Suboxone Addiction: Symptoms, Causes, Effects, Treatments And Prevention 

Suboxone addiction refers to a condition where an individual develops a dependency on Suboxone. The medication is a combination of buprenorphine and naloxone and is widely used to treat substance abuse withdrawal symptoms.

Suboxone addiction manifests through various physical (withdrawal, tolerance, and dependence) and psychological symptoms ( mood swings, depression).

Suboxone addiction impacts the user’s physical health (dental problems, infections, hormonal imbalances), mental well-being (depression, anxiety), and social relationships (social isolation and occupational problems).

The causes of Suboxone addiction include pharmacological (partial agonist effects, long-term use, and physical dependence ) and sociological (misuse in non-medical, inadequate medical supervision) factors.

Withdrawal symptoms of Suboxone include gastrointestinal problems, sleep disturbances, runny nose, dilated pupils, and flu-like symptoms.

Effective treatment for Suboxone addiction involves a combination of medication-assisted treatment (MAT), behavioral therapies  (cognitive behavioral therapy), and support systems (Narcotics Anonymous, family counseling).

What is Suboxone Addiction?

Suboxone addiction is a type of substance use disorder characterized by the compulsive seeking and use of Suboxone, which combines buprenorphine and naloxone. Buprenorphine serves as a synthetic opioid that treats opioid use disorder, while naloxone acts as an opioid antagonist that reverses opioid overdose. Individuals with Suboxone addiction often misuse Suboxone to achieve euphoria, which leads to dependence and withdrawal symptoms. 

Suboxone, also known as Bunavail, is widely used in the treatment of opioid addiction due to its effectiveness in reducing withdrawal symptoms and cravings. A 2020 report by Brar R., et al, on the use of a novel prescribing approach for the treatment of opioid use disorder.

Buprenorphine/naloxone micro-dosing – a case series, published in the Drug and Alcohol Review journal, demonstrated that Suboxone shown is highly effective in treating opioid use disorder. However, despite its intended purpose, Suboxone itself can become a substance of misuse.

According to Han, B.’s 2021 study, Trends in and Characteristics of Buprenorphine Misuse Among Adults in the US, in 2019, 2.4 million used buprenorphine, with 0.7 million misusing it. Common reasons for misuse were addiction (27.3%) and pain relief (20.5%). Misusers were more likely to use prescription opioids without their own prescriptions. Misuse was linked to being aged 24-49, living in nonmetropolitan areas, and polysubstance use, but negatively linked to receiving drug use treatment.

Suboxone partially activates opioid receptors, alleviating withdrawal symptoms and reducing cravings without producing the full opioid effects. It effectively blocks opioids, such as heroin, from binding to these receptors, thereby preventing euphoria. Naloxone serves to reverse the opioid effects on the brain. Although Suboxone is a valuable tool in medication-assisted treatment (MAT), the potential for dependency and misuse remains.

Addiction to Suboxone arises when individuals consume higher doses than prescribed or utilize the medication for non-medical purposes. The inclusion of naloxone aims to deter misuse by inducing withdrawal symptoms if injected; however, this measure does not prevent oral misuse. Chronic misuse ultimately leads to physical dependence and addiction.

What Are The Signs And Symptoms Of Suboxone Addiction?

The signs and symptoms of Suboxone addiction include various physical indicators such as withdrawal, tolerance, and dependence, as well as psychological symptoms like mood swings and depression.

Physical Symptoms

• Withdrawal Symptoms: When addicted individuals attempt to reduce or stop taking Suboxone, they experience withdrawal symptoms similar to those of other opioids, including muscle aches, insomnia, sweating, and gastrointestinal distress​. According to the guideline on suboxone medication by the US Food and Drug Administration, Suboxone contains an opioid and has the potential to cause dependency. Therefore, FD advises people taking the medication to consult a physician before discontinuing it. 

