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Suboxone Addiction: Symptoms, Causes, Effect and Treatment

Addiction to Suboxone, a medication widely used for opioid use disorder, presents unique challenges and concerns. While Suboxone is effective in treating opioid dependency by reducing cravings and withdrawal symptoms, there is a growing concern about its potential for misuse and dependence. According to a study by Shulman, Wai, and Nunes (2019), although Suboxone is considered safer than full opioid agonists, its misuse often stems from patients attempting to self-medicate withdrawal symptoms due to inadequate access to proper medical treatment. This highlights the importance of comprehensive care and monitoring for individuals undergoing Suboxone therapy.

There are a wide range of signs and symptoms of suboxone addiction, ranging from mild to severe. Cravings, slow breathing, inability to stop usage, pinpoint pupils, social withdrawal, and doctor shopping are among the common symptoms of suboxone addiction.

Some of the effects of suboxone addiction are excessive sweating, lightheadedness, persistent headache, constipation, nausea, feelings of faintness, and sleeping difficulties. Long-term effects like liver damage are also often experienced.

Suboxone Addiction can be effectively treated, with affected individuals making a full recovery, especially if treatment begins early.

What is Suboxone 

Suboxone is a prescription medication used in the treatment of opioid use disorder. It is designed to reduce withdrawal symptoms in an individual’s recovery process, with its two active ingredients being naloxone and buprenorphine. Despite its effectiveness in the treatment of opioid addiction, it also has a risk of being misused or abused. The condition that arises from the misuse or abuse of suboxone is referred to as suboxone addiction.

what is suboxone

Is Suboxone Addictive?

Yes, Suboxone can be addictive. Buprenorphine, one of the active ingredients in Suboxone, is a partial opioid agonist and can lead to dependence and addiction when misused or used without proper medical supervision. According to the Center for Substance Abuse Treatment, buprenorphine has a lower abuse potential compared to full opioid agonists, but caution is still necessary. The inclusion of naloxone in Suboxone is intended to reduce the potential for abuse, particularly through injection. However, Suboxone remains addictive and must be carefully monitored by prescribing physicians. (Source: U.S. Department of Health and Human Services, SAMHSA, 2018)

How Common is Suboxone Addiction?

While the occurrence of suboxone Addiction is low, the statistics of buprenorphine product misuse are significant. Hence, the abuse and addiction of suboxone is a significant challenge.

According to a 2021 report by the Substance Abuse and Mental Health Services Administration, about 690, 000 people in the United States were reported to have misused buprenorphine products within 12 months before the report, representing just 0.2% of the age category. The Center for Disease Control and Prevention reported in January 2022 that about 2.1 million people in the United States were suffering from an opioid use disorder.

What are the Symptoms of Suboxone Addiction? 

Suboxone Addiction presents diverse physical, behavioral, and psychological signs. The most common among them are discussed below:

  • Drug cravings: if the urge to use suboxone is persistent and intense, such that seeking and using suboxone becomes compulsive, there is psychological dependence on it.
  • Loss of control: if an individual is finding it difficult to control the quantity of suboxone used as well as the frequency, addiction has developed. Continued use despite adverse effects: the continued, persistent use of suboxone even when there are issues like health problems is an obvious indication of addiction.
  • Slow breathing: the depressant effects of buprenorphine on the central nervous system causes several issues including slow breathing.
  • Doctor shopping: when individuals seek prescriptions from various healthcare professionals or lie to get more suboxone, addiction has developed.
  • Drug-seeking behavior: suboxone addiction also requires individuals to dedicate a lot of time to get and use it, regardless of the consequences.
  • Social withdrawal: another obvious sign of suboxone addiction is isolation and reduced engagement in once enjoyable activities. This also includes neglect of responsibilities at home, school, work, or among friends.
  • Withdrawal symptoms: when use of suboxone is stopped: if a sudden stop or cut back on the use of suboxone causes physical and psychological discomfort, it indicates suboxone addiction. These withdrawal symptoms include: diarrhea, anxiety, nausea, vomiting, fatigue, depression, etc.

(Source: SAMHSA, “Buprenorphine,” 2019)​​.

What are the Causes of Suboxone Addiction?

