Suboxone addiction: symptoms, side effects, withdrawal, and treatments

Suboxone addiction is a condition that arises when individuals misuse or abuse the prescription medication Suboxone. Suboxone is a medication used in the treatment of opioid use disorder. It is a combination of two active ingredients: buprenorphine and naloxone.

The symptoms and signs of Suboxone addiction encompass drug cravings, loss of control, compulsive use, slow breathing, pinpoint pupils, continued use despite health issues, doctor shopping, social withdrawal, drug-seeking behavior, and withdrawal symptoms upon drug cessation.

The side effects of Suboxone addiction include feelings of faintness or lightheadedness, cough, fever, vasodilation with skin reactions, urinary issues, excessive sweating, difficulty sleeping, and persistent headaches. Additionally, individuals often experience constipation, abnormal vision, nausea and vomiting, and long-term liver damage.

The symptoms of Suboxone withdrawal are irritability, nausea and vomiting, diarrhea, muscle aches, dilated pupils, depression, and anxiety. Additionally, individuals addicted to Suboxone experience chills, fever, headaches, gastrointestinal issues, insomnia, and drug cravings.

The common treatments for Suboxone addiction are medically assisted detoxification, gradual tapering, medication-assisted treatment, behavioral therapies, support groups, and aftercare and relapse prevention.

Is Suboxone addictive?

Yes, Suboxone is addictive, as it contains buprenorphine, a partial opioid agonist, which causes dependence and addiction if misused or taken without proper medical supervision.

Buprenorphine is susceptible to abuse due to its agonist activity at opioid receptors, although its abuse potential is comparatively lower than that of full opioid agonists, as reported by the  Center for Substance Abuse Treatment in the 2004 “Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction” from the Substance Abuse and Mental Health Services Administration (US).

While it is designed to have a lower abuse potential compared to full opioid agonists, the study warns that caution is necessary when using buprenorphine. It is recommended that physicians prescribing buprenorphine, especially in combination with naloxone (Suboxone), monitor for medication diversion in conjunction with benzodiazepines, opioid antagonists, and other sedatives to mitigate the risk of serious drug interactions.

How addictive is Suboxone?

Suboxone is moderately addictive if used inappropriately or beyond the prescribed guidelines. Suboxone was categorized as a Schedule III controlled substance by the Drug Enforcement Administration (DEA) in 2022, meaning it has a moderate to low likelihood of inducing physical or psychological dependence, as stated in the DEA Diversion Control Division Drug & Chemical Evaluation Section “BUPRENORPHINE (Trade Names: Buprenex®, Suboxone®, Subutex®, Zubsolv®, Sublocade®, Butrans®),” published in May 2022, 

A combination with naloxone has been developed to reduce buprenorphine abuse potential through injection, nevertheless, Suboxone is not completely devoid of addictive properties, as outlined by the Center for Substance Abuse Treatment 2004 “Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction” from the Substance Abuse and Mental Health Services Administration (US).

Why is using Suboxone addictive?

Using Suboxone is addictive because it contains buprenorphine, a partial opioid agonist, which activates the same receptors in the brain that opioids do, though to a lesser extent.

When buprenorphine is misused, it results in moderate to low physical dependence or high psychological dependence, as stated in the Drugs.com article on “Buprenorphine,” last updated in August 2023. This is especially true for individuals who have a history of substance abuse, as misuse causes addiction, overdose, or death, as pointed out in the article.

According to Blazes CK. and Morrow JD.’s 2020 study on “Reconsidering the Usefulness of Adding Naloxone to Buprenorphine,” naloxone has been combined with buprenorphine to reduce the risk of diversion and inappropriate use of the combined drug product.

However, the effectiveness of naloxone in Suboxone during diversion attempts has recently sparked debate, as described in the 2022 issue of the Frontiers in Psychiatry “Suboxone: History, controversy, and open questions”. According to Suboxone’s Food and Drug Administration (FDA) label, naloxone has a half-life of 2 to 12 hours, while buprenorphine’s half-life can range from 24 to 42 hours.

