Suboxone is a prescription medicine that is used to treat opioid addiction, including prescription painkillers and illegal opioids like heroin. Suboxone contains two main ingredients – buprenorphine and naloxone. These two ingredients reduce cravings and withdrawal symptoms of opioid drugs like oxycodone, hydrocodone, codeine, fentanyl, and heroin. If you or a loved one are struggling with addiction, call our 24/7 hotline.

What is Suboxone?

Suboxone is a prescription medication for people addicted to heroin, prescription painkillers, or other opioids. Suboxone is a mix of buprenorphine and naloxone and helps to prevent opioid withdrawal and promote long term abstinence. Essentially, suboxone is a safer long-term replacement for opioids.

Suboxone is classified as a Schedule III controlled substance in the United States, and is technically considered a synthetic opioid.1 Substances in this schedule have a medical use and also a potential for abuse and addiction. For those who are addicted to opioids, suboxone is not an intoxicating substance if used as directed.

Because of its moderate risk for addiction, Suboxone can only be prescribed by physicians who are certified by the U.S. Department of Health and Human Services. Because of the potential for abuse, physicians who prescribe suboxone have to gain special certifications and are subject to additional oversight and regulation. 2 There are approximately 23,000 physicians in the U.S. who are authorized to provide Suboxone treatment. 3

Suboxone Ingredients: Buprenorphine and Naloxone

The two active ingredients in Suboxone, buprenorphine and naloxone, are present in a ratio of 4:1 respectively.4 Together these two ingredients of Suboxone help people overcome opioid addiction.

Buprenorphine: Buprenorphine is a long-acting partial opioid agonist. In other words, it binds to the same opioid receptors in the human nervous system as opioid drugs like heroin, morphine, fentanyl, and oxycodone. By blocking the opioid receptors, buprenorphine prevents opioid drugs from acting on the brain. However, since buprenorphine is an opioid itself, it causes some of the same effects as the opioid drugs.

People who have developed an opioid addiction often have a high tolerance to opioid drugs, and this means that suboxone does not normally cause them to experience a “high”. The medication does, however, prevent them from experiencing the unpleasant withdrawals and reduces drug cravings.

Illicit opioids like heroin and fentanyl have a high risk of fatal overdose, and by offering a painless way to stop using, suboxone can help to reduce the number of opioid overdoses. Studies show that Suboxone treatment substantially reduces the risk of adverse outcomes and death from opioid abuse and addiction. Buprenorphine is a safe medication and has been prescribed to hundreds of thousands of people worldwide. Its side effects are similar to opioid drugs, but less severe and less frequent. 5

Naloxone: Naloxone is used to reverse an opioid overdose. It is an opioid antagonist. In other words, it blocks and reverses the effects of opioid drugs in the body. This means that if a person were to relapse while the drug is in their system, they would not experience the euphoric effects. This further reduces the incentive to relapse.

Suboxone: Historical Context

Buprenorphine, the opioid component of Suboxone, was developed in the 1970s as a safer alternative to morphine for the management of pain.6 It was considered an attractive alternative to methadone, another opioid medication that is used for the treatment of opioid use disorders. The addiction treatment community lobbied for buprenorphine to be excluded from the Narcotic Addict Treatment Act which would require it to be administered by federally designated clinics.

The Drug Addiction Treatment Act of 2000 authorized waivers for individual physicians to prescribe buprenorphine for the treatment of opioid use disorders. Buprenorphine is the only drug authorized under this waiver. The buprenorphine-only formulation, Subutex, received FDA approval in the United States in 2002. However, because Subutex contains buprenorphine alone, there is a risk of diversion (unauthorized rerouting or misuse, for example, by selling or sharing with someone for whom the medication was not intended).

In the same year, 2002, the FDA approved Suboxone (buprenorphine and naloxone). The additional ingredient (naloxone) prevents opioid abusers from injecting Suboxone to get high and limits its abuse potential.

Addiction Potential of Suboxone

The risk of developing an addiction to Suboxone is lower than with heroin, morphine, fentanyl, and oxycodone. The lower addiction potential of Suboxone can be explained by the ceiling effect of buprenorphine, in which increasing doses of buprenorphine do not amplify its potency. Unlike other opioids, increasing the dose of suboxone will not result in heightened effects.

Although recreational use of Suboxone to get high has been reported, it is not very common because Suboxone produces a less potent high compared to other opioids. Because suboxone has limited recreational use, the psychological addictiveness of the substance is low.

