Suboxone’s main ingredient buprenorphine is technically a synthetic opioid. But today, the term opioid is used to describe both opioids and opiates. Previously, the terms opioid and opiate were differentiated, as they technically describe different things.
Suboxone’s main component, buprenorphine, is a long-acting opioid partial agonist. This is a key part of what makes the medication useful in addiction treatment, as it acts on the same parts of the brain as the opioids people typically misuse and can block the effects of those opioids even if a person taking Suboxone tries to misuse those drugs.
Suboxone is a brand-name medication that combines buprenorphine and naloxone, with buprenorphine being its main component at a ratio of 4 parts buprenorphine to 1 part naloxone.[1] This is the most common buprenorphine-based medication used to treat opioid use disorder, suppressing drug cravings and helping users avoid withdrawal, among other benefits.
The terms opiate and opioid are often used interchangeably, and today, opioid is used to describe both, but the terms actually mean different things. Opiates are drugs directly extracted from or refined from natural poppy plant matter.
Common examples of opiates include the following:
Opioid is a broader term, referring to drugs that derive from, or mimic, natural substances found in the opium poppy plant. Many people, including some experts, use the term opioid to refer specifically to “synthetic opioids,” which are drugs synthesized in a lab that mimic some properties of natural opioids but aren’t actually derived from the plant.
All opiates are also opioids, but not all opioids are opiates. Some common opioids that aren’t opiates include methadone, fentanyl, and the various drugs chemically related to fentanyl, such as alpha-methylfentanyl.
To fully answer this question, Suboxone is best thought of in terms of its components, buprenorphine and naloxone.
Buprenorphine is a synthetic opioid, specifically what is called a partial opioid agonist. This essentially means that it attaches imperfectly to the brain’s opioid receptors. This produces some effects similar to full opioid agonists, which includes the opioids more commonly misused, but with often significantly less potency.
The naloxone component of Suboxone is neither an opiate nor an opioid. It is an opioid antagonist, which refers to a drug that attaches to opioid receptors and reverses and blocks the effects of other opioids.[3] In Suboxone, it generally has no effect when the drug is taken under the tongue as intended. The only time it becomes active in the bloodstream is if someone attempts to misuse the Suboxone strip by dissolving and injecting it. In this scenario, the Naloxone binds to opioid receptors preferentially over the buprenorphine to prevent any euphoric effects and, most concerningly, an accidental overdose.
Many people are confused when learning that a synthetic opioid is used to treat opioid use disorder. While it may seem paradoxical, it is important to note that this type of Medication for Addiction Treatment is highly evidence-based.[4] Suboxone and other buprenorphine-based medications have been shown to help in addiction recovery in a number of useful ways.
First, buprenorphine is a long-acting, high-affinity partial agonist that binds to the brain’s opioid receptors. This means it prevents withdrawal in a person who is opioid dependent. It also suppresses their cravings for opioids and stabilizes the brain’s opioid receptors. This way it breaks the cycle of cravings leading to use.
Second, Buprenorphine blocks other opioids from binding to the receptors it has already bound to in the brain, meaning even if a person does misuse other opioids while on a buprenorphine, the effects of those opioids will be sharply reduced, reducing the risk of overdose.
As a partial agonist, it also has a relatively weak effect and lower “ceiling,” which means the drug only produces mild euphoria rather than the intense high associated with full opioid agonists, even if taken at high doses. Taking more of the drug will not produce a proportionally intense high, instead leveling out after a certain level of use.[4] This prevents an individual misusing it in an attempt to “get high”.
Suboxone, especially when used in combination with treatments like addiction counseling and therapy, can help a person stop misusing opioids. While Suboxone has the potential for some side effects, it is far better for a person’s physical and mental health, as well as their overall quality of life, to be taking Suboxone on a carefully controlled schedule than to be regularly engaging in opioid misuse.
If you are interested in learning more about Suboxone and its role as a first line treatment for OUD, reach out to your doctor, or to Bicycle Health to learn more.
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