Can You Overdose on Suboxone?

Ultimately, Suboxone is a medication that is designed to stop people from overdosing on opioids. Naloxone blocks the euphoric effects of opioids, including the buprenorphine in the medication.[1] This ingredient is dormant unless the medication is abused.

While it is possible to overdose on Suboxone, the likelihood is extremely low if you are taking the drug as directed.[2] In most cases, overdose only occurs when Suboxone is combined with the use of other substances that are not impacted by the presence of naloxone.[3]

Why Is the Risk of a Suboxone Overdose So Low When Taken Properly?

There is a low risk of overdose when taking Suboxone according to the doctor’s orders because of two unique pharmacological actions caused by its two main ingredients, buprenorphine and naloxone.[4]

When taken as directed and under medical supervision, the combination of buprenorphine’s ceiling effect and naloxone’s role in discouraging misuse of opioids makes Suboxone a safer option for treatment than methadone or buprenorphine alone.[5]

Buprenorphine’s Ceiling Effect 

Buprenorphine is a partial opioid agonist. This means it incompletely stimulates opioid receptors in the brain, whereas full opioid agonists completely trigger those receptors and have a much stronger effect.[6]

This action produces enough of an effect to prevent withdrawal symptoms and cravings in people who are in recovery for an opioid use disorder. However, it doesn’t come with the full opioid effect that leads to euphoria and respiratory depression, an issue that commonly causes overdose and death in users of full opioid agonists.[7]

In fact, buprenorphine has a ceiling effect, which means that beyond a certain dose, taking more buprenorphine does not increase its impact on the body.[6] People are less likely to take more of the drug as a result, and even if they did, it is unlikely that they will take enough to experience respiratory depression and other risks that come with abuse of opioids like heroin or oxycodone.[8]

Naloxone’s Blocking Effect

Naloxone is an opioid antagonist that reverses the effects of opioids by essentially “kicking them off” the opioid receptors, so they no longer have an effect.[9] 

In Suboxone, naloxone is designed to stop people from abusing the drug by injecting it or otherwise trying to circumvent the time-release mechanism.[1] 

When Suboxone is taken as prescribed (by allowing the tablet to dissolve under the tongue or the film to dissolve inside the cheek), naloxone is not activated and does not affect how buprenorphine impacts the body.[1] However, if someone attempts to inject Suboxone, the naloxone is activated and can cause precipitated withdrawal, which means that opioid withdrawal symptoms are harsh and immediate.[10]

By cutting down on the potential for abuse of the medication, naloxone contributes to the low risk of overdose when using Suboxone to treat opioid addiction.

Understanding Symptoms of a Suboxone Overdose

Although an overdose on Suboxone alone is rare due to its ceiling effect and the abuse-deterrent addition of naloxone, it can occur, especially if you are using the medication in combination with other substances that depress the central nervous system. Certain symptoms can indicate an overdose may be occurring.

Common Symptoms of Suboxone Overdose

These symptoms are commonly experienced by people who are having an opioid overdose and should not be ignored:[11]

Respiratory Depression

Slow or shallow breathing is the hallmark of an overdose caused by opioids or benzodiazepines. The person may be barely breathing or not breathing at all due to this effect. 

Sedation

Someone in an overdose state may appear to be extremely drowsy or passed out. They will not be able to be awakened and may look like they are sleeping. If they cannot be roused or this occurs in combination with other signs, get help.

Confusion or Dizziness

If conscious, the person may not be able to carry on a conversation, appear to be confused, or have a hard time thinking, walking, or talking. If they are talking, they may be saying things that don’t make sense or responding to things that are not there.

Physical Issues

There are a number of physical issues that can occur when someone is experiencing an overdose, including blurry vision, stomach cramps, pinpoint pupils, or nausea and vomiting. 