The physical addictiveness, however, is very real, and is experienced by people who want to stop using suboxone. Because suboxone is a long-acting opioid agonist, the withdrawals from the medication are similar to withdrawals from other opioids but can last for a longer time. Because of this, many people on suboxone stay on the medication for several years, and physicians do not generally push patients to taper off or stop.

Suboxone Addiction Statistics

Suboxone, a combination of buprenorphine and naloxone, was developed as an abuse-deterrent, but this does not mean it has no addictive potential. While the medication is generally not intoxicating as prescribed, people sometimes misuse the drug in ways that can cause intoxicating effects. Statistics show that buprenorphine prescriptions have grown rapidly over the last few years, as have the opportunities for Suboxone abuse. Here are some statistics that indicate the scope of Suboxone addiction: 7 8

  • 190 million dosage plus units of buprenorphine were sold in 2010 in the United States, up four-fold from 2006.
  • Close to 800,000 Americans received buprenorphine prescriptions from physicians in 2010, representing a five-fold increase from 2006. 
  • There is a rising trend of Suboxone diversion and addiction. A 2009 survey found that 46% of Suboxone prescribing clinicians believed the medication was diverted (rerouted to someone other than for whom it was intended). However, 44% of physicians believed the diversion (selling or sharing) was for self-management of withdrawal symptoms. More than half the surveyed physicians believed the source of diverted Suboxone was other substance abuse patients.
  • Approximately 6% of individuals in treatment for prescription opioid abuse report injecting buprenorphine to get high.
  • Between 2002 and 2013, a total of 464 deaths related to buprenorphine were reported, the majority of which (91%) involved a buprenorphine-naloxone combination, possibly because the combination is more widely prescribed than buprenorphine alone.
  • Buprenorphine-naloxone was involved in 9.5% of emergency hospitalizations for drug ingestion by children under the age of 6, greater than any other single medication, even though buprenorphine products account for less than 1% of all retail prescriptions. Compared to tablets, Suboxone films have a lower risk of unintentional exposure in children.

Suboxone vs Methadone

There are currently two medications approved for opioid addiction treatment in the United States – buprenorphine (which is a component of Suboxone) and methadone. Methadone was the first legally permitted drug for opioid addiction treatment. 9It is a full opioid agonist that provides maintenance treatment for people with addictions to opioid drugs. Both Suboxone and methadone have a potential for misuse and risk of withdrawal. Yet, they differ in many ways. How does Suboxone compare to methadone? What are the differences between the two? 10 11

  • Methadone is a generic drug, and also available under brand names such as Methadose and Dolophine. Suboxone is a brand name for the combination of buprenorphine and naloxone.
  • Methadone is a Schedule II drug. Suboxone is a Schedule III drug with lower addiction potential.
  • Methadone is available in tablet, solution, concentrate, and injectable solution formulations. Suboxone is a sublingual oral film which is placed under the tongue or between the cheek and gums to dissolve. Generic versions of Suboxone are available as sublingual tablets and oral films.
  • Methadone is more likely to cause users to get high. Suboxone is believed to have less recreational abuse potential. Methadone also has more potential side effects than Suboxone.
  • Methadone is typically distributed in clinics where users need to come for daily doses while Suboxone can be prescribed normally and taken at home. For this reason, Suboxone is often a more sustainable long-term option for users who cannot commit to coming to a clinic daily.
  • Methadone has more than 4 times the risk of overdose than buprenorphine. Therefore, Suboxone is a safer alternative to methadone.
  • Methadone has superior treatment retention, i.e., patients remain in treatment longer compared to Suboxone. However, among patients who remain in treatment, both drugs are equally effective in suppressing opioid abuse.
  • Suboxone is the treatment of choice in opioid-dependent pregnant women because studies show it is safer than methadone. Babies of patients treated with Suboxone have better outcomes in terms of birth weight, head circumference, and neonatal withdrawal symptoms.

