Suboxone: How It Treats Opioid Use Disorder

Written by Susan Bernstein, Deanna Altomara
Medically Reviewed by Shruthi N, MD on September 11, 2024
11 min read

Suboxone is a combination of two drugs, buprenorphine and naloxone, that treats opioid use disorder (OUD). OUD is a real medical condition, just like diabetes or cancer, and is not anyone’s fault. More and more doctors are realizing that medication is a powerful tool for treating OUD, especially because abstinence-based programs (when you stop using opioids cold turkey) often don’t work. Just as antibiotics can help you recover from an infection, medication for OUD (MOUD) can help you recover from addiction. 

Suboxone is a type of MOUD. Studies have shown that it is very effective. It also lowers the risk of hepatitis as well as death from opioid use disorder. Plus, people taking Suboxone are more likely to be sober, be employed, and have a good quality of life.

Suboxone is a brand-name version of the generic drugs buprenorphine and naloxone. These drugs are also available under the brand names of Bunavail, Cassipa, and Zubsolv. Regardless of the brand name, you need a prescription to use Suboxone and similar medications. People as young as 16 may use Suboxone.

Suboxone works best when you combine it with therapy, recovery coaching, housing assistance, support groups, employment programs, and other supports. But it should still help if you take it by itself.

Is Suboxone an opiate?

Buprenorphine, the main ingredient in Suboxone, is considered an opiate. These drugs, including legal drugs like oxycodone and codeine, work by attaching to certain molecules in your brain.

Buprenorphine is a partial opioid agonist. This means it attaches to the same molecules as regular opioids. But it doesn’t attach completely, so it doesn’t cause a high the way regular opioids do.

Suboxone is one of several drugs that may be prescribed as MOUD. It treats opioid use disorder, or recovery from addiction to opioids, such as fentanyl, heroin, hydrocodone (Vicodin, Lortab, Lorcet), morphine, or oxycodone (OxyContin).

Suboxone also can be used as part of medication-assisted therapy or treatment (MAT). MAT combines a medication to ease your opioid cravings and withdrawal symptoms along with behavioral therapy and counseling.

When you’re dependent on an opioid, and then reduce the amount you use or stop taking it, your brain and body go through withdrawal. This can be a life-threatening condition.

Withdrawal symptoms include:

  • Intense cravings for opioids
  • Anxiety and restlessness
  • Stomach upset
  • Heavy sweats
  • Rapid heartbeat
  • Muscle aches
  • Insomnia

Suboxone eases withdrawal symptoms, so you can continue to get well. It does this by taking the place of more dangerous opioids in your brain, so your brain doesn’t realize that it’s missing the old opioids.

Even after withdrawal ends, your doctor may keep you on Suboxone as maintenance treatment. It keeps your opioid cravings at bay as you work on your recovery long-term.

Suboxone for pain

Buprenorphine, the main ingredient in Suboxone, was originally developed in the 1970s to treat pain. It is still sometimes used to treat pain today. When taken for pain management, buprenorphine is placed in your cheek or given through an IV or skin patch.

Treatment with Suboxone, therapy, and counseling can help you manage your opioid use disorder or dependence.

The active component of Suboxone, buprenorphine, is a partial opioid agonist. Unlike a full opioid agonist (such as those listed above), it blocks and also partially activates the opioid receptor. When you take an opioid, it blocks signals called pain receptors in your brain. Your sense of pain is reduced. Your brain also releases chemicals called endorphins that make you feel pleasure. With Suboxone, side effects tend to be milder and the risk of overdose significantly reduced, compared to full agonists. It can block the effect of full opioids to ease cravings and withdrawal symptoms and improve function.

Some people are unable to stop using opioids. You may become addicted to the pleasure the drug causes even when there’s no longer a physical cause of pain. You need more and more opioids to get the same feeling. Your body can also come to depend on opioids. You go into physical withdrawal if you don’t take the opioid drug.

Suboxone gets in the way of that process. Pain receptors aren’t switched off. Suboxone helps you reduce a craving for the pleasure rush of opioids. It also eases withdrawal symptoms that you have when you stop taking opioids.

Suboxone comes as either a tablet or small, thin piece of film. Both forms dissolve in your mouth. They also both work the same way.

You just place the tablet or film under your tongue, and it melts on its own. You can also place the film inside your cheek.

