Yes, you are sober when you are on Suboxone.
Medications for opioid use disorder (mOUD) are clinically proven and effective treatments for OUD, helping to keep people in treatment programs and minimizing the odds of a dangerous relapse and possible life-threatening overdose.[1]
Suboxone is an FDA-approved mOUD. Contrary to common misconceptions, Suboxone does not get you high, and it can be taken on a long-term basisduring ongoing recovery. You are sober when taking Suboxone.
Suboxone is a prescription medication used to treat opioid dependence and addiction, generally as part of a complete opioid addiction treatment program.[2] It is a combination mOUD that contains both buprenorphine and naloxone.
Buprenorphine is a partial opioid agonist. This means that it binds to opioid receptors in the brain to keep them active, therefore minimizing drug cravings and opioid withdrawal symptoms.
Since it is only a partial agonist, Suboxone does not activate these receptors to the same extent that full agonists like heroin and prescription painkillers do. It is also only effective up to a certain point before plateauing.
Naloxone is an opioid antagonist that blocks opioids from these receptors. The naloxone component of Suboxone is only activated if the drug is misused via injection or if other short-acting opioids are introduced, such as during a relapse. In this way, the naloxone can act to deter misuse and is an effective relapse prevention tool.
Suboxone does not make you high in the same way that full opioid agonists do. The short answer is that you are not high when you take Suboxone.
The medication is usually taken as a sublingual film in specific dose strengths, often only once per day. The goal is to take the lowest dosage possible for maintenance. The general recommended maintenance dose is 16 mg buprenorphine/4 mg naloxone. It can also be taken as a sublingual tablet, and in this form the general recommended maintenance dose is 11.4 mg buprenorphine/2.9 mg naloxone [3].
Buprenorphine is only a partial opioid agonist. It has a ceiling effect, meaning that it stops working after a certain dosage is reached, making it very difficult (if not impossible) to create the same rush of euphoria that other opioids can cause.
The naloxone component of Suboxone will activate if the medication is misused, essentially kicking the opioid drugs off the receptors, blocking their effects. This will throw the person into opioid withdrawal.
As an mOUD, Suboxone is commonly misunderstood. There are several myths surrounding the medication that can stigmatize it and act as barriers to treatment.
Some of the most common myths are debunked here:
While Suboxone does contain an opioid medication (buprenorphine), this is only a partial agonist and does not interact with the opioid receptors to the same extent that other opioids and full agonists do [4].
Suboxone is proven to be effective in treating OUD and reducing the odds of relapse and further misuse of other opioid drugs. Suboxone does not make you high or impair your mind and body in the same way that narcotic prescription opioid pain relievers or the illicit drugs heroin and fentanyl do.
Myth #2: You Are Not in Recovery if You Are Taking Suboxone
Traditional versions of recovery often adhere to the complete abstinence-based methodology as outlined by AA (Alcoholics Anonymous) at its inception.
Addiction is defined as a chronic medical disease that impacts brain chemistry and function.[5] Suboxone helps to regulate brain chemistry that has been impacted by opioid dependence. Taking Suboxone is similar to taking medications to manage other chronic medical conditions or diseases, such as insulin for type 1 diabetes.
You can be in recovery and taking Suboxone.
It is very difficult to overdose on Suboxone due to its misuse-deterrent components. Naloxone will block the effects of opioids, and the ceiling effect of buprenorphine will limit how intensely the opioid receptors can be activated.
Overdoses involving Suboxone most often include other drugs or medications, particularly sedatives like benzodiazepines. It is very hard to overdose on Suboxone by itself.
Again, Suboxone has several properties that make it less desirable as a drug of misuse. It does not create the same rush of euphoria that other opioids can, and if the drug is misused by injection, naloxone will activate, which can precipitate difficult opioid withdrawal symptoms.
When Suboxone is misused (used without a valid prescription), it is generally in an effort to mitigate withdrawal symptoms and not in an attempt to get high. Improved access to mOUD and less stigma surrounding this form of treatment can help to reduce Suboxone misuse.
While Suboxone is intended to be taken as part of a more complete opioid addiction treatment program that includes supportive care and behavioral therapies, it can still be effective in treating opioid dependence on its own.
Suboxone is most effective when combined with additional methods of addiction treatment, but it is still better on its own than no treatment at all.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that approved medications for opioid use disorder, including Suboxone, are safe to take for months or even years.[6]
Suboxone can be taken in low maintenance doses as long as it is needed to manage recovery and prevent relapse. Many people continue to take Suboxone indefinitely.
Addiction is a chronic and relapsing disease, but it is also treatable. mOUD arean evidence-based treatment method with proven effectiveness, but are still highly stigmatized in some circles.
The Centers for Disease Control and Prevention (CDC) reminds people that these medications are useful and effective.[7] Taking them is not “taking the easy way out.” It is doing what works best to manage opioid use disorder.
Addiction looks different for everyone. You and your health care provider will decide what is the best course of action for you specifically. Most medical professionals support the use of mOUD.
It can be helpful to surround yourself with people who are supportive of your choice to use mOUD. You can join support groups of like-minded individuals who are also using medications to manage opioid use disorder.
There are several things to consider when discussing mOUD with people who are sober and may not understand. Consider these tips:
Talk only to those willing to listen. Your health care is only your business, and you are not required to share which medications you are taking with anyone. Not everyone is going to be supportive of your recovery efforts. If you sense that someone is not going to be supportive, skip the conversation and find others who will be supportive.
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