• Tolerance and Dependence: Over time, individuals develop a tolerance to Suboxone, requiring higher doses to achieve the same effect. Physical dependence also develops, leading to withdrawal symptoms if the medication is abruptly stopped​.

• Drowsiness and Dizziness: Suboxone causes drowsiness, dizziness, and lightheadedness, especially when the individual stands up quickly from a lying or sitting position. These symptoms interfere with daily activities and increase the risk of accidents​.

Psychological Symptoms

• Mood Swings and Depression: Suboxone addiction causes significant mood swings, irritability, anxiety, and depression. These symptoms exacerbate underlying mental health conditions or contribute to new psychological issues.
• Cravings: Persistent cravings for Suboxone dominate an individual’s thoughts and actions, making it difficult to focus on other aspects of life.

Behavioral Symptoms

• Drug-seeking Behavior: Individuals addicted to Suboxone engage in drug-seeking behaviors, such as visiting multiple doctors for prescriptions, using the medication in ways not prescribed, injecting Suboxone, and snorting Suboxone. The FDA advises against injecting Suboxone due to serious withdrawal symptoms.
• Neglecting Responsibilities: Suboxone addiction leads to neglect of responsibilities, including missing work, missing school, performing poorly in roles, and neglecting personal hygiene.
• Continued Use Despite Harm: Individuals continue using Suboxone despite negative consequences, including relationship problems and legal issues.

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What Are The Causes Of  Suboxone Addiction?

The causes of Suboxone addiction are pharmacological (partial agonist effects, long-term use, and physical dependence ) and sociological (misuse in non-medical, inadequate medical supervision) factors.

Pharmacological Factors

• Partial Agonist Effects: Buprenorphine, the primary component of Suboxone, binds to the same opioid receptors in the brain as other opioids like heroin and prescription painkillers but with less intensity. According to an article on Buprenorphine from the Substance Abuse and Mental Health Services.
  
  Administration (SAMHSA), Buprenorphine binding produces euphoria and physical dependence, although to a lesser extent than full agonists such as methadone. The reduced euphoric effect can make Suboxone less likely to be abused compared to other opioids, but dependency can still develop with prolonged use​​.
• Long-Term Use and Physical Dependence: For people in long-term treatment, physical dependence on Suboxone occurs. This dependence is often necessary to manage severe OUD effectively. However, when patients attempt to taper off the medication, they experience withdrawal symptoms similar to those of other opioids, which can lead to continued use or misuse​.
• Self-Medication and Psychological Factors: Patients with co-occurring mental health disorders, such as anxiety or depression, might misuse Suboxone to self-medicate. The psychological relief provided by the medication leads to inappropriate use and dependency. Additionally, individuals with a history of substance abuse are more prone to misuse Suboxone​.
  
  According to a 2018 article by Jennifer R.V., “Suboxone: Rationale, Science, Misconceptions”, published in the Ochsner Journal, Suboxone dependence usually develops when patients misuse the drug by self-medicating or combining it with other medications used for treating co-occurring disorders.

Sociological Factors

• Misuse in Non-Medical Contexts: Suboxone misuses occur outside of medical supervision. Individuals obtain Suboxone through illegal means to manage withdrawal symptoms from other opioids. Individuals also use Suboxone to experience milder euphoric effects. Non-medical use of Suboxone leads to addiction.
• Inadequate Medical Supervision: Proper medical supervision ensures safe use of Suboxone. Inadequate monitoring and improper dosing lead to misuse. The lack of comprehensive treatment plans further contributes to this misuse. Patients without adequate support often turn to higher doses or illicit sources of Suboxone.

What Are The Effects Of Suboxone Addiction?

The effects of Suboxone addiction include physical health, causing dental problems, infections, and hormonal imbalances. It impacts mental well-being, leading to depression and anxiety. It disrupts social relationships, resulting in social isolation and occupational problems.

