What Are the Dangers and Risks of Mixing Suboxone and Alcohol?
Both alcohol and Suboxone (the buprenorphine component) act as central nervous system depressants, meaning that their general action results in a decrease in the rate of neurons firing in the central nervous system (the brain and spinal cord). Mixing alcohol with any opiate drug, including Suboxone, can be an extremely dangerous practice. Continue reading to learn more about the dangers and risks associated with mixing alcohol and Suboxone.
What Is Suboxone?
Suboxone is a combination opioid drug containing both buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, which means that it binds to the same receptors in the brain as other opioid drugs, like morphine, hydrocodone, oxycodone, etc., but it does not produce the full effects of these drugs.
Individuals who have developed opioid use disorders will not get the same “high” from buprenorphine that they get from their opioid drug of choice, but the receptors in the brain will be “tricked” into thinking that they are taking an opioid agonist drug, and the person will not experience the withdrawal effects associated with stopping the opiate drug. The United States Drug Enforcement Administration (DEA) lists buprenorphine as a Schedule III controlled substance, indicating that it does have a potential for abuse and the development of physical dependence.1
Naloxone is an opiate antagonist, meaning it fits on the opiate receptors in the brain and occupies them, not allowing any opioid drugs to attach to these receptors. In the process of attaching to the opioid receptors in the brain, it removes any opiate drugs that are already there. Once this component of the drug is activated, individuals will immediately go through an opioid withdrawal syndrome. Naloxone can also be used as a standalone medication to treat individuals who overdose on heroin, Vicodin, OxyContin, or other opiate drugs, and its effects are often very fast and efficient.
Suboxone is primarily designed to be an opioid replacement drug to assist individuals who have opioid use disorders in going through the withdrawal process with minimal discomfort. Because Suboxone is an opiate drug, it can also be used to control pain. The buprenorphine in Suboxone controls opiate withdrawal symptoms, and it can be effective in controlling mild to moderate pain. The naloxone is designed as a safeguard to keep individuals from misusing Suboxone. Suboxone is designed so any attempt to grind up the Suboxone tablets activates the naloxone component, which avoids potential misuse of the drug when individuals attempt to use it in a non-prescribed manner.
In addition, while buprenorphine does produce mild euphoric effects, it also has a ceiling effect, meaning that any attempt to take other opiate drugs while taking buprenorphine, or trying to take more and more buprenorphine to increase feelings of euphoria, will not increase feelings of euphoria beyond very minimal levels. Because Suboxone is a long-acting drug, it is typically only taken once per day (in most cases).
Mixing Alcohol and Suboxone
The warning labels on opiate drugs strongly advise patients not to take them with alcohol. Physicians are required to instruct patients to not use these drugs in conjunction with alcohol. Even though buprenorphine is a partial opioid agonist, the same precautions and effects that are associated with other opiate drugs apply to buprenorphine. Because alcohol and buprenorphine are central nervous system depressants, taking them in combination leads to an enhancement of their effects.
Side effects that might occur with buprenorphine use can be significantly increased in intensity when the drug is used in combination with alcohol. These side effects include:2
- Issues with nausea, vomiting, and constipation.
- Headache, blurred vision, dizziness, and fainting spells.
- Increased sweating, heart palpitations, increased or decreased blood pressure, and an increased potential for myocardial infarction.
- Decreased motor coordination, poor response times, and extremely impaired thinking processes, including issues with judgment.
Because central nervous system depressants like alcohol and buprenorphine decrease the activity of the neurons in the brain and spinal cord, these drugs can contribute to a number of potentially serious conditions when used in combination on a long-term basis. These conditions include:3
- Serious effects associated with the respiratory suppression (decreased breathing rate) that both drugs induce: These effects can include respiratory infections and tissue and organ damage as a result of hypoxia (decreased blood flow to the organs and tissues). Serious brain damage can occur as a result of chronic issues with respiratory suppression.
- Decreased blood flow as a result of heart rate alterations: Issues with decreased blood flow can, of course, produce tissue and organ damage over the long-term due to a lack of nutrients and oxygen being delivered to organs and other tissues.
- Altered thinking processes: These can lead to an increased potential to become involved in accidents, engage in risky behaviors, or engage in intentional self-harm as a result of becoming depressed.
- Comatose states: These occur due to a suppression of the neurons in the brain stem that control the automatic functions of breathing and heart rate. This situation can be potentially fatal or result in serious damage to the brain and other organs in the body.
Chronic use of alcohol and Suboxone in combination can also lead to a number of other potential issues that can include:4
- Increased risk for a number of different forms of cancer, including cancer of the liver, kidneys, and/or gastrointestinal system.
- Increased risk for cirrhosis of the liver, ulcers, and/or brain damage due to stroke.
- Increased risk for cardiovascular disease.
- Increased risk to contract a number of diseases as a result of a weakened immune system or as a result of engaging in unhealthy or risk-taking behaviors.
- The development of physical dependence on one or both drugs.
- The development of a substance use disorder to one or both drugs.
Other Important Things to Consider if Mixing Alcohol & Suboxone
Individuals using Suboxone to help them recover from an opiate use disorder are in a very delicate situation. A phenomenon known as the abstinence violation effect sometimes occurs in individuals who are attempting to abstain from using drugs, overeating, drinking alcohol, etc., and have a small lapse or slip.5 This small lapse or slip results in the individual adopting a cavalier attitude regarding drugs or alcohol, and the individual binges excessively.
They have made the determination that since they have slipped, they might as well “go all the way.” This behavior is sometimes seen in individuals who have lapses in recovery and even in individuals who are on strict diets and suddenly have a small “treat” that leads to a short period of bingeing. Bingeing on alcohol and opiate drugs can result in a potentially fatal overdose.
A few other important things to consider if Suboxone and alcohol are combined:
- Individuals who have a history of any form of substance misuse have often misused alcohol in conjunction with other drugs. Someone attempting to recover from an opiate use disorder by using Suboxone may trigger strong cravings for opioids if they begin drinking.
- Drinking alcohol while on Suboxone, even small amounts, can result in a number of issues with judgment that can lead to deleterious effects.
- Drinking small amounts of alcohol while using Suboxone may result in extreme lethargy, sleepiness, and even unconsciousness that can have potentially dangerous effects.
Conclusions
While Suboxone is not a major drug of misuse and the naloxone component of the drug is a potential safeguard against its abuse, the drug may still be misused. The instructions for using Suboxone specifically warn against taking it with any amount of alcohol.
There are a number of potentially serious dangers and risks associated with using Suboxone and alcohol for lengthy periods of time and even using them in combination occasionally.
Individuals who are prescribed Suboxone are typically prescribed the drug as an opiate replacement drug to help them recover from an opiate use disorder. Drinking alcohol with Suboxone is counterproductive to engaging in a healthy and successful recovery and may result in severe long-term consequences.
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