Uses of Suboxone

Doctors prescribe Suboxone to people with an addiction to short-acting opioids such as prescription painkillers and heroin. Suboxone treatment typically starts during the detoxification from opioids to alleviate withdrawal symptoms and reduce cravings. Following this, patients are transitioned to the Suboxone maintenance phase. At this stage of the opioid addiction treatment, Suboxone works by reducing or eliminating cravings and thus preventing relapse. Some additional indications for Suboxone use include: 12

  • Management of opioid addiction in patients who have a contraindication to methadone.
  • Treatment of opioid dependence when methadone facilities are not available, for example, if there is a long waiting list to join a methadone clinic.
  • For opioid-addicted patients who have failed methadone treatment.
  • In patients with a short history of opioid abuse or lower needs for opioid agonists.

If a person specifically requests, a physician can recommend a tapering procedure to safely come off of the medication. It is still likely that users will experience some withdrawal symptoms during this tapering phase.

While both methadone and Suboxone are effective, Suboxone is becoming a more commonly recommended treatment for opioid addicts because it is more accessible and generally considered safer.

Correct Suboxone Administration

To reduce the risk of addiction and other health complications, Suboxone should be used exactly as directed by the prescribing physician. Do not use Suboxone more often than prescribed. Remember, Suboxone is not an as-needed medication. The sublingual Suboxone film must be used once every day. Some people may be prescribed two Suboxone films per day.

The Suboxone films should be carefully stored out of the reach of children. Accidental use of Suboxone by a child is a medical emergency and can result in death. 13If a child has accidentally used Suboxone, you should get emergency help right away. To prevent accidents, Suboxone comes in a sealed, child-proof foil pouch.

To correctly use Suboxone, the film should be placed under the tongue or inside the cheek where it should be allowed to dissolve. Drinking some water to moisten the mouth before taking Suboxone can help the film to dissolve more easily. It’s important not to chew or swallow the film because this will cause Suboxone to not work as well. “Shooting up” (injecting) or snorting a Suboxone film can lead to life-threatening infections and serious health problems. Also, patients should not switch from Suboxone to other formulations of buprenorphine as the amount of active drug in different formulations can vary.

People who have been prescribed Suboxone should not stop taking the medication without talking to a doctor. Coming off Suboxone suddenly can lead to uncomfortable withdrawal symptoms. Last but not least, selling or sharing Suboxone with others is against the law and can harm them or cause death.

Misconceptions About Suboxone

There are several misconceptions about Suboxone, both among physicians and recovering opioid addicts. To benefit from Suboxone treatment and avoid Suboxone addiction, it is important to understand clear these misunderstandings.

Suboxone is not a substitution for opioids or heroin because it is not intoxicating. People who use the medication are not getting high from the medication. It is a safe, long-acting medication that can improve the chances of recovery from opioid addiction. Use of suboxone helps to stabilize patients during opioid withdrawal and prevent relapse during rehab. Suboxone addiction is a concern, but is unlikely, and risks can be reduced with increased monitoring, regular urine drug tests, and film/tablet counts.

Suboxone Abuse and Signs of Addiction

Although Suboxone is prescribed to help people overcome opioid addiction, it can still be abused. Suboxone abuse consists of taking more of the drug than prescribed or using it in ways not prescribed (i.e. snorting or injecting it). Heavy opioid abusers, especially heroin users, are less likely to misuse Suboxone because it does not replicate the kind of “high” they are accustomed to. People without a tolerance to opioids are more likely to experience euphoric effects from the medication.

Suboxone film strips are easy to smuggle and hide. People abuse Suboxone by using the film strips as is or by dissolving the films and injecting the drug. Injection of Suboxone puts users at risk of contracting infections like HIV/AIDS.

Some of the signs and symptoms of Suboxone addiction include:

  • Doctor or pharmacy shopping in an attempt to obtain Suboxone from multiple sources.
  • Stealing Suboxone from friends or family members or buying from others.
  • Repeated episodes of asking for early refills, saying that Suboxone was stolen or lost.
  • Displaying Suboxone withdrawal symptoms.
  • Mixing Suboxone with other substances, such as alcohol, to intensify its effects.

Side Effects of Suboxone

Some of the common side effects of Suboxone sublingual film include: 14

  • Nausea and vomiting
  • Constipation
  • Headache
  • Sweating
  • Swollen or painful tongue
  • Numbness of the mouth
  • Redness inside the mouth
  • Lightheadedness (feeling intoxicated)
  • Poor attention
  • Palpitations
  • Insomnia
  • Blurred vision
  • Dizziness and fainting
  • Sleepiness

Besides the risk of Suboxone dependence and addiction, the use of this medication can also cause some serious health effects. The most worrisome side effect of Suboxone is respiratory depression (slowed breathing). This risk is especially high when Suboxone is taken with other medicines like benzodiazepines (Xanax, Valium, Ativan).