• Physical Health: Chronic misuse causes liver damage, hormonal imbalances, and an increased risk of infectious diseases if injected. According to a 2013 study by Suzuki, J., et al, “Sublingual Buprenorphine and Dental Problems: A Case Series”, published in The Primary Care Companion for CNS Disorders journal, Buprenorphine treatment is linked with tooth decay, cavities, and other dental problems.
• Mental Health: Suboxone addiction exacerbates existing mental health issues. Addiction leads to severe depression, anxiety, and cognitive impairments. According to Li, J.’s 2023 study, ‘Comparison of the effect of hostility on the level of depression of drug addicts and non-addicts and the mediating role of sense of life meaning between them’, severe depression among drug addicts can be as high as 44%, while mild to moderate depression affects about 25% of this population.
• Social Impact: Suboxone addiction deteriorates relationships and social functioning. Addiction takes precedence over personal and professional responsibilities, resulting in social isolation and occupational problems.

What Are The Withdrawal Symptoms Of Suboxone?

Withdrawal symptoms of Suboxone include gastrointestinal problems, sleep disturbances, runny nose, dilated pupils, and flu-like symptoms. According to a 2012 report by Westermeyer, J., et al, “Course and Treatment of Buprenorphine/Naloxone Withdrawal.

An Analysis of Case Reports”, published in The American Journal on Addictions, people using Suboxone should gradually reduce their dosage over weeks or months. According to the report sudden cessation of Suboxone results in mild opiate withdrawal symptoms.

• Gastrointestinal Issues: These include nausea, vomiting, diarrhea, and abdominal cramping.

• Sleep Disturbances: Insomnia and restless legs syndrome significantly affect sleep quality.

• Flu-like Symptoms: These include body aches, chills, sweating, and fever-like sensations.

• Psychological Symptoms: Sudden cessation of Suboxone results in anxiety, irritability, mood swings, and depression.

• Other Physical Symptoms: These include runny nose, yawning, dilated pupils, and increased heart rate or blood pressure.

The onset of withdrawal symptoms usually begins within 24-72 hours after the last dose of Suboxone, peaking at around 72 hours to a week. Symptoms can last for several weeks, with acute symptoms subsiding after about a month, but psychological symptoms like anxiety and cravings may persist longer.

What Are The Treatment Options For Suboxone Addiction?

Treatment options for suboxone addiction involve a combination of medication-assisted treatment (Lucemyra)), behavioral therapies  (cognitive behavioral therapy), and support systems (Narcotics Anonymous, family counseling).

Medication-Assisted Treatment (MAT)

MAT is the use of medications like buprenorphine, methadone, or naltrexone, combined with counseling and behavioral therapies. This approach aims to provide a “whole-patient” approach to treating substance use disorders​. A 2018 press release, “FDA Approves The First Non-Opioid Treatment For Management Of Opioid Withdrawal Symptoms In Adults”, by the Food and Drug Administration,  approved Lucemyra (lofexidine hydrochloride) to treat opioid withdrawal symptoms in adults. 

Behavioral Therapies

Cognitive-behavioral therapy (CBT) and contingency management are crucial in helping patients modify their behaviors and develop coping strategies to deal with cravings and triggers​. According to a 2010 study by McHugh, R. K., “Cognitive-Behavioral Therapy for Substance Use Disorders”, CBT is highly effective in treating substance abuse disorders.

Support Systems

Support groups, such as Narcotics Anonymous, and family counseling provide a network for emotional support and accountability, which are essential for long-term recovery​.

How To Treat Suboxone Overdose?

Treating Suboxone overdose involves contacting medical services, administering naloxone, and providing supportive care. Suspected Suboxone overdose requires calling emergency medical services immediately. Medical professionals administer naloxone, an opioid antagonist, upon arrival to reverse overdose effects. According to a 2023 report by the Food and Drug Administration (FDA), the FDA approved over-the-counter naloxone nasal spray to reduce opioid deaths.

Supportive care ensures adequate ventilation and monitors vital signs. In a hospital setting, additional treatments include intravenous fluids and medications to manage respiratory depression. Continuous monitoring is essential due to Suboxone’s long half-life, requiring extended observation to prevent relapse of overdose symptoms.