Suboxone dosage

Both the tablet and film come in many dosages or strengths. Usually, you start with a dose of 4 milligrams of buprenorphine and 1 milligram of naloxone per day. The highest dose is 24 milligrams per day. Your doctor will prescribe the best dose for your recovery. They’ll lower your dose slowly over time. Never try to lower your dose on your own.

Suboxone injection

Right now, Suboxone is only available as a dissolvable tablet or film. But buprenorphine is sometimes given by itself as an IV injection to treat pain.

Suboxone is designed to melt under your tongue or inside your cheek. Ask your doctor or pharmacist if you’re not sure how to take it. They can explain it to you.

If you take the tablet form:

  • Place the tablet under your tongue. Let it dissolve.
  • Don’t swallow it with water.
  • Don’t eat or drink anything until the tablet is totally dissolved.
  • If each prescribed dose is more than one tablet, put the tablets at different places under your tongue at the same time.

If you take the film form:

  • You can drink a little water first to moisten your mouth.
  • For the first few days of treatment, place the film under your tongue, not inside your cheek.
  • Place the film under your tongue near the base.
  • Don’t move the film until it totally dissolves.
  • Don’t chew, swallow, or cut the film into pieces.
  • If your prescribed dose is two pieces of film, place the first film on one side under the base of your tongue, and let it totally dissolve. Then, place the second film on the opposite side. If there’s a third film, place it on the same side where you put the first film.
  • After a few days, you may choose to put the films on the inside of your cheek or under your tongue.

The most common side effects of using Suboxone are constipation, diarrhea, headaches, and nausea. You may also start to depend on it too much for relaxation.

Suboxone may cause a severe side effect called respiratory depression. That’s shallow, slowed breathing that drops oxygen levels in your blood.

Anyone who takes Suboxone and has these symptoms of respiratory depression should get emergency medical care right away:

  • Dizzy or lightheaded
  • Slow or labored breathing
  • Extremely sleepy or not responsive

Respiratory depression is rare if you take Suboxone at the prescribed dose. It’s more likely if you inject Suboxone, or take it along with alcohol or drugs called benzodiazepines (sedatives that help you sleep or that relieve anxiety).

Suboxone may also cause these side effects in some people:

People who take Suboxone may also have mental side effects like anxiety, depression, or nervousness. Let your doctor know if you notice any of these mood changes. They may put you at risk of using opioids again as a way to dull these feelings.

Only use Suboxone as part of MAT for opioid addiction recovery. Don’t take it for pain relief.

Before you start Suboxone, talk with your doctor. If you start taking it too soon after you stop using opioids, you can have strong withdrawal symptoms like shaking, sweating, nausea, vomiting, diarrhea, body aches, or mood changes. Your doctor will decide when it’s safe and healthy for you to start taking Suboxone as part of your recovery. 

Here are a few other important precautions to take when you take Suboxone:

  • Don’t stop taking Suboxone on your own for any reason, even if you start to feel better and think you don’t crave opioids anymore. If you just stop taking Suboxone, you’ll go through withdrawal symptoms too.
  • Try not to miss your regular dose of Suboxone. If you skip or miss doses for any reason, you’re at risk of relapsing and wanting to use opioids. Ask your spouse, family, or friends to remind you to take your dose. Put your pills or film in a container that has a slot for each day’s dose of your medicine. You can also set reminders on your phone or write it on your calendar.
  • If you miss a dose of Suboxone, take it as soon as you remember, unless it’s very close to the time for your next dose. Don’t double your next dose if you miss a dose.
  • Don’t operate heavy machinery or equipment while you take Suboxone until you know how much it affects you.
  • Don’t take anyone else’s Suboxone to relieve or treat pain. If you’ve never taken opioids as a pain reliever, using Suboxone to treat pain on its own can cause death even at low doses.
  • Never misuse, overuse, or inject Suboxone. This can cause withdrawal symptoms, respiratory depression, or death.

Is Suboxone addictive?

If you take Suboxone as directed, you won’t get high, although you will to through withdrawal if you suddenly stop taking it. Like other opioids, buprenorphine (the main ingredient in Suboxone) can be misused. To prevent this, scientists add a second ingredient called naloxone.

Naloxone is an opioid antagonist. This means it blocks opioids from attaching to molecules in your brain, preventing the drugs from working. If you inject opioids, including buprenorphine, at the same time as naloxone, you’ll feel very sick. But Suboxone itself won’t make you sick because naloxone doesn’t work when you take it by mouth. 