Suboxone addiction arises from several key factors. Buprenorphine, an active ingredient, is a partial opioid agonist that produces euphoric effects similar to other opioids, driving misuse among those with prior substance abuse issues. The ease of access and less stigmatizing distribution methods compared to methadone further facilitate misuse and diversion. According to the U.S. Department of Justice’s intelligence bulletin “Buprenorphine: Potential for Abuse” (September 2004), even with safeguards like naloxone, Suboxone abuse and illegal distribution have been documented, particularly in regions with high opioid abuse rates. This underscores the necessity for stringent monitoring and regulation. Other causes of Suboxone Addiction include:

  • Opioid dependence treatment: this is perhaps the biggest contributing factor to suboxone addiction because without the treatment of opioid dependence, most of the people facing suboxone addiction wouldn’t know about suboxone. In the course of treating opioid dependence with suboxone, dependence is often developed, especially when there is no proper medical supervision.
  • History of childhood trauma and abuse: people who have a history of substance abuse are more likely to develop an addiction to substances, including suboxone. Similarly, previous trauma often makes people abuse substances as a coping mechanism, hence increasing the risk of substance addiction.
  • Heredity: a combination of genetic factors and complex interactions among multiple genes and environmental factors influence the development of substance use disorder (SUD), according to the National Institute on Drug Abuse. Therefore, people with a history of addiction in their family are at a higher risk of developing a substance use disorder and drug addictions, including suboxone addiction. For example, the children of an addict are more likely to become addicts. It is not an inevitability, but they are more vulnerable, especially when aided by other factors.
  • Mental health disorders: people who have mental health disorders like anxiety or depression, are at a higher risk of developing substance abuse problems. They often resort to the use of substances, including suboxone, as a way of self-medicating for relief of symptoms.
  • Availability and accessibility: the accessibility and availability of suboxone as well as other factors like the ease of obtaining a prescription play key roles in the chances of addiction development. If an individual easily gets suboxone and proper medical supervision isn’t available, there is a high risk of abuse.
  • Environmental factors: individuals living in an environment where substance abuse is common, face stressful living events daily, and lack social support are at a high risk of abusing substances, including suboxone.

What are the Side Effects of Suboxone Addiction?

side effects of suboxone

Suboxone addiction causes a wide range of physical and psychological effects, varying in severity. The side effects include:

  • Cough: Suboxone’s depressant effects on the central nervous system (CNS) can disrupt normal respiratory function, leading to symptoms like ongoing coughing.
  • Dizziness or Lightheadedness: The impact on the CNS can cause disruptions in coordination and balance, resulting in dizziness or lightheadedness.
  • Sweating: Increased sympathetic nervous system activity caused by Suboxone’s disruption of thermoregulatory mechanisms manifests as sweating.
  • Sleeping Difficulties: Suboxone addiction alters brain chemistry, leading to disrupted sleep patterns.
  • Fever: Unsafe drug use practices increase the risk of infections and fever, and interactions with other substances can also cause fever.
  • Urinary Issues: Buprenorphine’s influence on the CNS reduces signals controlling bladder function, causing urinary retention.
  • Vasodilation and Skin Reactions: Suboxone addiction often causes flushing or redness of the skin due to its impact on the circulatory system.
  • Headache: Severe or persistent headaches result from changes in brain chemistry and blood flow.
  • Other Side Effects: These include abnormal vision, reduced sex drive, constipation, nausea, vomiting, chest pain, back pain, muscle pain, joint pain, stomach pain, and liver damage.

Some side effects are mild, while others are severe, and some may be short-term while others are long-term or permanent. According to the “SUBOXONE® Product Monograph” by Indivior UK Limited (2019), the most commonly reported adverse effects include headache, abdominal pain, anxiety, and muscle aches, which align with opioid withdrawal symptoms. The study emphasizes the need for comprehensive monitoring and medical supervision to mitigate these effects.

What are the Symptoms of Suboxone Withdrawal? 

When individuals dependent on suboxone suddenly stop using it or reduce its dosage, the period of body readjustment leads to withdrawal symptoms. The symptoms include irritability, vomiting, anxiety, depression, nausea, muscle aches, diarrhea, and dilated pupils. The symptoms experienced depend on dosage of suboxone, duration of usage, underlying health conditions, and alcohol use.

Withdrawal symptoms of suboxone usually last about a month, peaking around the second week. The guidance and support of professionals is vital in this period because it’s a very uncomfortable period and the risk of a relapse is high.

Can You Overdose Suboxone?

Yes, you can overdose on Suboxone. While Suboxone is effective in treating opioid use disorder by reducing cravings and withdrawal symptoms, misuse, especially when combined with other respiratory depressants like alcohol or benzodiazepines, can lead to overdose and death. According to the Tennessee Department of Health, there were 67 deaths associated with buprenorphine (a component of Suboxone) in 2016, with many cases involving multiple drugs. It is crucial for physicians and pharmacists to provide clear guidance on its use to prevent such tragedies

What are the Treatment Options Available for Suboxone Addiction?

