Can Suboxone Cause Psychosis?

The U.S. Food and Drug Administration (FDA) doesn't include psychosis on its list of known Suboxone side effects.[1] But case reports suggest some people get it while taking the drug, and others while they withdraw from it.

Psychosis refers to a mental state where there is a loss of contact with reality. Symptoms can include delusions (false beliefs) and hallucinations (seeing, hearing, or feeling things others do not).

Here’s what you need to know about psychosis as it relates to Suboxone. 

Can Suboxone Cause Psychosis?

Psychosis from Suboxone would be an extremely uncommon symptom of Suboxone use. Psychosis could theoretically occur in two situations:

1. Underlying mental health condition 

Presumably, a patient who developed psychosis after starting Suboxone would likely have a history of psychosis or other severe mental health disorder. It would be very unusual for Suboxone alone to cause psychosis without other underlying mental health conditions. Some patients do experience tactile and visual hallucinations while taking their Suboxone doses, although this is also exceedingly rare. [2]

2. During Suboxone Withdrawal 

Some patients experience a sudden onset of psychosis when they stop taking Suboxone. Typically, the problem appears when people stop taking their doses abruptly. Returning to their medications makes the issue disappear.[3] Again, this is much more likely if the patient has a history of mental health disorders or previous history of psychosis.

In either case, abruptly stopping Suboxone isn't smart. Sudden discontinuation can lead to psychosis or other withdrawal symptoms.[4] Always talk to your doctor before you stop taking any prescribed medication.

What Else Causes Psychosis?

Many things can cause psychosis. It is a common symptom of some mental illnesses, like bipolar disorder and schizophrenia. Psychosis can also be triggered by using drugs or medications, including alcohol, marijuana, hallucinogens, opioids, or antidepressants/antipsychotics. 

Can Buprenorphine Reduce Psychotic Symptoms?

In many cases, particularly in patients who have underlying mental health conditions, drug and opioid use can precipitate psychotic symptoms. In these cases, MAT including Suboxone may be particularly important for helping patients to avoid opioid misuse and to help improve the symptoms of psychosis. 

If you have a history of psychosis, Buprenorphine-containing medications like Suboxone are very safe for you to use. In fact, preventing opioid misuse will likely improve your overall mental health and avoid repeat episodes of psychosis.

If you have any concerns about taking Suboxone with a history of psychosis, talk to your doctor. They can provide you the information you need as you move forward with Suboxone treatment.

Sources

1. Prescribing Information: Suboxone. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed July 2022. 
2. Buprenorphine-Induced Psychotic Symptoms: A Case Report. The Primary Care Companion for CNS Disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869611/. August 2018. Accessed July 2022.
3. Possible Psychosis Associated with Buprenorphine Withdrawal. Journal of Clinical Psychopharmacology. https://journals.lww.com/psychopharmacology/Citation/2017/12000/Possible_Psychosis_Associated_With_Buprenorphine.27.aspx. December 2017. Accessed July 2022. 
4. Acute Psychosis and Buprenorphine Withdrawal: Abrupt vs. Progressive Could Make a Difference. European Psychiatry. https://www.sciencedirect.com/science/article/abs/pii/S0924933813774091. July 2013. Accessed July 2022. 
5. A Double-Blind Randomized Clinical Trial of Buprenorphine Augmentation for Treatment of Psychotic Symptoms in Opioid-Addicted Bipolar Patients. Journal of Opioid Management. https://www.wmpllc.org/ojs/index.php/jom/article/view/2660. 2019. Accessed July 2022.