Theoretically, the antagonist effects of naloxone wear off before the agonistic effects of buprenorphine. It is believed that drug-associated rewards are separated from the pleasurable effects, causing individuals to pursue mostly subconscious manifestations and become sensitized through repeated exposures to the drug.

How common is Suboxone addiction?

Suboxone addiction is uncommon, with about 690,000 people, or 0.2% of the US population aged 12 and older, reporting to have misused buprenorphine products, including Suboxone, in the past year, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2021 report “Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health”.

According to the article “Medications for Opioid Use Disorder Study (MOUD Study)” from the Centers for Disease Control and Prevention, last revised in January 2022, around 2.1 million people in the United States were reported to suffer from an opioid use disorder (OUD) resulted from prescription opioids, including buprenorphine.

The acknowledgment of Suboxone’s addictive properties and the statistics of buprenorphine product misuse underscore the significant challenge of addressing and preventing the abuse and potential addiction of this medication.

What is another name for Suboxone addiction?

Another term for Suboxone addiction is buprenorphine addiction. Buprenorphine is the active ingredient in Suboxone, and when individuals misuse or become dependent on this medication, it is referred to as buprenorphine addiction.

Individuals using buprenorphine often hold misconceptions, believing it is a less potent opioid and, consequently, not as addictive as other opioids like methadone. However, despite potency and efficacy, all controlled substances, including pain relievers like buprenorphine, have the potential for abuse, dependence, and addiction, as outlined in the “Drugs of Abuse; A DEA RESOURCE GUIDE,” edited by Drug Enforcement Administration in 2020.

What are the symptoms and signs of Suboxone addiction?

Suboxone addiction manifests through various physical, behavioral, and psychological symptoms and signs. 

The common symptoms and signs of Suboxone addiction are listed below.

• Drug cravings: Persistent and intense urges or desires for suboxone signify an individual’s psychological dependence on the drug. These cravings often drive individuals to seek out and use Suboxone compulsively, contributing to the addictive nature of the behavior.
• Loss of control: Difficulty in managing the quantity or frequency of suboxone use, despite attempts to cut down or quit, indicates a lack of control over substance use. This loss of control is a clear sign of the Suboxone addiction.
• Compulsive use: Uncontrolled and compulsive consumption of Suboxone, even in the face of negative consequences in personal, professional, or social life, highlights the addictive behavior associated with Suboxone abuse.
• Slow breathing: Slow breathing, or hypoventilation, manifests as a symptom of Suboxone addiction due to the central nervous system depressant effects of buprenorphine found in Suboxone. When individuals misuse Suboxone by taking it in excess or in combination with other substances, it exaggerates the depressant impact on the respiratory system, leading to a reduction in breathing rate.
• Pinpoint pupils: When an individual consumes opioids, their pupils undergo constriction as a physiological response to the substance. The opioid compounds influence the muscles controlling the size of the pupils (iris sphincter muscle), causing them to become smaller. Additionally, the pupils often lose their ability to dynamically adjust in response to changes in light levels. 
• Continued use despite health issues: The persistent use of Suboxone despite experiencing physical or mental health issues underscores a disregard for the harm caused by the drug, which is a clear sign of addiction.
• Doctor shopping: Seeking prescriptions from multiple healthcare providers or engaging in deceptive practices to obtain more suboxone is a manipulative behavior that supports and sustains the addiction. A 2023 study conducted in France by Soeiro T. et al., named “Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study,” found that opioids, including buprenorphine, had the highest proportions of doctor-shopped medications during the study period, indicating a significant issue with non-medical use of these substances.
• Social withdrawal: Isolation, neglect of responsibilities, and reduced engagement in activities once enjoyed are consequences of Suboxone addiction.
• Drug-seeking behavior: Devoting a significant amount of time and effort to acquire, use, and recover from the effects of Suboxone characterizes drug-seeking behavior. This behavior reflects the compulsive and driven nature of addiction, with individuals actively seeking out the substance.
• Withdrawal symptoms upon drug cessation: Experiencing physical and psychological discomfort and distress when Suboxone use is abruptly stopped or reduced indicates Suboxone addiction. Withdrawal symptoms associated with Suboxone are akin to those observed in the withdrawal from other opioids, encompassing anxiety, depression, gastrointestinal issues (e.g., diarrhea, abdominal pain), headaches, nausea and vomiting, fatigue, and others, as indicated in the Drugs.com issue titled “How long does Suboxone withdrawal last?” updated in March 2023.