Also, in some people, Suboxone can lead to liver problems, a drop in blood pressure, or symptoms of opioid withdrawal. An allergic reaction to Suboxone can produce symptoms such as hives, rash, facial swelling, wheezing, low blood pressure, and loss of consciousness. A Suboxone allergic reaction is a medical emergency and warrants immediate medical attention.

Suboxone Withdrawal

Stopping the use of Suboxone can result in distressing withdrawal symptoms that can make it difficult for patients to wean off the drug. The severity of the withdrawal symptoms typically becomes worse as the dose of Suboxone is gradually reduced. The withdrawal symptoms can last for up to one week after completely stopping Suboxone use. Some of the common Suboxone withdrawal symptoms include: 15

  • Formication (a sensation of creepy crawlies or insects under the skin)
  • Nausea, vomiting, diarrhea, and stomach cramps
  • Chills
  • Dizziness
  • Fever blisters on the mouth
  • Hallucinations
  • Insomnia
  • Anxiety or depression

Suboxone Overdose

Suboxone overdose is uncommon, and rarely occurs. The only way to overdose on Suboxone is to take excessively high doses. In these cases, the symptoms would mirror those of an opioid overdose and could include:

  • Dizziness or fainting
  • Confusion or mental changes
  • Slowed breathing
  • Severe drowsiness
  • Blurred vision
  • Problems with coordination
  • Slurred speech
  • Slowed reflexes

The risk of Suboxone overdose is higher if a person is taking it in combination with other drugs such as benzodiazepines, tranquilizers, sedatives, antidepressant medications, and alcohol.

Causes of Suboxone Addiction

The first step in preventing Suboxone addiction is for physicians to understand the reasons for diversion and misuse, some of which are listed below:11,15

  • Some patients on Suboxone treatment are under peer pressure to share their medication to help an addicted friend or family member.
  • People receiving Suboxone may feel their dose is not high enough (perceived under-dosing).
  • Patients sometimes sell Suboxone to pay off debt, cover medical or living expenses, or buy a preferred opioid to abuse.
  • Some people are habituated to snorting or injecting drugs and abuse Suboxone out of habit.
  • People experiencing opioid withdrawal and/or cravings may misuse Suboxone to get relief from their symptoms.
  • Suboxone is sometimes abused to get high or get extra energy.

Preventing Suboxone Addiction

A no-tolerance approach to the prevention of Suboxone addiction involves discharge from treatment if misuse of Suboxone is discovered. However, such an approach is not helpful to patients and puts them at risk of opioid addiction relapse. This does not imply that physicians should accept Suboxone misuse and diversion and do nothing about it.

There are several things physicians can do to prevent diversion and misuse and reduce the risk of Suboxone addiction: 16

  • Physicians should explain Suboxone misuse and diversion to each patient and discuss strategies to combat these behaviors. This information should be repeated at each clinic visit.
  • Patients should not receive excessively high daily doses or large supplies of Suboxone.
  • Clinicians should be vigilant for non-healing track marks on the skin that can indicate potential injection Suboxone abuse.
  • Repeated requests for early refills due to reasons such as lost, stolen, or washed medication (forgot to remove from pockets), should raise a red flag.
  • Urine drug tests can confirm whether a patient is taking Suboxone daily as prescribed. Regular monitoring of urine with drug tests for buprenorphine can be used to ensure compliance with treatment.
  • State prescription monitoring programs can prevent doctor or pharmacy shopping, i.e., attempts to obtain Suboxone from multiple sources.
  • Random medication counts at the doctor’s office or pharmacy can be used to screen for potential Suboxone misuse or diversion.

People can develop a Suboxone addiction despite the prescribing physician’s best efforts to encourage responsible use of this medication. Treatment programs for Suboxone addiction can help such individuals get clean.

When to Call a Suboxone Helpline Phone Number

If you notice you are using your medications other than prescribed, getting help as soon as possible can prevent significant problems down the road. In addition, if you seek opioids or other narcotics from family, friends, or even from drug dealers, you should seek the support from addiction professionals.

