Suboxone: Uses, Side Effects, and Costs

What is Suboxone?

Suboxone is an opioid-treatment medication that helps people stop their misuse of opioids.² It comes in a tablet or film form that dissolves under the tongue and consists of two medications: buprenorphine (the active ingredient) and naloxone. Naloxone is added to decrease the likelihood of misuse of Suboxone. Suboxone can be successful even if a person is not also involved in behavioral therapy. While therapy is recommended, it should never be mandatory.

There is also a long-acting injectable form of buprenorphine without naloxone, called Sublocade. This can be helpful when compliance may be an issue.

Buprenorphine

Buprenorphine is a weak opioid and part of the Suboxone product.³ It blocks potentially dangerous withdrawal symptoms and cravings. Suboxone blocks opioid receptors, and the naloxone in it  makes overdose much less likely than the buprenorphine alone, saving countless lives that could have been lost to unintended overdose.⁴

Naloxone

Naloxone is included in Suboxone to prevent the risk of misuse of buprenorphine by blocking opioid receptors and effects. Without this combination product people would be limited to using Subutex, which is a mono-product, meaning that it doesn’t contain this protective feature. Many medical providers never prescribe Subutex because it lacks the protection that naloxone provides. The combination product is considered to be much safer. There aren’t any documented cases of significant allergic reactions to naloxone, and it is even safe enough to use during pregnancy.

6 Benefits of Suboxone Treatment

Let’s take a look at what Suboxone maintenance treatment involves and how it can be used in rehab facilities or in outpatient and inpatient settings. Suboxone can help people make it through the grueling and miserable experience of withdrawal from opioids. It can help correct the brain changes that occur with opioid use. This medication is taken every day, often for a long period of time. There is no urgency to stop its use. This doesn’t require frequently going to a clinic, as the medication is taken at home.

Below are six benefits of Suboxone in treating opioid use disorder:

1. The risk of an unintended opioid overdose is dramatically reduced due to the inclusion of naloxone along with the buprenorphine. This is a life-saving benefit, especially with the increase of Fentanyl in many opioids. Fentanyl is much more potent than other opioids, and other opioids are often tainted with Fentanyl without the user knowing it. This can lead to unintended opioid overdose.
2. Suboxone helps people get through withdrawal. Opioid withdrawal is horrible and includes physical pain and emotional torment.
3. Using medication for treatment reduces cravings for opioids. Cravings can be powerful and overwhelming, leading many people to continue their use.
4. Suboxone blocks the impact of opioids. If someone is on Suboxone and has a slip and uses an opioid, it will not have the same impact as without Suboxone.
5. Opioids cause brain changes with use, such as a reduced brain volume in the amygdala that can occur within 30-days of opioid use. Suboxone helps correct those brain changes to normalize brain functioning.⁵
6. Suboxone can help reactivate the brain’s reward system. This allows the person to feel renewed pleasure and satisfaction with life and what’s important to them.

Suboxone Side Effects

Side effects of Suboxone rarely cause someone to stop taking the medication. Any side effects are generally minimal and temporary. If you think you’re having side effects, contact your provider.

Common Suboxone side effects include:

• Insomnia
• Constipation
• Mouth or tongue numbness: due to the dissolvable film, this is temporary
• Sweating
• Nausea
• Vomiting
• Headache

More serious side effects of Suboxone can include:

• Impaired liver function
• Adrenal changes
• Low blood pressure upon standing
• Sleep-related breathing changes
• Possible allergic reactions to medication ingredients
• Twice the risk of dental decay

Warning & Associated Risks of Suboxone

Suboxone is a safe and effective treatment, but there may be some people who aren’t able to use it. Because it’s a very low-dose opioid, there is the potential for misuse if enough is injected at one time. It shouldn’t be used by anyone besides the person it was prescribed to.

To ensure health and safety, people who shouldn’t use Suboxone include:

• People who are unaware of how to use the medication
• Individuals who don’t understand the side effects
• People who take Benzodiazepines, such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam) ,Ativan (lorazepam), and Restoril (temazepam)

Risk of Suboxone Misuse & Addiction

Some people wonder if it’s possible to develop an opioid addiction to Suboxone. This isn’t a medication that is typically used as a primary drug of abuse. If someone wants to get high from an opioid, they would have to use a lot of Suboxone to do that. Most people don’t bother with that, and instead will just use other opioids. When they realize they aren’t getting the desired effect from using opioids while on Suboxone they often end up not using the opioids again.

There is a difference between addiction and dependence. People can have a physical reliance on an opioid but not have the addictive behaviors related to opioid use disorder. Using Suboxone for treatment is NOT trading one addiction for another and it is not a cross-addiction. These are common myths. Suboxone is a partial opioid agonist, and the inclusion of naloxone helps prevent Suboxone addiction.

Risk of Overdose

It is possible that children under the age of two can overdose on Suboxone, so be sure to store it safely. Fatal overdose of Suboxone is not a usual risk. The only exception to this is if someone has taken a lot of Suboxone along with a large quantity of alcohol or benzodiazepines (anxiety medication). If someone appears to be overdosing in this way, it’s best to administer Narcan (the overdose reversal medication) and call 911.

Suboxone Drug Interactions

There are some drug interactions to be aware of. Make sure to discuss this with your provider so you have the awareness of these risks. You don’t want to make Suboxone less effective or contribute to the seriousness of side effects.

Medications and substances that can negatively interact with Suboxone include:

• Benzodiazepines
• SSRIs
• Alcohol
• Niacin
• Muscle relaxers
• Tranquilizers
• Sleeping medications
• Cocaine
• Methamphetamines

Suboxone Withdrawal

If you are on Suboxone and decide that you’d like to stop taking it, you should discuss this with your provider. Your provider can guide you in how to slowly taper your dose so you can avoid withdrawal symptoms. Tapering down from Suboxone is easier and doesn’t take as long as tapering from opioids. Because of the opioid-induced brain changes many people stay on methadone (an opioid-alternative of Suboxone that does not contain naloxone) or Suboxone long-term.

Costs, Insurance Coverage & Where to Get Suboxone

The cost for Suboxone depends on the number of doses, strength of the dosing, and frequency of dosing. Methadone’s cost is dependent on the dosage. Methadone is generally less costly than Suboxone. Most insurance companies cover the cost of treatment.

If you’d like to begin using Suboxone, you should set up a time to meet with a Suboxone provider to discuss whether this is a good choice for you. Once it’s decided that this will be an effective treatment for you, you will get a prescription for the medication. You can start it in your provider’s office or can start it at home.

Suboxone Alternatives

If you feel that Suboxone may not be a good fit for you, you have some other options.  You can consider Vivitrol, which is an injectable form of naltrexone. The outcomes for Vivitrol are not as impressive as the results of buprenorphine and methadone, so it isn’t used as often as buprenorphine and methadone.

There are medications and substances that can have harmful interactions with Suboxone, including:

• Other buprenorphine products like Sublocade and Subutex
• Combined buprenorphine and naloxone medications like Bunavail and Zubsolv
• Naltrexone, which has the brand name of Vivitrol

Final Thoughts

Suboxone is a life-saving treatment for opioid use disorder. It’s important to discuss your personal medical history with your provider and car team to determine if Suboxone is the right treatment to address your use. Though the concerns are minimal, you do want to be aware of any risks and side effects that could occur.