What Are The Different Forms Of Suboxone?

The different forms of Suboxone include sublingual film, buccal film, implants, and extended-release injections.

What Are The Different Slang Names For Suboxone?

Suboxone has several slang names derived from its appearance and effects. 

According to a 2018 intelligence report by the Drug Enforcement Administration  “Slang Terms and Code Words: A Reference for Law Enforcement Personnel”, common Suboxone slang names include:

• Subs: Informal shorthand for Suboxone.
• Strips: Refers to the sublingual film form of Suboxone.
• Boxes: Derived from the packaging of Suboxone film or tablets.
• Orange Guys: Refers to the orange color of Suboxone tablets or film.

Other slang names include bupes, sobos, stop signs, and stops.

What Are The Facts And Statistics On The Prevalence Of Suboxone Addiction?

Facts and statistics on the prevalence of Suboxone addiction include 2.1 million Americans who used opioids in 2020, high treatment rates for Suboxone treatment, and more than 2,500 law enforcement agencies issuing officers with the medication to deal with opioid overdose incidents.

According to a 2024 study by Dydyk AM, et al, “Opioid Use Disorder”, published in StatPearls,  opioid use disorder (OUD) affects 16 million globally and 2.1 million in the United States.

• Prevalence: Approximately 2.1 million Americans had an opioid use disorder in 2020, with a significant number receiving buprenorphine-based treatments like Suboxone​. 

• Treatment Success: Extended Suboxone treatment has shown better outcomes compared to short-term detoxification and counseling, reducing the likelihood of relapse and illicit opioid use​​. A 2008 study, “Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults”, published in the Journal of the American Medical Association, demonstrated that Suboxone yielded better results compared to those treated using detox and psychotherapy.

• Law Enforcement Data: A 2019 article “Law Enforcement Looks to Research to Help Fight the Opioid Crisis” by the National Institute of Justice, required that over 2,500 law enforcement agencies equip officers and first responders with naloxone, highlighting the critical role of first responders in addressing opioid overdoses​​. 

How Are The Effects of Suboxone Addiction And Fentanyl Addiction Different Or Similar?

The effects of Suboxone addiction and fentanyl addiction are both similar and different in various ways. Both Suboxone and fentanyl are opioids that bind to opioid receptors in the brain, leading to physical dependence and withdrawal symptoms. They both carry a risk of overdose, with Suboxone posing a lower risk due to its ceiling effect, while fentanyl’s high potency increases danger.

Suboxone treats opioid addiction, while fentanyl manages pain. Fentanyl has a higher potential for abuse and addiction due to its potency and rapid effects, whereas Suboxone’s misuse potential is reduced by its partial agonist nature and naloxone. Withdrawal from fentanyl is more acute and intense compared to Suboxone.

For a detailed comparison, see the table below.

Aspect	Suboxone	Fentanyl
Type	Opioid	Opioid
Use	Treats opioid addiction	Pain management
Dependence	Leads to physical dependence	Leads to physical dependence
Withdrawal Symptoms	Less severe	More acute and intense
Risk of Overdose	Lower risk due to ceiling effect	Higher risk due to high potency
Abuse Potential	Lower potential due to partial agonist nature	Higher potential due to potency and rapid onset
Design	Includes naloxone to deter misuse	Prioritizes pain relief with high potency

What Are The Implications Of Suboxone Addiction For Public Health?

The implications of Suboxone addiction for public health lead to increased healthcare costs due to the treatment of addiction and associated health issues. Additionally, there is a potential rise in opioid overdose deaths if Suboxone is misused. According to a 2014 study by Lavonas, E. J., “Abuse and diversion of buprenorphine sublingual tablets and film”, published in the Journal of Substance Abuse Treatment,  37.8% of patients who participated in the study endorsed recent misuse of Buprenorphine.