Although Suboxone is used effectively as an adjunct for treating opioid addiction, Suboxone abuse and addiction also occur. This unusual opioid is associated with an unusual pattern of abuse and can become embedded in people’s opioid addiction pattern.
In this article, we discuss the facts about Suboxone addiction, its effects, and how to recognize it.
- Despite its effectiveness as a tool for treating opioid addiction, Suboxone is itself addictive
- The characteristics and effects of Suboxone addiction are similar to other opioids
- Suboxone is often abused in a cycle of opioid use alternating with using Suboxone to temporarily relieve the withdrawal symptoms until the next opioid dose is available
- Suboxone has safeguards against overdose, but overdose and death occur, especially when used IV or combined with other drugs or when used by individuals who are opioid-naive
- Treatment is available to give people with Suboxone or other drug addictions the opportunity to heal and recover
Suboxone Side Effects – Short Term
Suboxone side effects are similar to the side effects of other opioids but are usually somewhat less pronounced because the drug is only a partial opioid agonist. The side effects stem from buprenorphine, as naloxone is virtually free of side effects.
A side effect of Suboxone – unique among opioids – is that it causes precipitated withdrawal from other opioids. Both active ingredients of Suboxone will displace other opioids from their receptors in the brain. Since buprenorphine has only weak opioid effects compared to the opioids it is displacing, the result is a rapid and severe opioid withdrawal with a rapid onset.
Physical Side Effects
The short-term physical side effects of Suboxone are those of the immediate drug use effects and the period after the drug wears off. They may include:
- Mild euphoria (warm feelings of well-being)
- Confusion, cognitive impairment
- Muscle aches
- High body temperature, sweating
- Light-headedness, dizziness
- Swelling in the legs
- Urinary retention
Behavioral Side Effects
Behavioral side effects during and shortly after Suboxone use may include:
- Loss of inhibition
- High-risk behaviors
- Precipitation or worsening of symptoms of an underlying mental health disorder
Typical Suboxone emotional side effects (i.e. psychological) include:
- Obsessive thoughts about drug use
- Drug cravings
- Irritability and agitation
- Negative feelings: guilt, anger, resentment, self-pity, low self-esteem, regret, self-loathing and remorse
- Irrational beliefs in order to support and rationalize the drug use
Suboxone Side Effects – Long Term
The long-term effects of Suboxone addiction include the repeated short-term effects of frequent use of the drug, as well as the long-term effects of opioid use. However, the most harmful and significant effects of long-term Suboxone abuse are the consequences of opioid addiction on the ability to function normally in life.
Physical Side Effects
Long-term use of opioids has been associated with:
- Chronic constipation, often refractory to treatment
- Stomach bleeding
- Sleep-disordered breathing, including sleep apnea and other disorders
- Cardiovascular adverse events (especially heart attack and heart failure)
- Hyperalgesia (increased sensitivity to pain)
- Precipitation or worsening of symptoms of underlying mental health disorder
- Neurotoxicity (toxic effects on the brain and nerves)
- Increased risk of bone fractures
- Disruption of the hypothalamic-pituitary-adrenal hormonal system
- Sexual effects: reduced sex hormones in men and women, infertility and sexual dysfunction
- Immune system suppression
- Blood-borne infections
- Injection track marks around the body (not just the arms) for injection users
- Poor dental health
- Poor hygiene
- Excessive weight loss
These long-term effects of opioid use are based on studies of people using prescription opioids at appropriate doses. It is safe to assume that opioid abuse at doses well above those used in medical applications would be magnified.
Behavioral Side Effects
The long-term effects of Suboxone and other opioid addiction are a result of the progressive detachment from normal life functions. This condition only escalates as the drug use accelerates and the means to financially support drug use declines:
- Additional substance use
- High-risk behaviors
- The development or worsening of a mental health disorder
- Job loss
- Relationship difficulties
- Job loss
- Financial problems
- Loss of custody of children (if Child Welfare services become aware of the drug use)
- Legal problems
- Confusion, euphoria, detachment from reality
- Deterioration of physical and mental health
How Suboxone is Abused?
It might not make sense: how can you become addicted to Suboxone, a drug that is designed for helping people overcome addiction and that has safeguards against abuse built into the drug? Well, Suboxone is an unusual opioid and it has an unusual pattern of abuse.
Studies have shown that in the United States, 18% of people who have been prescribed opioid replacement medications (such as Suboxone) admit to selling, sharing or giving away their medication; this figure is as high as 28% in some countries.Many of those who sell their Suboxone do so to obtain their drug of choice (such as heroin).
Data from addiction studies show that Suboxone abuse has one characteristic that is unique: although some people (about 20%) abuse it to try to get high, most (about 74%) obtain it illegally to try to manage their own opioid withdrawal. However, this seldom works well.
Some individuals try to manage their opioid dependency by keeping Suboxone on hand to manage withdrawal symptoms when they run out of their drug of choice until they can obtain some more, a rather dysfunctional arrangement. Still others legitimately try to stop their opioid use by using Suboxone that they obtained illicitly.
However, one of the core characteristics of addiction is a total inability to control drug use. So, people who try to manage their own withdrawal by using Suboxone almost invariably end up in a dysfunctional spiral of drug use alternating with Suboxone use.
But Suboxone can also be abused in the same way as other opioids. About 16.3% of people receiving prescriptions for a buprenorphine-naloxone combination drug (such as Suboxone) report having used it IV to get high in the past month. This is particularly concerning, because IV abuse of Suboxone carries a significant risk of overdose.