What are the causes of Suboxone addiction?

The causes of Suboxone addiction involve a combination of physiological, psychological, and environmental factors.

The potential causes of Suboxone addiction are listed below.

• Opioid dependence treatment: Suboxone is commonly used to treat opioid dependence, but individuals often develop addiction if the medication is not used as prescribed or if there is a lack of appropriate medical supervision during the treatment process.
• Misuse or self-medication: When individuals misuse Suboxone by taking higher doses than prescribed or using it without a medical prescription in an attempt to self-medicate or achieve euphoria, the likelihood of developing Suboxone addiction becomes higher. According to the findings from the JAMA Network Open 2021 study, titled “Trends in and Characteristics of Buprenorphine Misuse Among Adults in the US,” buprenorphine was often misused as a result of self-treatment for craving and relieving withdrawal symptoms among people with opioid use disorder (OUD).
• History of childhood trauma and abuse: Individuals with a history of substance abuse are at higher risk of developing an addiction to Suboxone, as mentioned in the National Library of Medicine article on “Opioid Use Disorder”, updated in July 2023. Individuals with previous trauma and abuse use substances as a coping mechanism along with an increased vulnerability to addiction associated with adverse experiences.
• Genetic predisposition: According to NIDA’s 2023 March issue, titled “New NIH study reveals shared genetic markers underlying substance use disorders,” the development of substance use disorders (SUD) is influenced by a combination of genetic factors and complex interactions among multiple genes and environmental elements. Individuals with a family history of addiction are more susceptible to developing SUD and drug addictions, including Suboxone addiction.
• Co-occurring mental health disorders: Individuals with co-occurring mental health disorders, such as depression or anxiety, are at an increased risk of developing substance abuse issues, including addiction to Suboxone, as emphasized in the SAMHSA article “Co-Occurring Disorders and Other Health Conditions,” last updated in July 2023.
• Environmental factors: Environmental factors, such as exposure to a substance-abusing environment, lack of social support, or stressful life events, contribute to the development of Suboxone addiction.
• Availability and accessibility: The availability and accessibility of Suboxone, coupled with factors like ease of obtaining prescriptions, contribute to the risk of addiction, especially if the medication is not used under proper medical supervision.

What are the side effects of Suboxone addiction?

The common side effects of Suboxone addiction are listed below.

• Feeling faint, dizzy, or lightheaded: Suboxone’s impact on the central nervous system contributes to feelings of faintness, dizziness, or lightheadedness in individuals grappling with addiction. These sensations indicate the drug’s influence on neurological functions, disrupting the balance and coordination crucial for maintaining a steady and upright posture.
• Cough: The depressant effects of Suboxone on the central nervous system disrupt normal respiratory function, causing individuals with addiction to experience ongoing coughing as a symptom of respiratory distress.
• Fever: Fever associated with Suboxone addiction is likely attributed to potential infections resulting from unsafe drug use practices, such as injecting or using the medication improperly. Additionally, interactions with other substances and individual variations in response to the medication contribute to fever as a side effect in certain cases.
• Vasodilation and skin reactions: In individuals struggling with Suboxone addiction, the drug’s impact on the circulatory system leads to vasodilation, causing flushing or redness, particularly in the facial and neck areas. 
• Urinary issues: Buprenorphine, the partial agonist element of Suboxone, affects the opioid receptors in the central nervous system, potentially causing urinary retention by reducing the signals that prompt normal bladder function. This opioid-induced effect results in difficulty initiating urination and incomplete emptying of the bladder.
• Sweating: Suboxone disrupts the body’s thermoregulatory mechanisms, leading to increased sympathetic nervous system activity, which, in turn, manifests as excessive sweating. The altered balance in neurotransmitter activity, particularly within the autonomic pathways, is a direct consequence of Suboxone’s opioid properties.
• Difficulty sleeping: Excessive Suboxone alters brain chemistry and disrupts normal sleep patterns, leading to insomnia or trouble falling asleep.
• Headache: Persistent Suboxone use causes changes in blood flow or brain chemistry, leading to persistent or severe headaches.
• Constipation: Opioids in Suboxone slow down the digestive tract’s activity, leading to difficulty in bowel movements.
• Abnormal vision: Suboxone can affect the nervous system, potentially leading to changes in vision, specifically blurred vision.
• Reduced sex drive: Opioids in Suboxone suppress the production of sex hormones, leading to a decrease in libido.
• Chest, stomach, back, muscle, and joint pain: These pains result from Suboxone’s effects on the central nervous system and its pain perception pathways.
• Nausea and vomiting: Suboxone irritates the stomach lining or affects the brain’s vomiting center, causing nausea and loss of appetite, which leads to vomiting and unintentional weight loss.
• Liver damage: Long-term Suboxone misuse leads to liver issues. The buprenorphine component of Suboxone, is metabolized in the liver, which often causes toxicity in certain individuals.

