Can you overdose on Suboxone? The quick answer
Yes, it is technically possible to overdose on Suboxone (buprenorphine/naloxone). For people who are prescribed Suboxone, overdose is extremely rare and almost only occurs when they also take other drugs (opioids, benzodiazepines, stimulants, etc.). Suboxone lowers the overall risk of overdose for people with opioid use disorder.
How often do people actually overdose from Suboxone?
Suboxone is made up of two active ingredients: buprenorphine and naloxone. The part of Suboxone that has the potential to cause overdose is buprenorphine, which is a partial opioid agonist. This means it is an opioid medication that bonds to and partially activates the opioid receptors in the brain. Because it is an opioid, it is possible for buprenorphine to cause an overdose. But as it is a partial opioid agonist and has a “ceiling effect” beyond which its effects do not increase, the risk of overdose is much lower than for other opioid medications.
Illustrating this, one study found that buprenorphine was present in 2.6% of opioid-involved overdose deaths. Of those overdose deaths that included buprenorphine, 92.7% also involved at least one other drug. So there were approximately 143 buprenorphine-only overdoses out of the 74,474 opioid-involved overdose deaths that occurred between July 2019 and June 2021. This shows that buprenorphine overdose can sometimes happen, but at a much, much lower rate than other opioids.
What increases the risk of Suboxone overdose?
- Other health conditions can increase risk. This includes people with hypersensitivity to buprenorphine, with respiratory depression, and with gastrointestinal obstruction. Your provider will talk to you about your health history before prescribing buprenorphine medications.
- People without an opioid tolerance have a greater possibility of overdose. As I mentioned above, buprenorphine only partially activates opioid receptors. For people with opioid use disorder, this partial activation is enough to relieve withdrawal symptoms and cravings but not enough to create euphoria or a significant danger of overdose. But for people who have no tolerance, buprenorphine’s effect can be more intense, increasing the risk.
- Combining buprenorphine with other substances is dangerous. In the study cited above, 92.7% of overdoses in which buprenorphine was present also included another substance. It is dangerous to mix buprenorphine with alcohol, benzodiazepines, antidepressants, anticonvulsants, or other opioids.
How to reduce the chance of overdosing on Suboxone
- Only take Suboxone as prescribed. Don’t increase your dose or how often you’re taking it without guidance from your healthcare provider. Note that Suboxone is only approved for treating opioid use disorder, so “taking as directed” means that people with no tolerance for opioids shouldn’t be taking it at all.
- Do not combine Suboxone with any other substances. Sometimes folks assume that because buprenorphine is considered safer than other opioids, that means they can take it with impunity and mix it with other substances. This is incorrect, and greatly increases the risk of overdose.
- Keep naloxone (Narcan) on hand. Naloxone is a rescue medication that can reverse opioid overdose. It is available without a prescription and is administered via a convenient nasal spray. Anyone who uses any opioids, including buprenorphine, should have it available in case of overdose.
Bottom line: the risk of Suboxone overdose is very small of people who are prescribed it for opioid use disorder, and the medication greatly reduces the overall risk of opioid overdose.