Treatment for Suboxone addiction involves a comprehensive approach that combines medical, psychological, and social support. The primary treatment options include:

  1. Medically Supervised Tapering: Gradually reducing the dose of Suboxone under medical supervision helps to minimize withdrawal symptoms and reduce dependence. This process should be personalized based on the patient’s clinical condition and response to the tapering schedule.
  2. Behavioral Therapies: Cognitive-behavioral therapy (CBT), contingency management, and motivational interviewing are effective in addressing the psychological aspects of addiction. These therapies help patients develop coping strategies, improve their emotional well-being, and reduce the likelihood of relapse.
  3. Support Groups and Counseling: Participation in support groups such as Narcotics Anonymous (NA) or therapy sessions provides emotional support and encouragement from peers who are also in recovery. Counseling sessions can address underlying issues contributing to addiction and help patients build a support network.
  4. Medication-Assisted Treatment (MAT): In some cases, alternative medications such as methadone or naltrexone may be used as part of the treatment plan. These medications can help manage withdrawal symptoms and reduce cravings.

According to a study by Shulman, Wai, and Nunes (2019) published in CNS Drugs, buprenorphine (the active ingredient in Suboxone) is effective for treating opioid use disorder but requires careful management to prevent misuse and addiction. The study highlights the importance of integrating behavioral therapies and medical supervision to achieve successful outcomes .

Is buprenorphine safe for everyone, including pregnant women?

Buprenorphine can be safe for many patients, but it must be used carefully, especially in those with liver conditions. For pregnant women, methadone is typically safer, but in special circumstances, a naloxone-free form of buprenorphine may be used. Always consult with a doctor for personalized medical advice. (Source: U.S. Department of Health and Human Services, SAMHSA, 2009)

How is buprenorphine administered?

Buprenorphine is typically taken as a pill that dissolves under the tongue. It is available in two forms: Suboxone, which contains buprenorphine and naloxone, and Subutex, which contains only buprenorphine. The medication is usually taken once a day, with the possibility of every other day dosing. (Source: U.S. Department of Health and Human Services, SAMHSA, 2009)

Is buprenorphine just replacing one addiction with another?

No, buprenorphine does not replace one addiction with another. It is a medication used to treat opioid use disorder (OUD) by preventing withdrawal symptoms and reducing cravings, allowing individuals to maintain a stable and healthy life. (Source: U.S. Department of Health and Human Services, SAMHSA, 2018)

Is outpatient therapy or counseling mandatory for those on Suboxone?

Behavioral health support can be beneficial but is not mandatory for all patients. Providers should refer patients for counseling if needed, but treatment plans are individualized. (Source: U.S. Department of Health and Human Services, SAMHSA, 2018)

How Can I Tell if I’m Developing a Dependence on Suboxone?

Recognizing the signs of Suboxone dependence early is crucial. If you find yourself needing higher doses to achieve the same effect, experiencing cravings, or using Suboxone more frequently than prescribed, you might be developing a dependence. Changes in behavior, such as isolating yourself from friends and family or neglecting responsibilities, can also be indicators. According to the Tennessee Department of Health, consistent misuse and the need for increased doses often signal the onset of dependence (Source: “TDH Finds Some Overdose Deaths Associated with Buprenorphine,” Tennessee Department of Health, January 8, 2018)​​.

What Should I Do If I Suspect Someone I Know Is Misusing Suboxone?

If you suspect someone is misusing Suboxone, it’s important to approach the situation with empathy and concern. Encourage them to speak with a healthcare professional about their use. Look for signs such as changes in mood, behavior, and physical health. According to the U.S. Department of Justice, understanding and addressing misuse early can prevent more severe addiction and health complications (Source: U.S. Department of Justice, “Buprenorphine: Potential for Abuse,” September 2004)​​.

How Does Suboxone Addiction Affect Daily Life?

Suboxone addiction can severely impact daily life, leading to disruptions in work, relationships, and overall well-being. Physical side effects, such as drowsiness and dizziness, can impair your ability to perform daily tasks. Psychological effects, including mood swings and anxiety, can strain relationships and reduce quality of life. The Substance Abuse and Mental Health Services Administration highlights that these disruptions can make it difficult to maintain a stable and productive lifestyle (Source: SAMHSA, “Buprenorphine,” 2019)​​.

Are There Any Support Groups Specifically for Suboxone Addiction?