Signs of Suboxone Abuse
Suboxone and other opioid abuse usually rapidly progresses into addiction, which is also known as opioid use disorder (OUD). It is characterized by the five C’s of addiction:
- Chronic, ongoing use with changes in brain function and behavior
- Compulsive use
- Impaired Control: inability to control or stop the drug use despite efforts to do so
- Craving the substance
- Continued use despite negative consequences
Opioid abuse (including Suboxone) is also characterized by drug tolerance developing and withdrawal symptoms occurring when drug use stops.
As drug use draws people deeper into their addiction, they lose their ability to function normally. The effects are often observed on social, physical, biological, psychological, financial, spiritual and vocational levels.
Anyone who is using Suboxone that was not prescribed to them – or using it at a dose or in a way that was not prescribed – is abusing the drug.
Suboxone Addiction and Abuse Statistics
Obtaining reliable statistics about people who abuse drugs is difficult because they are understandably reluctant to be forthcoming due to the secretive nature of addiction and because of fear of legal ramifications. However, there are some reliable Suboxone abuse/addiction statistics available:
- Buprenorphine (the opioid in Suboxone) is the most abused prescription opioid in the U.S., yet it is not in the top three most prescribed opioids
- In 2012 there were 11K illegal drug seizures in the U.S. involving buprenorphine (including Suboxone), and nearly 19K in 2017
- The estimated number of ER visits in the U.S. associated with non-medical use of buprenorphine rose form4K in 2006 to 21K in 2011
- 76% of people who abuse Suboxone obtained it illicitly
- Of those who obtain Suboxone illicitly, 36% got it from someone with a prescription who does not sell other drugs, 32% got it from a friend, 24% got it from dealers who sell other drugs and 12% traded sex for Suboxone
- 12% of people who abuse Suboxone attempt to inject it
- Among people who obtain Suboxone illicitly, 43% say it is very easy to obtain, 30% say it is easy, 16% say it is difficult and 8% say it is very difficult
How Addictive Is Suboxone?
How long does it take to get addicted to Suboxone? Not long. Many people become addicted to opioids after a single use. However, if used properly under the care of a knowledgeable prescriber, Suboxone has very little abuse potential
Because buprenorphine is only a partial opioid agonist, it has less of the addictive ”reward effect” as do other opioids. In fact, people who have been using opioids regularly seldom feel any high from the drug.
Symptoms of Suboxone Overdose
Suboxone overdose symptoms may include:
- Pinpoint pupils
- Sedation, loss of consciousness or coma
- Low blood pressure
- Respiratory depression (slow, shallow or stopped)
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has a Opioid Overdose Prevention Toolkit available for download, which suggests that people should suspect overdose if they see the following signs:
- Pale and/or clammy face
- Limp body
- Fingernails and/or lips appear bluish
- Vomiting or making gurgling noises
- Cannot be awakened or cannot speak
- Breathing slow or stopped
- Heartbeat is slow or stopped
Suboxone has certain pharmacological properties that make it less likely to cause overdose:
- Ceiling effect: respiratory suppression (the usual cause of death in opioid overdose) reaches a plateau and doesn’t increase with increasing doses
- Partial opioid agonist: buprenorphine binds to opioid receptors but has very little opioid activity, so it has a much lower risk of respiratory suppression than do other opioids
- Poor oral absorption: if Suboxone is swallowed inadvertently (such as by children) it has very little absorption from the gut, making overdose highly unlikely
- Naloxone: this opioid blocker is included in Suboxone to discourage IV use, the most dangerous way to abuse the drug
Overdose from Suboxone alone is not common, and most overdose deaths occur when the drug is used together with other drugs, especially benzodiazepines.
Suboxone is indicated only for treating opioid-dependent individuals, so the potential for overdose increases in people who take it but are not habituated to opioid use (i.e. who do not have opioid tolerance).
Suboxone Withdrawal Symptoms
Physical symptoms dominate the acute phase of withdrawal, but usually resolve once the acute phase has ended. Typical physical Suboxone withdrawal symptoms include:
- Dilated pupils in the eyes
- Diaphoresis (intense sweating)
- High blood pressure, rapid heart rate, heart palpitations
- Shaking, hot and cold chills, Goosebumps (piloerection)
- Diarrhea, sometimes intense
- Muscle aches, twitching
- Fatigue, lethargy
- Runny nose
- Loss of appetite
Psychological symptoms tend to be more of a challenge in the weeks or months after the acute withdrawal phase; these are known as protracted withdrawal symptoms. However, although the physical symptoms dominate during the acute phase, some psychological symptoms are often present as well, such as:
- Intense cravings
- Depressed mood
- Irritability, agitation
- Relapse dreams
Treatment of Suboxone Addiction
Recovery from substance addiction is not simply the absence of using drugs. Rather, it is based upon identifying and addressing the causes of the addiction, and the emotional, physical, psychological and social effects of drug use.
For most people, their substance use was no longer about getting high. Instead, it became a repetitive, daily process of avoiding withdrawal symptoms and escaping from their reality. Addiction treatment is the process where the deep issues around the addiction are carefully healed.
Without treatment, remaining abstinent from Suboxone or other drug use becomes a matter of pure willpower, and research and experience have shown that willpower alone is not an effective deterrent to drug abuse. Treatment allows individuals to counteract the powerful effects of addiction on the brain.
Specialized addiction treatment programs give the best opportunity for a successful recovery and a return to good health and function. As well, rehab enables participants to put together a plan for long-term recovery and relapse prevention in order to optimize their ongoing growth in recovery.
If you have concerns about Suboxone abuse or any other substance use or mental health disorders in yourself or a loved one, please feel free to contact us at The Recovery Village Columbus for a confidential discussion with one of our staff.
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