Does Suboxone affect personality?

Yes, Suboxone affects personality indirectly, leading to varied individual experiences, such as alterations in emotional responses, increased sociability, or extroversion, alongside instances of heightened withdrawal and introversion. These variations stem from the medication’s influence on the brain and differ among individuals

While certain individuals observe shifts in mood or personality while taking Suboxone, these changes are not solely attributable to the medication itself. Suboxone is often initiated during crucial phases of individuals’ lives, particularly when they commit to recovery, leading to a spectrum of emotional experiences such as negative mood changes or improved feelings associated with success in abstaining from drug use.

Attributing mood changes, including fatigue, anxiety, or irritability, to medication overlooks the complex influences of quitting drugs and significant lifestyle alterations. Given the intricate and multifactorial nature of mood and personality, distinguishing whether mood changes stem from Suboxone or other life factors is challenging.

The indirect effects of buprenorphine on personality were observed in the 2008 study, led by Sansone RA. et al., “The prevalence of borderline personality among buprenorphine patients,” published in the International Journal of Psychiatry in Medicine. The researchers employed three self-report surveys, revealing that the prevalence of borderline personality disorder (BPD) was notably high among individuals addicted to opioids and seeking treatment through buprenorphine.

BPD is a psychiatric condition that significantly impacts an individual’s capacity to regulate their emotions, increasing impulsive behavior, influencing self-perception, and having adverse effects on interpersonal relationships. Individuals undergoing buprenorphine or Suboxone treatment often experience shifts in their emotional reactivity, particularly heightened reactions to negative stimuli and diminished responses to positive stimuli.

Can you overdose on Suboxone?

Yes, you can overdose on Suboxone, especially if you take it in excessive amounts or combination with other substances, such as alcohol or benzodiazepines.

According to Medsafe’s consumer medicine information on “SUBOXONE® Sublingual Tablets”, last updated in July 2021, while Suboxone is prescribed for managing opioid dependence, it carries potential dangers of misuse, resulting in overdose and potentially fatal outcomes.

The likelihood of overdosing on Suboxone is higher in individuals without prior opioid use, older individuals, or those who combine Suboxone with alcohol, benzodiazepines, or other medications, as outlined in the Drugs.com article, titled “Can you overdose on Suboxone?” last revised in March 2023.

An overdose on Suboxone results in symptoms such as irregular, fast, slow, or shallow breathing, extreme drowsiness, confusion, unusual tiredness or weakness, and dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, as mentioned in the  Drugs.com issue on “Suboxone Side Effects,” last updated in August 2023. Blurred vision, pale or blue lips, fingernails, or skin, and pinpoint pupils are additional Suboxone-related overdose symptoms.

Moreover, in severe cases, Suboxone overdose leads to seizures, coma, and death. It is crucial to take Suboxone only as prescribed by a healthcare professional and to inform them of any other medications or substances being used to minimize the risk of overdose.

What are the symptoms of Suboxone withdrawal?

The symptoms of Suboxone withdrawal are irritability, nausea and vomiting, diarrhea, muscle aches, dilated pupils, depression and anxiety. Suboxone withdrawal symptoms manifest when individuals dependent on the medication suddenly reduce their dosage or discontinue its use.

