As opioid use—and subsequent addiction and overdoses—has risen throughout the United States, so has research into prevention of opioid overdoses and treatment of opioid use disorder. One of the most successful and life-saving developments to come from this research has been the creation of Suboxone®, which was introduced in 2003 (important safety information).
Suboxone, a brand name of the generic buprenorphine/naloxone drug, is a prescription medication used as part of a treatment for opioid addiction. It is a combination of two substances: buprenorphine and naloxone. It comes in both a film and a tablet form, depending on the patient’s needs.
How does Suboxone work?
Buprenorphine is an opioid that only partially activates the brain’s opioid receptors, resulting in the usual medical effects of an opioid without the risk of toxic effects when the dose is increased. This ceiling effect means that the drug does not produce euphoria, sedation, or slowed breathing, even when taken in larger doses. The other benefit of buprenorphine is that it’s long-lasting, meaning it reduces withdrawal symptoms and cravings over longer times than comparable drugs.
Naloxone, often sold by itself as Narcan®, is an opioid antagonist. It competes with opioids for the same receptors without activating them, thereby blocking effects of opioids. When it is given to someone with a lot of opioids on board, naloxone also reverses effects of an overdose by countering the depression of breathing in victims.
Naloxone is combined with buprenorphine in medications used to treat opioid addiction to reduce the risk of medication misuse. The dose of naloxone used in Suboxone, and all other medications approved for treatment of opioid use disorder, is low enough that it produces minimal effects when taken correctly by letting the film or tablet dissolve from under the tongue. However, naloxone becomes fully active if the medication is misused—either by snorting or injecting—producing very unpleasant state of opioid withdrawal, therefore discouraging its misuse.
When used together in the form of Suboxone, this medication is very effective in reducing cravings for opioids and protracted opioid withdrawal, which are often the reasons people are not able to remain fully abstinent. Moreover, these two drugs block the effects of other opioids and reduce the risk of overdose and death by overdose by an extreme margin. When combined with counseling and behavior therapy as part of a whole-patient approach to treatment, Suboxone sees high rates of success in treating opioid use disorder.
What are the side effects?
The side effects of this treatment vary greatly from person to person and may be more serious depending on any pre-existing conditions you might have. However, in general, Suboxone’s side effects are considered safer than those of other opioid treatments such as methadone. Because the drug includes buprenorphine, the common opioid side effects are to be expected.
General side effects include, but are not limited to:
- issues falling or staying asleep
- increased body temperature and sweating
- nausea, vomiting, and pain
- trouble breathing
- physical dependency
- liver problems.
These are considered normal, often resolve with a dose decrease, and are unlikely to indicate a need for medical assistance. More severe side effects, such as allergic reactions and liver problems—including jaundice and darkened urine—may indicate a serious problem. If you are in doubt, contact your healthcare provider for guidance.
Your medical provider should screen you for any risk of developing liver problems before prescribing you Suboxone. This may include taking a blood test to check liver health if you are in a high-risk group. It’s also important to avoid alcohol and other prescription medications while taking Suboxone, and you should inform your doctor ahead of time if you expect to have any of these substances in your system using a Suboxone prescription. Alcohol and other depressants, such as benzodiazepines, can exacerbate certain symptoms, such as trouble breathing and blood pressure changes. These interactions are dangerous and may lead to injury or death.
Some side effects may also vary depending on what form of the drug you’re taking. When taking the sublingual film, you may experience:
- tongue pain
- decreased sensation in the mouth
- redness of the mouth.
This list is not exhaustive, and you should check with your medical provider to ensure that Suboxone is safe for you to use. Do not use heavy machinery while on Suboxone until you are confident of the drug’s effects on your body, as light-headedness and breathing problems can be extra dangerous while operating machinery.
How long does Suboxone stay in your system?
The length of time that your body takes to process opioids is measured by the substance’s half-life. This represents how much time passes before half of the total substance has been metabolized and removed from your system. Many common opioids have a half-life measuring just a few hours. For example, heroin has a half-life between 12 and 16 hours.
Suboxone stays in your system considerably longer and has a half-life of about 40 hours. This means that you can benefit from its effects for a longer period on a smaller dose. Some people may only need to take the drug once a day or once every other day as part of their treatment plan.
If you’re taking Suboxone as part of a treatment plan and are worried about it complicating tests, such as a pre-employment drug screen, you should know that buprenorphine doesn’t show up as a typical opioid in these tests. That means that you will be able to pass such screens even if you’re still in treatment.