Can you overdose on Suboxone?

It’s possible, but extremely unlikely. Regular opioids attach to molecules in the brain, triggering a high and side effects like breathing problems. If you take too much of an opioid, these breathing problems can cause an overdose. 

The main ingredient in Suboxone, buprenorphine, works similarly but is much more gentle. It attaches to the same brain molecules that regular opioids do. But it only attaches partway. Because of this, it causes fewer effects than regular opioids would. This means it won’t cause as many breathing problems.

If someone overdoses on Suboxone, it’s probably because they’re taking other drugs too. Mixing Suboxone with sedatives like benzodiazepines can cause breathing problems to add up, leading to an overdose.

Suboxone withdrawal

Suboxone helps ease the symptoms of opioid withdrawal. This is because it’s an opioid agonist, so it acts as a safer substitute for opioids in your brain. When you’re taking Suboxone, your brain doesn’t realize the old opioids are missing. But this also means that it causes withdrawal if you stop taking it too quickly. Because of this, your doctor will slowly lower your dose of Suboxone over time.

Suboxone could also cause withdrawal symptoms if you misuse it. If you take Suboxone by mouth, as directed, you won’t have these symptoms. But if you inject Suboxone, the naloxone in it will make you very sick.

People with severe liver disease shouldn’t take Suboxone. It’s rare, but Suboxone could cause liver injury. While you take Suboxone, your doctor will watch for signs of liver disease with regular blood tests. If you notice these signs of liver disease, call your doctor right away:

  • Yellow skin or eyes
  • Sharp pain in your belly
  • Severe nausea or vomiting

Teens in recovery for opioid addiction may be prescribed Suboxone. There isn’t much research on the use of Suboxone in adolescents, but a few studies show that the drug is effective, well-tolerated, and only causes mild side effects in teens. No teens in these studies had liver toxicity from Suboxone.

Young children are at risk of respiratory depression and death if they accidentally take Suboxone. Keep your medicine well out of the reach of children in your home.

Don’t take Suboxone along with alcohol, sedatives or sleep medicines, or prescription medicines that contain opioids, like some cough syrups. Don’t use illegal drugs while you take Suboxone. This can cause severe side effects.

Don’t switch from taking Suboxone to another drug that contains buprenorphine unless you talk to your doctor. They need to find the right dose of medicine for you.

If you think you’ve taken too much Suboxone, or if you think someone has overdosed on Suboxone, call 911. You can be given an injection or nasal spray with naloxone that may save your life.

Suboxone is a promising treatment for OUD and is shown to be very effective. It helps ease symptoms of opioid withdrawal and lowers your cravings for more opioids. It contains buprenorphine, which is a safer substitute for the opioids your brain has gotten used to. If you think you might have an opioid problem, talk with your doctor about whether medications like Suboxone can help.

Can you use Suboxone while breastfeeding?

Many people taking MOUD are able to breastfeed. Buprenorphine does pass to your baby through breast milk. There are studies that show these babies don’t have any ill effects. Talk with your doctor about what is best for you and your baby.

Can you use Suboxone if you’re pregnant?

New studies suggest that taking Suboxone during pregnancy is safe for your baby. The main ingredient in Suboxone, buprenorphine, is generally considered safe for use during pregnancy. It doesn’t appear to cause birth defects, although more research is needed to be sure. Some babies could be born with neonatal abstinence syndrome, but this risk is generally low for buprenorphine. Doctors used to worry that Suboxone’s other ingredient, naloxone, could affect the baby, but new research suggests this is unlikely. 

Even if you are concerned about Suboxone’s effects on your baby, remember that opioid misuse is much more dangerous than MOUD. Misusing opioids while pregnant can harm your baby, causing problems like low birth weight, premature birth, or death. Treating your OUD can help you have a safer pregnancy and give birth to a healthy baby. If you’re pregnant, think you may be pregnant, or plan to get pregnant, let your doctor know.

What are the two drugs in Suboxone?

Suboxone contains two medicines:

  • Buprenorphine, a partial opioid agonist

  • Naloxone, an opioid antagonist

Is Suboxone covered by medical insurance?

Yes, Suboxone treatment costs are covered by most insurance plans. Your individual plan will determine what form or brand of Suboxone you use, or where you can go for this treatment.

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