Yes, there are support groups specifically for individuals struggling with Suboxone addiction. Groups like Narcotics Anonymous (NA) and other local support groups provide a community of individuals who share similar experiences. These groups offer a safe space to discuss challenges, share coping strategies, and gain support from peers. The Tennessee Department of Health emphasizes the importance of support networks in recovery, noting that they play a critical role in maintaining sobriety and preventing relapse (Source: “TDH Finds Some Overdose Deaths Associated with Buprenorphine,” Tennessee Department of Health, January 8, 2018)​​.

How Can Family Members Support Someone Struggling with Suboxone Addiction?

Family members can play a crucial role in supporting someone with Suboxone addiction by being understanding, patient, and encouraging them to seek professional help. Educating themselves about addiction and treatment options can also be beneficial. Providing a supportive environment and avoiding judgment can help the individual feel more comfortable seeking help. According to Shulman, Wai, and Nunes, involving family in the treatment process can significantly improve outcomes and provide additional emotional support for the patient (Source: Shulman, Wai, & Nunes, CNS Drugs, 2019).

How does Suboxone compare to Xanax in terms of addiction risk and treatment?

Suboxone and Xanax differ significantly in terms of addiction risk and treatment. Suboxone, used in medication-assisted treatment for opioid addiction, contains buprenorphine and naloxone and helps reduce withdrawal symptoms and cravings. While Suboxone has a lower risk of abuse compared to other opioids, addiction can still occur if misused. Xanax, a benzodiazepine prescribed for anxiety and panic disorders, has a high potential for addiction due to its calming and sedative effects. Treatment for Xanax addiction typically involves gradual tapering of the dose to prevent withdrawal symptoms, alongside behavioral therapies to address the psychological aspects of addiction.

What are the long-term effects of Suboxone use?

Long-term use of Suboxone can have several effects, both positive and negative. On the positive side, Suboxone helps individuals maintain sobriety, reduce opioid cravings, and engage in productive activities. However, prolonged use may lead to physical dependence, where stopping the medication abruptly can cause withdrawal symptoms. Some individuals might experience side effects such as constipation, insomnia, or hormonal imbalances. It is essential for those on long-term Suboxone therapy to work closely with their healthcare provider to monitor their health and make any necessary adjustments to their treatment plan.

Can Suboxone be used during pregnancy to treat opioid addiction?

Suboxone can be used during pregnancy to treat opioid addiction, but it requires careful management and medical supervision. Buprenorphine, one of the active ingredients in Suboxone, is generally considered safer for use during pregnancy than other opioids, as it helps manage withdrawal symptoms and reduce the risk of relapse. However, the presence of naloxone in Suboxone can complicate its use during pregnancy, so healthcare providers might prefer prescribing buprenorphine-only formulations.

What Are the Risks of Stopping Suboxone Abruptly?

Stopping Suboxone abruptly can lead to severe withdrawal symptoms, including nausea, vomiting, muscle pain, and intense cravings. It can also increase the risk of relapse into opioid use. A medically supervised tapering plan is recommended to gradually reduce the dosage and minimize withdrawal effects. The “SUBOXONE® Product Monograph” by Indivior UK Limited stresses the importance of medical supervision when discontinuing Suboxone to ensure a safe and effective transition off the medication (Source: “SUBOXONE® Product Monograph,” Indivior UK Limited, January 2019)​​.

Can Suboxone Addiction Lead to Other Health Complications?

Yes, Suboxone addiction can lead to various health complications, including respiratory issues, liver damage, and cardiovascular problems. Long-term misuse can exacerbate these conditions, making it essential to address addiction early. Regular medical check-ups and monitoring are crucial for individuals on Suboxone to detect and manage any arising health issues. The Tennessee Department of Health reports that combined use with other substances, especially depressants, significantly increases the risk of severe health complications and death (Source: “TDH Finds Some Overdose Deaths Associated with Buprenorphine,” Tennessee Department of Health, January 8, 2018)​​.

Ryan Wakim MD
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Dr. Wakim is a board-certified psychiatrist with a passion for and expertise in addiction, mood disorders, trauma-related disorders and the subspecialty of interventional psychiatry. He obtained his medical degree from West Virginia University where he also completed his residency training, finishing as chief resident. Dr. Wakim co-founded and served as the CEO of Transformations leading to a successful merger with Shore Capital in May 2021. He is purpose driven towards improving the standard of and removing stigma related to behavioral healthcare. Dr. Wakim enjoys golf, traveling and time spent with his two dogs, Lulu and Rayna.

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