machinery or driving. Some common side effects associated with it include headaches, back pain, stomach pain, constipation, trouble sleeping, mouth numbness, and blurred vision.[1]
When considering if a drug is “safe”, the real question is, “safe compared to what?” Suboxone is almost certainly safer than taking full opioids such as prescription painkillers or other illicit opioids such as heroin or fentanyl. If you have any concerns about the health effects or safety of Suboxone, talk openly with your doctor about your concerns and make sure your questions are answered.
While rare, buprenorphine and buprenorphine/naloxone misuse does occur. [5] Some patients, particularly those who are opioid naive and not used to taking opioids, may get a mild euphoria or high after taking the medication. In spite of this, studies show that the majority of patients are not taking Suboxone to “get high”. In contrast, they are trying to prevent the crippling withdrawal symptoms and cravings that create a cycle of return to opioid use. [6] Buprenorphine is considered to have moderate to low abuse potential compared to the high abuse potential of most opioid full agonists [7].
If you’re seeking help for any kind of drug use problem, even an issue with a drug generally considered to have low misuse potential like Suboxone, talk to an addiction treatment professional. They can help you form a treatment plan suited to your needs and discuss all your options with you.
A good place to start if you’re unsure how to begin is SAMHSA’s National Helpline. This is a free, confidential government resource available 24/7 at 1-800-662-HELP (4357).[8] It is designed to help people learn more about local addiction treatment and mental health resources that can help them further.
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