What Are the Dangers and Risks of Mixing Suboxone and Alcohol?

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 opiate 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 opiate 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.

Naloxone is an opiate antagonist, meaning it fits on the opiate receptors in the brain and occupies them, not allowing any opiate drugs to attach to these receptors. In the process of attaching to the opiate 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 opiate 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 abusing Suboxone.

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 only needs to be taken once per day in most cases.

Despite all these safeguards, buprenorphine can be a drug of abuse, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).  There was a significant increasing trend of emergency room hospital visits as a result of the nonmedicinal use of buprenorphine from 2006 (4,440 cases) to 2011 (21,483 cases).  Younger individuals were most often involved, with the 18-25 age group having the highest number of ER admissions, followed by the 26-34 age group, and finally by the 35-54 age group. Abuse of buprenorphine in individuals age 55 and over resulting in a hospital admission was rarely documented. Despite these figures, abuse of buprenorphine is not as prevalent as abuse of other opiate drugs, such as oxycodone (the opiate drug found in OxyContin and other drugs), hydrocodone (the opiate drug found in Vicodin and other drugs), heroin, methadone, etc. In addition, a great deal of prescription drug abuse occurs in individuals who have friends with prescriptions for the drug. Over half of prescription pain medicine abuse occurs in individuals who get the medication from a friend or relative, according to data provided by SAMHSA.

Alcohol abuse is the most common form of drug abuse in the US, according to SAMHSA. 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 firing of neurons in the central nervous system (the brain and spinal cord). Mixing alcohol with any opiate drug, including Suboxone, can be an extremely dangerous and even lethal practice.

Mixing Alcohol and Suboxone

The warning labels on opiate drugs strongly advise patients who take these drugs 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 and number when the drug is used in combination with alcohol. These side effects include:

• 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

Chronic use of alcohol and Suboxone in combination can also lead to a number of other potential issues that can include:

• 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

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Other Important Things to Consider

If all of the potential risks and dangers listed above are not enough to persuade an individual not to drink alcohol and use Suboxone in combination, there are some other important considerations.

• Individuals who have a history of any form of substance abuse have often abused or 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.
• Individuals using Suboxone to help them recover from an opiate use disorder are still 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. 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 often 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.
• 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 abuse and the naloxone component of the drug is a potential safeguard against its abuse, the drug may still be abused. 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.