Suboxone Side Effects: Physical, Mental, and Addictive

Opioid use disorder (OUD) is primarily characterized by a strong urge to use opioids. These are drugs prescribed for managing moderate to severe pain. Sometimes, people misuse them for other purposes. 

Several medications can treat OUD, one of which is Suboxone. 

What is Suboxone?

The Food and Drug Administration (FDA) has approved Suboxone for OUD treatment. Healthcare providers prescribe this drug more often than methadone, another OUD medication but with more addictive potential. 

Suboxone contains two active ingredients—buprenorphine and naloxone—in a 4:1 ratio. It exists as a sublingual film. It’s placed under the tongue and dissolves within 5 to 10 minutes.

Healthcare providers prescribe Suboxone to treat dependence on heroin and prescription opioids like morphine, oxycodone, and fentanyl.

Although Suboxone contains buprenorphine, it should not be used as a pain medication.^1-6

Buprenorphine

Buprenorphine is a partial opioid agonist. It’s an opioid that attaches to brain receptors so that other opioids can’t stick to them. It can reduce cravings and withdrawal symptoms.

As an opioid, buprenorphine produces effects like euphoria. Its effects, however, are weaker than those of methadone and other opioids.

Buprenorphine has a ceiling effect, meaning its effects level off at a certain amount, even in higher doses. This allows the drug to be used safely with a lower risk of misuse, even though it’s an opioid.

Buprenorphine (without naloxone) is commonly prescribed for pain management. It’s also an FDA-approved medication for treating OUD. 

Buprenorphine is a Schedule III medication. Doctors need a special waiver for prescribing it.^{1, 2, 4, 5}

Naloxone

Naloxone is an opioid antagonist. It blocks opioid receptors and reverses the effects of opioids. The medication comes as a nasal spray or an injection. 

Naloxone is the immediate remedy for people showing signs of an opioid overdose. It can quickly restore breathing that has slowed down or stopped due to excessive opioid intake.  

Naloxone has no effect when taken orally, but is included in Suboxone to deter people from abusing Suboxone by injecting it. It’s not a treatment for OUD and doesn’t affect people without opioids in their system.^{2, 4, 7}

Physical Side Effects of Suboxone

Suboxone may cause side effects mainly due to its buprenorphine component. 

Some of its common physical side effects include:^{1, 2, 5, 6, 8, 9}

• Trouble breathing
• Dizziness, drowsiness, or sleepiness
• Fatigue
• Sweating
• Shaking or tremors
• Blurred vision
• Intoxication (feeling lightheaded or drunk)
• Headache 
• Coordination problems
• Dry mouth
• Oral hypoesthesia (numbness inside the mouth)
• Tongue pain
• Tooth decay
• Nausea
• Vomiting
• Constipation
• Palpitations (fast or pounding heartbeats)
• Muscle aches or cramps

Some rare but severe side effects of Suboxone include:^{2, 5}

• Low blood pressure when standing
• Liver problems (liver failure or changes in liver function)
• Changes in adrenal gland function
• Sleep-related breathing disorders
• Allergic reactions (due to hypersensitivity to buprenorphine, naloxone, or other ingredients)
• Respiratory depression (slowed breathing)
• Opioid withdrawal symptoms
• Overdose symptoms
• Neonatal opioid withdrawal syndrome (NOWS) in newborns

Suboxone may lead to overdose and death. The risk is higher if Suboxone is taken with sedatives (like benzodiazepines) or depressants (like alcohol). Overdose symptoms include:⁶

• Pinpoint pupils
• Sedation
• Low blood pressure
• Respiratory depression (slowed breathing)

If you believe you or someone else has overdosed on Suboxone, call 911 and seek medical help immediately.

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Mental Side Effects of Suboxone

Suboxone may also cause mental side effects like:^{1, 2, 5, 6, 8, 9}

• Anxiety
• Trouble concentrating
• Opioid dependence
• Irritability
• Insomnia
• Nervousness

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Is Suboxone Addictive?

Yes, Suboxone can be addictive mainly due to its buprenorphine component. 

Although buprenorphine is a partial opioid agonist, it can still produce withdrawal symptoms if you quit cold turkey.^{1, 9}

Suboxone Withdrawal Symptoms

Some withdrawal symptoms associated with Suboxone include:^{6, 8, 9}

• Shaking or tremors
• Abnormal sweating
• Chills
• Feeling hotter or colder than normal
• Fever
• Headaches
• Runny nose
• Dilated pupils
• Watery eyes
• Goosebumps
• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Muscle aches
• Decrease in blood pressure
• Anxiety
• Depression
• Irritability
• Trouble concentrating
• Insomnia
• Fatigue
• Cravings for Suboxone

Suboxone Warnings

Here are some warnings and precautions regarding Suboxone treatment:^{1, 2, 6, 8}

• Tell your doctor about your medical history before starting Suboxone treatment. It’s not recommended if you have certain conditions like chronic breathing disorders or liver problems. 
• Don’t take Suboxone if you’re pregnant or breastfeeding. Suboxone may be passed on to the newborn and cause life-threatening neonatal opioid withdrawal syndrome (NOWS).   
• Only use Suboxone for its intended purpose: to treat OUD. Never use Suboxone as a pain reliever. Misuse can cause addiction, overdose, or death. 
• Take Suboxone as directed. Do not cut, chew, swallow, or inject the medicine. Don’t take the medication at a higher dose or frequency.
• Talk to your doctor about possible drug interactions. Don’t mix Suboxone with benzodiazepines, alcohol, or other substances that can cause serious side effects like respiratory depression and death.
• Don’t stop taking Suboxone without your doctor’s permission. If you discontinue Suboxone, monitor withdrawal symptoms and treat them appropriately.
• Avoid potentially dangerous tasks (like driving a car or operating machinery). Suboxone may impair the physical and mental abilities required for such tasks. 
• Don’t take Suboxone if you have an allergic reaction to buprenorphine, naloxone, or other ingredients. 
• Seek immediate medical attention if you feel sleepy, dizzy, uncoordinated, have trouble breathing, blurred vision, or slowed reflexes. 

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Alternatives to Suboxone

Alternatives to Suboxone sublingual film include:¹

• Buprenorphine-naloxone combination medication in the form of a sublingual tablet
• Buprenorphine injectable, implant, and sublingual tablet
• Naltrexone injectable and tablets
• Lofexidine tablets
• Methadone tablets or oral liquid

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