Suboxone® is widely recognized for its effectiveness in treating opioid use disorder, with the U.S. Department of Health and Human Services as a first-line treatment. But it still must be taken with care (important safety information). As with any drug, there are side effects to consider, some of them potentially harmful.
Buprenorphine—one of the key ingredients in Suboxone—can affect the central nervous system, such as respiratory depression and lowered blood pressure. The death of "Friends" actor Matthew Perry, who passed away in a hot tub in late 2023, has shed light on this issue since toxicology reports showed evidence of buprenorphine.
If you've been prescribed Suboxone to treat opioid addiction, you may be wondering if it's safe to enjoy a soak while on the medication. Below, we explain the possible dangers of taking hot baths while on Suboxone.
What are the possible side effects of Suboxone?
Suboxone is a combination medicine made up of two key substances. One is naloxone, which blocks the effects of opioids in the brain's opioid receptors. The other is buprenorphine, which activates the receptors, lessening cravings and withdrawal symptoms. Naloxone by itself has no clinical effect when taken orally; it becomes active when combined with buprenorphine.
Taken as prescribed in the appropriate dosage, Suboxone minimizes uncomfortable withdrawal symptoms, like nausea and cramps. It also reduces and, in some cases, elimiantes cravings. This improves the odds of long-term success without relapse.
Suboxone can also have side effects. In film formulations, the most common side effects are excessive sweating, sleeping troubles, swelling of the extremities, pain, decreased sensation and redness in the mouth, tongue pain, headache, nausea, vomiting, and constipation.
In general, the buprenorphine in Suboxone slows down the central nervous system. This can lead to side effects like low blood pressure, drowsiness, and dizziness—and these effects are why Suboxone can prove risky in a hot tub. This grouping of symptoms is also known as orthostatic hypotension, which can occur due to dehydration or after sitting for long periods and standing up too quickly.
Suboxone + the dangers of hot water
The possible risks of buprenorphine's side effects were illuminated by the passing of Matthew Perry. Experts suggest that, while drowning was a contributing factor, the ketamine in Perry's system was the ultimate cause of his death. However, according to the medical examiner (ME), buprenorphine was also found in Perry's system and may have been an additional factor.
The ME concluded that the buprenorphine may have contributed to the actor's passing because of the respiratory depression it can cause, especially if it’s combined with other sedating substances. Since the medicine generally slows the central nervous system, it can lead to symptoms like drowsiness, dizziness, low blood pressure, and respiratory depression.
This effect on blood pressure may be amplified in a hot tub. The high temperatures generally cause the body's blood vessels to dilate, which further reduces blood pressure. While this can have therapeutic benefits in some cases, like soothing aches and pains, it can create risks for those taking buprenorphine.
Low blood pressure and respiratory depression, combined with dizziness and drowsiness, may increase the risk of drifting off in a hot tub, for instance. This can increase the chances of drowning, a contributing factor in Perry's death. The presence of other sedating substances, like ketamine or alcohol, increases the risks even more.
There is even a term for the combination of changes to the body: hot tub syncope. This occurs when a hot tub causes a person's heart rate and blood pressure to initially rise and then decrease. Although it isn't common, syncope following hot tub immersion can be deadly. Precautions to avoid it include keeping the water temperature below 104 degrees Fahrenheit and not soaking for more than 15 minutes at a time.
Is buprenorphine still considered safe?
Although Matthew Perry's death may appear to be a cautionary tale, it's just as much a reminder of the important role that buprenorphine can play in battling OUD—and the incident should not deter people from using Suboxone or another buprenorphine medication.
First, it's important to note that it was the high levels of ketamine in Perry's system, not the trace amounts of buprenorphine, that are considered the ultimate culprit in his death. Any potential side effects of buprenorphine were likely outweighed by the effects of the ketamine.
Further, the fact that Perry appeared to be on medications for addiction treatment (MAT) and opioid-free at the time of his passing is a testament to MAT's power. The amounts of buprenorphine in Perry's blood were at therapeutic levels, while he didn't have any other opioids (like heroin, fentanyl, or oxycodone) in his system.
The value of Suboxone in treating OUD
Matthew Perry's death may be seen as a warning regarding the dangers of taking hot baths when also taking buprenorphine. However, it also serves as a valuable opportunity to raise awareness about MAT and its ability to help people struggling with opioid use disorder OUD.
Like any medication, Suboxone has side effects. That doesn't mean it should be ruled out as a viable option for treating OUD. Hundreds of medical research papers have validated Suboxone's effectiveness. It's approved by the Food and Drug Administration (FDA) and has also been recognized by the World Health Organization (WHO) for its life-saving abilities.
If you have been prescribed Suboxone by a healthcare professional as part of an MAT program, it's important to adhere to your treatment plan. With knowledge about potential side effects and risks, like the dangers of hot tubs, you can make sure you're staying safe.
If you struggle with OUD and think you might benefit from MAT, Ophelia can help. We simplify access to treatment by connecting patients with healthcare professionals online. If you're eligible, we’ll send a prescription for Suboxone or another buprenorphine-naloxone to your local pharmacy.
Most importantly, your care team is available 7 days a week to answer questions about medication management and lifestyle changes during treatment because you deserve comprehensive care that fits into your daily life.
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