The withdrawal process generally follows a distinct pattern. In the initial 72 hours, individuals encounter physical symptoms such as chills, fever, headaches, gastrointestinal issues, and insomnia, as per the Drugs.com article “How long does Suboxone withdrawal last?”, last revised in March 2023.

Following the first week, muscle aches and pains, insomnia, and mood swings persist. After approximately two weeks, individuals experience symptoms of depression, and then drug cravings are present. 

The duration of Suboxone withdrawal symptoms commonly spans around a month, although individual experiences differ based on factors such as the duration of the dosage of Suboxone, length of the drug usage, concurrent medical condition, and alcohol use.

It is crucial for individuals considering discontinuation or detoxification to do so under the guidance of a healthcare professional. Employing a gradual tapering strategy, specific medications, and behavioral therapies helps effectively mitigate withdrawal symptoms, enhancing the prospects of a successful transition.

What are the available treatments for Suboxone addiction?

The treatments for Suboxone addiction involve comprehensive approaches aimed at addressing physical dependence, managing withdrawal symptoms, and addressing the underlying psychological aspects.

The available treatments for Suboxone addiction are listed below.

• Medically assisted detoxification (detox): Detox in the treatment of Suboxone addiction is a critical phase that focuses on safely managing withdrawal, ensuring physical stability, and providing a gateway to comprehensive treatment. It is the initial step in Suboxone addiction treatment and it is crucial to be medically supervised as withdrawal symptoms are often uncomfortable and, in certain cases, dangerous. Medical supervision ensures that these symptoms are managed effectively and that the patient’s safety and comfort are prioritized.
• Gradual tapering: Gradual tapering of Suboxone is commonly employed to reduce the intensity of withdrawal. A 2013 study “A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers,” published in JAMA Psychiatry, assessed the efficacy of different buprenorphine taper durations in primary prescription opioid abusers. The study found that a 4-week tapering regimen resulted in better outcomes compared to 1- and 2-week regimens. Additionally, this longer tapering duration led to higher rates of treatment retention and naltrexone ingestion, which are important factors in successful addiction treatment​​.
• Medication-assisted treatment (MAT): According to Maglione MA. et al.’s 2020 study on the “Effects of Medication-Assisted Treatment (MAT) for Opioid Use Disorder on Functional Outcomes: A Systematic Review” MAT for OUD, including Suboxone addiction, involves the utilization of authorized medications alongside counseling, certain behavioral therapies, and patient supervision. MAT for Suboxone addiction involves the use of medications like methadone and naltrexone administered under medical supervision. As per the MedlinePlus article titled, “Opiate and opioid withdrawal,” last revised in April 2022, methadone alleviates withdrawal symptoms and aids in detox, while naltrexone helps prevent relapse.
• Behavioral therapies: Behavioral therapies, particularly cognitive-behavioral therapy (CBT), have shown efficacy in treating Suboxone addiction and other SUDs. The effectiveness of these interventions is grounded in a study “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” conducted by Ray LA. et al. in 2020. The researchers concluded that combining CBT with pharmacotherapy was more beneficial than usual care and pharmacotherapy alone. It also indicated that CBT did not outperform other evidence-based modalities in this context but was a crucial component of an effective combined treatment approach​.
• Support groups: Participation in support groups like Narcotics Anonymous (NA) or other 12-step programs provide a sense of community and understanding. Sharing experiences with others facing similar challenges creates a supportive environment, contributing significantly to the emotional and psychological aspects of Suboxone addiction treatment.
• Aftercare and relapse prevention: Aftercare provides ongoing support after the initial Suboxone addiction treatment. This includes medical check-ups, monitoring medication, assistance in building a healthy lifestyle, and peer support. A comprehensive approach in treating Suboxone addiction, where medication management is coupled with supportive aftercare programs improves overall life quality, which is a critical factor in long-term recovery and relapse prevention.

What is Suboxone used for?

Suboxone is primarily used for the treatment of opioid dependence. It is part of a comprehensive medical, social, and mental treatment plan that works by suppressing opioid withdrawal symptoms and reducing cravings for opioids, as defined in Medsafe’s consumer medicine information on “SUBOXONE® Sublingual Tablets”, last updated in July 2021.