If you are worried about a loved one’s struggles with narcotics, you here are some red flags to look out for:

  • Inability to stop using medications or other opioids
  • Withdrawing from family and friends
  • Running out of prescriptions early
  • Jumping from doctor to doctor to get more medications
  • Erratic or irritable behavior
  • Altered sleeping habits
  • Periods of intense sweating, nausea, shaking, or chills
  • Disappearing for long periods of time
  • Neglecting work, family, or other responsibilities

What to Expect When Calling A Suboxone Hotline Phone Number

If you’re thinking about calling a drug hotline, you may be a little nervous. After all, you’ve been through a lot–either with a loved one’s or your own addiction. Change can be difficult. You may be scared to once again go through the awful withdrawal symptoms.

Don’t worry. Others have been through these same painful moments. Many found calling a Suboxone hotline for addiction has changed their lives for the better. All it takes is a few courageous moments to pick up the phone and call.

Once you are connected with an addiction specialist, you’ll wonder why you didn’t make the call sooner. They understand what you are going through and can lend an empathetic ear to all the emotions and confusion in your mind.

More importantly, they provide you the knowledge and resources to get help for you or a loved one. This can include local detox centers, drug treatment facilities, or counselors specializing in substance abuse.

You are never alone during this difficult time. Support is just a phone call away.

Last updated: October 1, 2020

About the author

Hailey Shafir
Hailey Shafir, M.Ed., LCMHCS, LCAS, CCS

Hailey Shafir is a licensed addiction specialist and mental health counselor. She graduated from North Carolina State University with a master of education in clinical mental health counseling in 2012, and has developed deep expertise in the areas of mental health, behavioral addictions and substance abuse. She is passionate about using this knowledge to raise awareness, provide clear and accurate information, and to improve the quality of treatment for these disorders.

Hailey is an LCMHCS (license number: S9539) under the North Carolina Board of Mental Health Counselors, and an LCAS (ID: LCAS-21333) and CSS (ID: CCS-20721) under the North Carolina Addictions Specialist Professional Practice Board.

References

  1. US. Department of Justice. Drug Enforcement Administration. Diversion Control Division. Controlled Substance Schedules. No date. Available online. https://www.deadiversion.usdoj.gov/schedules/ Accessed 31 July 2020
  2. Huhn AS, Dunn KE. Why aren’t physicians prescribing more buprenorphine?. J Subst Abuse Treat. 2017;78:1-7. doi:10.1016/j.jsat.2017.04.005
  3. Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315-326. doi:10.1097/ADM.0000000000000045
  4. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.
  5. Welsh C, Valadez-Meltzer A. Buprenorphine: a (relatively) new treatment for opioid dependence. Psychiatry (Edgmont). 2005;2(12):29-39.
  6. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.
  7. Lofwall MR, Walsh SL. A review of buprenorphine diversion and misuse: the current evidence base and experiences from around the world. J Addict Med. 2014;8(5):315-326. doi:10.1097/ADM.0000000000000045
  8. Johanson CE, Arfken CL, di Menza S, Schuster CR. Diversion and abuse of buprenorphine: findings from national surveys of treatment patients and physicians. Drug Alcohol Depend. 2012;120(1-3):190-195. doi:10.1016/j.drugalcdep.2011.07.019
  9. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.
  10. Whelan PJ, Remski K. Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. J Neurosci Rural Pract. 2012;3(1):45-50. doi:10.4103/0976-3147.91934
  11. Srivastava A, Kahan M, Nader M. Primary care management of opioid use disorders: Abstinence, methadone, or buprenorphine-naloxone?. Can Fam Physician. 2017;63(3):200-205.
  12. Kumar R, Viswanath O, Saadabadi A. Buprenorphine. [Updated 2020 Feb 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459126/
  13. Suboxone Medication Guide. No Date. Available online https://www.suboxone.com/pdfs/medication-guide.pdf Accessed on 31 July 2020
  14. Suboxone Medication Guide. No Date. Available online https://www.suboxone.com/pdfs/medication-guide.pdf Accessed on 31 July 2020
  15. Blum K, Oscar-Berman M, Femino J, et al. Withdrawal from Buprenorphine/Naloxone and Maintenance with a Natural Dopaminergic Agonist: A Cautionary Note. J Addict Res Ther. 2013;4(2):10.4172/2155-6105.1000146. doi:10.4172/2155-6105.1000146
  16. Yokell MA, Zaller ND, Green TC, Rich JD. Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review. Curr Drug Abuse Rev. 2011;4(1):28-41. doi:10.2174/1874473711104010028