Suboxone & Alcohol: Are They Safe to Combine?

It is not safe to combine Suboxone with the use of any illicit or mind-altering substance. Despite this fact, it is estimated that about a third of people undergoing medication-assisted treatment (MAT) using medications like Suboxone also abuse alcohol. This is a significant point of concern, especially for people in recovery for addiction.[1]

Alcohol and Suboxone are both depressants, which means that they slow down the central nervous system.[2] This is a potentially deadly effect, which means that too much alcohol in combination with Suboxone can result in overwhelming sedation of the mind and body, which can lead to overdose or death.[3]

If you are unable to stop drinking and are taking Suboxone, speak with your doctor about your options. 

If you believe you are having a negative response after taking both alcohol and Suboxone, seek medical attention immediately. 

Suboxone & Alcohol Are Both Depressants

Depression of the central nervous system means slowing of the heart rate and rate of breathing.[4] Opioids cause this effect, and Suboxone contains buprenorphine, which is a partial opioid agonist and therefore a central nervous system depressant.[5]

Similarly, alcohol depresses the central nervous system on its own. When combined with other substances that have the same effect, the result can be synergistic.[6] This means that rather than the depression of the central nervous system caused by alcohol adding to the respiratory depression caused by Suboxone, the effect can be multiplied. 

How Alcohol & Suboxone Interact

There are a number of chemical processes that take place in the body when Suboxone and alcohol are combined. These processes negatively impact the central nervous system, the respiratory system, and the liver or metabolic system.

Effects on the Central Nervous System

Alcohol increases the activity of the neurotransmitter gamma aminobutyric acid, or GABA, in the brain which slows everything down and causes sedation.[7]

Buprenorphine also causes sedation, but it works by binding to the mu opioid receptors in the brain. This depresses the central nervous system, making it hard for the person to think or function as they normally would.[8]

When both of these effects occur together, the central nervous system may be overwhelmed and shut down the person’s ability to think or perform basic tasks.

Effects on the Respiratory System

Both alcohol and Suboxone repress the body’s ability to manage automatic functions like breathing—the functions that should happen without any thought on the part of the individual. 

When taken on its own, buprenorphine has a ceiling effect that stops it from repressing the respiratory system entirely even if the person takes more than prescribed. However, when buprenorphine is combined with alcohol, the result can be repression of the respiratory system that ultimately stops the person’s breathing, which can be fatal.[9]

Effects on Metabolism 

Metabolic competition occurs when both alcohol and Suboxone are ingested at the same time because both substances are metabolized by the liver, primarily by an enzyme called cytochrome P450.[8,10]

There is only so much cytochrome P450 available at any given time to process these substances. When both are taken at the same time, it can slow down the metabolism of one or both substances, causing levels to build up in the body that can trigger an increase in side effects.

Potential Side Effects of Mixing Suboxone With Alcohol 

There are a number of potential side effects that can occur when mixing Suboxone with alcohol that are both physical and mental in nature. These may include the following:[11]

• Dizziness or drowsiness
• Nausea and vomiting
• Impaired motor coordination and skills
• Triggering or worsening of mental health conditions
• Sedation or loss of consciousness
• Overdose 
• Coma
• Death

Why You Shouldn’t Drink While on Suboxone

Drinking alcohol while taking Suboxone can have a negative impact on your ability to experience the full effects of the medication. For those in recovery, it can come with a host of other complications as well. These are some of them: 

Harm to Recovery

Most people take Suboxone for the purposes of treating an opioid addiction, using the drug to safely transition from active use of street drugs like heroin or prescription painkillers like oxycodone to Suboxone, which helps to manage cravings and withdrawal symptoms.[12]

When mixed with alcohol, Suboxone may not be as effective. The person is unable to focus on the mental health work and other issues that require attention during recovery since they are abusing another substance. 

Drinking alcohol while in addiction treatment would be considered a relapse. It is important to work with your doctor, sponsor, or therapist in the aftermath to protect against it happening again.[13]

Mental Health Issues

Alcohol is a depressant. Those who live with underlying mental health conditions like depression or anxiety may drink alcohol in an attempt to alleviate symptoms of their mental health issues, but this will ultimately worsen those symptoms. Drinking can potentially contribute to an increase in episodes of depression and anxiety as well as increased severity of those episodes.[14,15] 

Additionally, alcohol-involved suicides are increasingly common. This a growing problem in every age group, year over year, making it a potentially deadly combination even if the combination of substances is not overwhelming to the body.[16]

Physical Health Issues

Both alcohol and Suboxone cause significant sedation and respiratory depression, which leads to slowed breathing and an inability to think clearly and act reasonably.[7, 9] This combination of effects can lead to a deadly overdose, in which the person loses consciousness and then stops breathing. If no one is around to see it happen, the person could die without medical intervention. 

If not deadly, the combination of Suboxone and alcohol can lead to intense impairment and side effects that can make it difficult for someone to function, drive safely, or manage basic tasks without accident or injury.[11]

Get Help to Manage Recovery

If you are in recovery and unable to stop drinking while taking Suboxone, reach out to your treatment team. Your prescribing doctor or another member of your addiction treatment team can help you assess the situation and determine a best path forward. 

It’s likely that a change in your treatment plan is needed to effectively address your alcohol abuse issues. Don’t delay in getting the help you need.