What is the Suboxone ‘Ceiling Effect’?

Suboxone, like all opioids, does cause some sedation and “euphoria”, particularly in patients who are “opioid naive” (do not take opioids regularly).

Full opioid drugs will continue to give more and more euphoria at higher and higher doses, and eventually cause so much sedation and respiratory depression that the patient will become somnolent and overdose.

However, unlike pure/full opioids, Suboxone is called a “partial opioid”, and has a “ceiling effect”. 

The ceiling effect means that Suboxone will produce a certain degree of euphoria and pain relief, but those effects will plateau at higher doses. This means that the patient will not continue to get more and more sedated at higher and higher doses. This means the risk of over-sedation and overdose are much much lower with Suboxone than with “full” opioids. 

The ceiling effect is part of what makes Suboxone so safe compared to other opioids.

How Does the Suboxone Ceiling Effect Work?

Suboxone contains two medications: the partial opioid agonist buprenorphine and an opioid antagonist component called naloxone.

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 analgesia, euphoria, and respiratory depression plateau at high doses. This is what is called the ceiling effect. [1]

If misused or taken in doses higher than prescribed or in a method other than intended, the patient will not continue to "get more and more high" as they would with a full opioid agonist.

This minimizes the utility of taking more and more of the medication, lowering the risk of overdose and preventing the temptation to misuse the medication. 

What Does It Feel Like When You Take Suboxone?

Suboxone generally takes about 10 to 45 minutes to take effect depending on the individual.[2]

People may experience the following:

• Better mood: Opioid naïve users could potentially feel some euphoria, but not to the same degree you'd experience with other full agonist opioids. You will not feel "high."
• Fewer addiction symptoms: Suboxone will reduce drug cravings and limit withdrawal symptoms.
• Less pain: Suboxone blocks pain receptors, having an analgesic effect.
• Subtle side effects: Suboxone can also make you sleepy and create some slight nausea, dizziness, slowed breathing, and coordination issues. These side effects may be stronger as the body adjusts to the new medication, but they often dissipate once a person is accustomed to taking daily Suboxone.

If you try to inject Suboxone, the naloxone component of the medication will bind to the receptors in the body instead of the buprenorphine. You can feel sick and experience opioid withdrawal symptoms. The manufacturers intend these side effects as a deterrent to misuse.

Suboxone for MAT 

Suboxone is prescribed as a Medication for Addiction Treatment (MAT) for opioid use disorder (OUD).[3] The medication is a sublingual film that you place under your tongue to dissolve.

Suboxone generally comes in the following dosage strengths:[4]

• Buprenorphine 2 mg and naloxone 0.5 mg
• Buprenorphine 4 mg and naloxone 1 mg
• Buprenorphine 8 mg and naloxone 2 mg
• Buprenorphine 12 mg and naloxone 3 mg

It is important to start taking Suboxone after opioid withdrawal symptoms begin. You may need to wait the following time frames:

• 12 to 24 hours after the last use of opioids like heroin or oxycodone
• Closer to 48 to 72 hours if you have been using longer-acting opioids, including methadone

After initiation, Suboxone is generally taken as a single daily dose. However, depending on your needs, it can sometimes be dosed two or even three times a day.

The dose range varies between patients. It is sometimes as low as 2 mg of buprenorphine, and it can be as high as 24 mg of buprenorphine daily. It sometimes takes a few days to slowly adjust the dose to find what is right for you, which is why it is important to work closely with a medical prescriber as you first begin to take Suboxone.

Get Started With Bicycle Health

Bicycle Health is a leading provider of OUD treatment. A unique telemedicine model allows skilled and talented doctors to work with people in need, no matter where they live. Doctors hold virtual appointments, and they call medications into pharmacies near their patients. 

If you're interested in using Suboxone for OUD treatment, contact us to learn more about how our model works.

Sources

1. Clinical Pharmacology of Buprenorphine: Ceiling Effects at High Doses. Clinical Pharmacological Therapy. https://pubmed.ncbi.nlm.nih.gov/8181201/. May 1994. Accessed December 2022.
2. A Patient’s Guide to Starting Buprenorphine at Home. It Matters. https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed December 2022.
3. MAT Medications, Counseling, and Related Conditions. Substance Abuse and Mental Health Services Administration. November 2021. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions#medications-used-in-mat. Accessed December 2022.
4. Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.suboxone.com/pdfs/prescribing-information.pdf. June 2022. Accessed December 2022.