Rare Symptoms of Suboxone Overdose

In some cases, people may experience one or more rare symptoms when in a state of overdose. These usually occur along with some of the issues described above and may include the following:[11]

• Bluish skin, fingernails, or lips due to low oxygen levels caused by respiratory depression
• Low blood pressure due to slowed heart rate
• Muscle weakness
• Coma 

If you believe that you or someone you love is experiencing an overdose, call 911 immediately and stay on the line with the dispatcher until help arrives. Answer all questions that the dispatcher asks, including telling them which drugs were taken and how much, if possible. If you have naloxone (Narcan) on hand, administer it.

Why Does Mixing Other Substances With Suboxone Increase Overdose Risk?

Taking Suboxone along with other substances can significantly increase the risk of experiencing an overdose. 

Here’s how mixing substances with Suboxone can lead to an increased risk of overdose:

Synergistic Effects

Some substances may amplify the effects of Suboxone when they combine in the body. This synergistic effect means that their effects are not simply added together but compounded, which can mean experiencing extreme side effects like respiratory and central nervous system depression that can be fatal.[12]

Masking Symptoms

Depending on the substances taken, one drug can mask, or diminish, the experience of effects from another substance. This can mean that the person may keep taking a substance or take a large dose without realizing that they are putting themselves in a state of overdose.[13]

Variable Tolerance

Not everyone reacts the same way to the same dose of a substance or combination of substances. In fact, the same person may react differently to the exact same combination of substances at different times depending on a variety of factors.[14] This ever-shifting tolerance can make it hard to predict what will happen when combining drugs, causing people to inadvertently take too much while believing that they are taking a dose that is “safe” or “normal” for them. 

Substances That Can Lead to a Suboxone Overdose

There are a number of different substances that are likely to trigger an overdose in someone who has Suboxone in their system. These include but are not limited to the following:

Benzodiazepines

Medications like Xanax, Valium, and Klonopin can significantly depress breathing and lead to fatal respiratory failure when combined with Suboxone, even if all medications are taken as prescribed.[15]

Alcohol

Drinking even a small amount of alcohol can increase the effects of sedation and respiratory depression when combined with opioids, including Suboxone.[16]

Antidepressants

Some antidepressants, especially those that cause sedation or impact serotonin levels, can compound Suboxone’s effects or lead to serotonin syndrome, which can be deadly.[17]

Cocaine

Even though it is a stimulant and does not depress the respiratory or central nervous system, cocaine’s cardiovascular effects can be dangerous when combined with Suboxone.[18] Heart problems may occur, or cocaine may serve to mask opioid-related sedation until its effects wear off.

Ketamine

Ketamine is another central nervous system depressant, which means that mixing it with Suboxone can lead to increased sedation, respiratory depression, and potentially coma or death.[19]

Other Opioids

Adding more opioids to the buprenorphine in Suboxone can increase the risk of respiratory depression, especially if so much is taken that it overrides the naloxone in Suboxone.[20] 

Other Substances

While the substances listed above represent common examples, almost any drug that depresses the central nervous system, including non-prescription drugs and some herbal supplements, can increase the risk of overdose when combined with Suboxone. 

If you are taking any medications or supplements that make you feel tired or fall into any of the categories above, tell your prescribing physician. 

Get Emergency Care if You Are Experiencing an Overdose

No matter how rare it is to experience an overdose on Suboxone or any opioid overdose while taking the medication, it is possible. You can also potentially overdose on another non-opioid drug while taking Suboxone. Naloxone does not have a blocking effect on other medications, such as stimulants and benzodiazepines. 

If you think you are experiencing an overdose, or someone near you is, do not wait to contact emergency medical care. Tell the operator that you or the person is on Suboxone, and an overdose may be occurring. 

If you experience an overdose from opioid drugs (such as heroin, fentanyl, methadone, or oxycodone), emergency medical treatment can be life-saving. Get help immediately. Once stable, you can pursue addiction treatment or an adjustment to your current treatment plan to help you avoid another overdose in the future.