In 2018, the FDA released a document “FDA approves first generic versions of Suboxone sublingual film, which may increase access to treatment for opioid dependence,” stating that it has granted approval for the initial generic forms of Suboxone (buprenorphine and naloxone formulation) sublingual film, intended for the treatment of opioid dependence. As mentioned in the statement, individuals undergoing MAT to address OUD experience a 50% reduction in the risk of death from all causes.

Why is Suboxone used to treat opioid use disorder (OUD)?

Suboxone is used to treat opioid use disorder (OUD) because it contains buprenorphine, a partial opioid agonist that reduces cravings and withdrawal symptoms without causing intense euphoria. Additionally, naloxone, the other element of Suboxone formulation, discourages misuse and blocks the effects of other opioids.

As claimed by the World Health Organization (WHO) in the 2009 “Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence,” the partial activity of buprenorphine means it does not induce opioid tolerance to the same extent as methadone. Additionally, it has high receptor affinity, allowing it to block additional opioid effects without causing the same level of tolerance as methadone.

The slow dissociation from receptors contributes to a milder withdrawal syndrome compared to methadone.As per the Center for Substance Abuse Treatment in the 2004 “Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction” from the Substance Abuse and Mental Health Services Administration, one of the advantages of buprenorphine or its formulation Suboxone is its safety due to its partial agonist action. It has a “ceiling effect,” which reduces the risk of overdose compared to opioids like methadone.

What is medication-assisted treatment (MAT)?

Medication-assisted treatment (MAT) is the integration of medications along with counseling and behavioral therapies for treating substance use disorder, specifically opioid use disorders and assisting individuals in sustaining their recovery journey, as defined by the United States Food & Drug Administration in the article titled, “Information about Medication-Assisted Treatment (MAT)” last updated in May 2023.

As per this article, the FDA has approved only three medications for treating opioid dependence, including buprenorphine, methadone, and naltrexone, due to their safety and effectiveness.

In a randomized study “Medication-Assisted Treatment for Opioid Use Disorder in a Rural Family Medicine Practice,” published in the Journal of Primary Care & Community Health in 2020, individuals diagnosed with OUD and allocated to either methadone or Suboxone demonstrated a 33.2% abstinence rate from heroin and a 20.7% abstinence rate from all opioids over a span of 5 years. Furthermore, the study mentioned that medication-assisted treatment led to a 51% reduction in the utilization of emergency department services.

MAT is an evidence-based method that aids individuals in navigating their journey through addiction. Incorporating medication into a tailored and comprehensive treatment plan assists individuals in handling their addiction and striving toward enduring recovery.

What is the difference between Suboxone addiction vs methadone addiction?

The difference between Suboxone addiction vs methadone addiction lies in their composition, effects on the body, susceptibility to misuse, administration methods, and dosing schedule.

Suboxone, combining the partial opioid agonist buprenorphine and naloxone, an opioid antagonist, is administered under the tongue, minimizing the risk of misuse due to naloxone’s presence. On the other hand, methadone, a full opioid agonist, is dispensed orally at specialized clinics.

Classified as a Schedule II controlled substance, methadone has a higher potential for misuse and addiction compared to Suboxone, which is categorized as a Schedule III controlled substance.

Since Suboxone is less risky than methadone, the drug’s withdrawal symptoms are milder compared to full agonists like methadone. Withdrawal from methadone addiction is reported to be more intense, especially if the dosage is high, due to its full agonist action.

Moreover, buprenorphine’s ceiling effect means that its effects do not increase beyond a certain point, reducing the risk of abuse and respiratory depression compared to methadone, which lacks this protective feature and poses a higher risk of overdose.

Suboxone offers flexibility with the convenience of prescription and administration in a physician’s office, while methadone necessitates daily visits to designated treatment centers.

Buprenorphine’s longer half-life (36-48 hours) compared to methadone (24-36 hours) allows for less frequent dosing, providing flexibility in prescribing daily or alternate day regimens, whereas methadone typically requires daily dosing for effective treatment.