The myth that Suboxone “swaps one addiction for another” is false. But that doesn’t mean there aren’t any risks with taking it.
Medication assisted treatment (MAT) is considered the gold standard for treating opioid use disorder (OUD). It involves managing OUD through the use of medication, sometimes in combination with psychotherapy.
One of these medications is buprenorphine/naloxone, known as Suboxone.
Suboxone helps ease withdrawal symptoms while also decreasing your body’s dependence on other opioids. But some people are hesitant to try Suboxone because of concerns they might become addicted to it.
This concern has been fueled by the myth that using Suboxone and similar medications is just “swapping one addiction for another.”
When used as prescribed, it’s very unlikely to develop an addiction to Suboxone. However, as with many prescription medications, your body can develop a physical dependence on it. Keep in mind that physical dependence is not the same thing as addiction.
Here’s a closer look at how Suboxone works and the potential risks associated with it.
Technically, yes — but the full answer is a bit more complex.
Suboxone is considered a partial opioid agonist. There are two types of opioid agonists:
- Full agonists: These fully activate your brain’s opioid receptors, helping relieve pain, encourage relaxation, and create a sense of euphoria. Examples of full agonists include fentanyl, heroin, morphine, and oxymorphone.
- Partial agonists: These still activate opioid receptors but to a much lesser extent and work slightly differently than full agonists. Buprenorphine — one of Suboxone’s two active ingredients — is a partial agonist.
Compared with full agonists, buprenorphine “binds much stronger and stays attached to the receptor for longer,” explains Dr. Robert Ochsner, chief medical officer at Sandstone Care.
As a partial agonist, Suboxone works in two ways. First, it helps reduce cravings and withdrawal symptoms by producing mild opioid effects.
Second, it blocks full agonists, like heroin or oxycodone, from attaching to receptors. This prevents them from causing a “high.”
But there’s more than just buprenorphine in Suboxone: It also contains naloxone. This drug is an opioid antagonist and, under certain circumstances, works to reverse the effects of an opioid on the brain.
Suboxone comes in two forms. One is a sublingual tablet you place under your tongue. The other is a thin film that dissolves either in your cheek or under your tongue. When taken as directed, the naloxone in Suboxone won’t have any effect.
However, some people attempt to inject Suboxone to experience stronger, more fast-acting effects. When injected, the naloxone in Suboxone causes abrupt withdrawal, which can be quite uncomfortable. Naloxone is included to help prevent people from misusing Suboxone.
Before getting into whether Suboxone is addictive, it’s important to understand the difference between addiction and dependence. While the terms are sometimes used interchangeably, they mean two different things.
“Addiction is the loss of control despite worsening consequences,” says Dr. Arthur Robin Williams, an addiction psychiatrist and the chief medical officer at Ophelia. These consequences can start to take a significant toll on various areas of life, including personal relationships and work.
Dependence occurs when your body becomes used to a substance and you experience withdrawal symptoms when you stop using it. Dependence can occur with all kinds of substances, from opioids to antidepressants to caffeine.
In the United States, buprenorphine is classed as a Schedule III controlled substance, meaning it has a low to moderate risk of physical or psychological dependence.
Suboxone also has a “ceiling effect.” This means you won’t experience stronger effects after a certain dosage point. For Suboxone, this limit is 24 milligrams per day. If you take more than that amount, you won’t feel any added effects.
While you may develop a dependence on Suboxone, addiction is unlikely because of its “ceiling effect.”
Finally, once in the body, Suboxone “has a very steady action,” says Williams. It produces effects in a slow, consistent fashion, which further minimizes the potential for misuse.
MAT, whether it involves Suboxone or another medication, is considered to be a highly effective and safe approach for treating OUD.
For example, one
A 22-week study from 2022 also compared Suboxone with methadone, another medication used in MAT. Researchers learned that, while both medications were effective, Suboxone was more successful in reducing cravings among participants.
That said, Ochsner recommends undergoing MAT as part of a broader treatment plan.
“[Medications] are just one part of treating the disease of addiction and are best used when coupled with therapy and engagement in a recovery community,” he adds.
If Suboxone seems to be working well, it may be tempting to stop taking it sooner than a doctor advises. But doing so can increase your risk of returning to opioid use.
Your tolerance for opioids will also be lower, increasing your risk of an overdose if you do use an opioid.
When the time comes to stop taking Suboxone, it’s essential to do so slowly under the supervision of a healthcare professional to avoid withdrawal symptoms.
How long will I need to take Suboxone?
According to Williams, people typically take Suboxone for 2 to 5 years, but this timeline can vary greatly from person to person.
Your healthcare professional will wait until you’ve gone a certain amount of time without using other opioids and have a low risk of returning to use before advising you to stop taking Suboxone.
If you find yourself misusing Suboxone by taking more than prescribed or altering its form, talk with your prescriber about next steps. They can work with you to adjust your dosage or incorporate other treatment approaches.
You can also reach out to one of the following free and confidential resources:
- Substance Abuse and Mental Health Services Administration’s National Helpline at 800-662-HELP (4357) or online treatment locator
- SAFE Project
If you’re taking Suboxone without a prescription because of difficulty finding an affordable treatment program, Shatterproof has additional resources for navigating insurance issues, negotiating costs, and finding free or reduced cost programs.
Suboxone is a combination of buprenorphine and naloxone. It’s used to treat opioid use disorder.
When taken as directed, the risk of addiction to Suboxone is low. That said, your body can become physically dependent on it, though this isn’t necessarily a cause for concern.
“Suboxone is a life changing (and often lifesaving) medication,” says Ochsner. However, it’s crucial to remember that “it comes with some risks and side effects, just like any other medication.”