Suboxone is a buprenorphine-based sublingual medication commonly prescribed in the treatment of opioid use disorder (OUD). Buprenorphine is a partial opioid. What is an opioid, and what is OUD? 

An opioid is a chemically altering substance that binds to proteins in the brain called opioid receptors. Opioids can be broken down into two categories: full opioid agonists and partial opioid agonists. Examples of full opioid agonists include heroin, oxycodone, fentanyl, and methadone. Examples of partial opioid agonists include tramadol, butorphanol, and buprenorphine.

Opioid use disorder or OUD is the medical term for opioid dependence and addiction. Opioids mimic the effect of endorphins being released in the brain. It is, for this reason, they become addictive. 

Is Buprenorphine Addictive? 

Drugs as potent as opioids can cause dependence, without them it can be very difficult to function but the introduction of a partial opioid can help establish equilibrium in the brain and enable the individual to rebuild their lives without using opioids illicitly. While buprenorphine is an opioid, it is a partial opioid. This distinction is very important. 

Full agonists and partial agonists activate the opioid receptors in the brain to different extents. Buprenorphine, the partial agonist/antagonist, is much more competitive than full agonists such as heroin or oxycodone. Buprenorphine will overthrow full agonist opioids and bind more aggressively than synthetic opioids to the brain’s opioid receptors. In addition to this, the drug retains a ‘ceiling effect’ or threshold, which means that tolerance to buprenorphine does not increase over time as it does in conjunction with full opioid agonists. 

Continued opioid use reconfigures the brain’s chemical make-up. The brain uses neurotransmitters to communicate and regulate the body’s response to stimuli. Neurotransmitters such as endorphins are secreted by neurons in the brain to initiate action and combat pain. Neurotransmitters are chemical substances that attach to the brain’s opioid receptors and release endorphins. The neurons then propel the endorphins through the brain’s pain corridors to alleviate discomfort and deliver relief.  The ingestion of opioids simulates the effects of natural secretion in the brain and imitates neurotransmission. Refer to Suboxone Ingredients: All You Need to Know for more on this.

Opioid receptors essentially control our pain corridors, pain, and perception of pain while also providing analgesic effects that include discharging dopamine by way of the reward system heralded in the brain. See Can Suboxone be Used for Pain and Can You Overdose on Suboxone for more. The pharmacological effects of opioids are targeted at the brain’s opioid receptors. These receptors are named the delta, kappa, and mu receptors. When stimulated, either naturally or synthetically, the mu receptor is the primary receptor responsible for neuromodulation, the alteration of the brain’s chemical structure. 

The euphoric feeling created by the stimulation of the brain’s opioid receptors and the ensuing release of endorphins becomes something your body craves and depends upon. Continued opioid use desensitizes the opioid receptors, which requires increased ingestion of the opioid to achieve the same and/or higher level of euphoria with each use which in turn poses a massive risk of overdose. While opioids stifle pain, they also slow down and retard your immune system, renal system, nervous system, cardiovascular system, and other bodily functions, which is why overdose can be fatal. 

When opioids leave the bloodstream, your bodily systems are catapulted into withdrawal. Withdrawal symptoms include, among others, fever, sweating, diarrhea, and nausea. Avoiding the withdrawal phase is one of the leading reasons for continued opioid use. For more on withdrawal, see Does Suboxone Make You High?

Opioids train the brain to want more pain relief than it is capable of producing naturally. This is where the medication assisted treatment (MAT) of OUD comes in. Suboxone (buprenorphine/naloxone) is a medication commonly prescribed in MAT. 

The partial effects of buprenorphine help prevent dependency, suppress withdrawal symptoms, mitigate tolerance and allow the opioid receptors to re-establish sensitivity, while the antagonist effects of naloxone block stimulation of the opioid receptors. Both of these medicines  are combined to form Suboxone. 

Is Suboxone Addictive? 

The main differentiating factor between the addictive properties of full opioid agonists and Suboxone is the way in which the drugs stimulate the mu receptor. When the opioid receptors in the brain are engaged, the mu is the primary receptor responsible for neuromodulation. Suboxone possesses opioid effects; however, the buprenorphine binds so tightly to the mu it blocks illicit and synthetic opioids from attaching. The drug’s threshold controls the opioid effects and stabilizes cravings. The fact that Suboxone is a partial opioid means that Suboxone can become addictive if misused, i.e., ingested intravenously or intranasally. It is for this reason that it should be administered in consultation with a medical professional. 

Suboxone is a very effective drug in the treatment of OUD when accurately dosed and used properly. It does not produce the same level of euphoria full agonists produce, and it protects against craving and withdrawal. Physical and emotional withdrawal increases the risk of relapse. Medication (Suboxone) controls and regulates this. Its gradual effects curb the euphoric high experienced with opioid use allowing the patient to function productively and focus on engaging employment, securing suitable accommodations, repairing interpersonal relationships, and other fundamental facets of recovery.

Signs of misuse and symptoms of Suboxone misuse include self-administered dosing, use with alcohol, sedatives, tranquilizers, opioids, or other drugs that act on the nervous system. The side effects of Suboxone misuse include relapse, overdose, and precipitated withdrawal. 

Can You Get Addicted to Suboxone?

Is Suboxone safe? Can you get addicted to Suboxone? Suboxone and other buprenorphine products can change and save lives if taken responsibly and as prescribed. When combined with therapy, medication assisted addiction treatment can replace chronic opioid use disorder with functioning rehabilitation. Suboxone dependency is not the same as opioid dependency. Suboxone dependency enables functioning productivity; opioid dependence does not. To understand more about this distinction, reach out to medical professionals on staff at Confidant.