How Does Suboxone Work?

When someone uses opioids in a problematic or addictive pattern that impacts their daily life, it's called opioid use disorder (OUD), otherwise known as opioid dependence.

In the worst of scenarios, OUD may lead to an opioid overdose, which can be fatal.

Healthcare providers diagnose this disorder based on specific criteria, such as unsuccessful attempts to reduce or quit opioid use and social problems or difficulties at work, school, or home.

Suboxone is a medication prescribed to treat OUD as part of a comprehensive treatment program.

It is a combination drug that contains two active ingredients: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, while naloxone is an opioid antagonist.

Suboxone has two active ingredients that work in different ways. Buprenorphine partly mimics the action of opioids to reduce drug cravings and minimize withdrawal symptoms, while naloxone prevents misuse of the drug.

Keep reading this article to learn more about how Suboxone works for opioid dependence, along with information about its efficacy, side effects, dosage, and more.

Opioid Addiction in the United States

The term “opioids” refers to a group of drugs that act on specific receptors (“binding sites”) in the body known as opioid receptors.

Opioids fall into two main categories:

1. Prescription opioids, including medications like Oxycontin (oxycodone extended-release [ER]) and MS-Contin (morphine ER) that healthcare providers prescribe to treat severe pain
2. Illicit opioids, such as heroin

Developing Dependence

Drug dependence occurs when the body becomes accustomed to receiving a medication. When someone takes prescription opioids and/or uses illicit opioids regularly, their body adapts to it.

Once someone develops dependence, they experience uncomfortable physical symptoms known as withdrawal when they stop taking the medication.

Dependence on opioids is dangerous because the body develops tolerance to these drugs over time, requiring more and more of the medication to get the same effect.

Ultimately, dependence can lead to addiction or even overdose.

Narcotic Addiction vs. Opioid Use Disorder

Narcotic addiction, opioid dependence, and OUD are all similar terms that people use to describe a reliance on opioids, leading to problematic patterns and disruptions in daily life.

However, the Centers for Disease Control and Prevention (CDC) and other experts now recognize OUD as the preferred term.

History and Statistics

The OUD epidemic in the United States began in the late 1990s as prescription opioid medications became more common.

To date, more than one million Americans have died as a result of an opioid overdose since 1999.

Opioids most frequently associated with OUD contain methadone, oxycodone, and hydrocodone.

Opioid-related overdoses have risen dramatically over the last two decades, with six times more deaths occurring in 2021 than in 1999.

In 2021, West Virginia had the highest rate of opioid overdoses in the United States, with 91 out of every 100,000 citizens experiencing an overdose that year.

What Is Suboxone?

The Food and Drug Administration (FDA) has approved Suboxone for treating OUD, along with counseling and other supportive measures, as part of a complete treatment plan.

Suboxone is administered via a film you dissolve under the tongue (sublingually) or against your inner cheek (buccally).

The drug is approved for managing OUD in adults (18 years and older); it is not approved for use in children or adolescents.

Suboxone contains two active ingredients:

1. Buprenorphine: Buprenorphine belongs to a drug class called partial opioid agonists. It works by partly activating opioid receptors, providing a weaker effect than other opioids, which are “full” activators (agonists) of opioid receptors. This partial activation helps to lessen opioid cravings and minimize withdrawal symptoms after stopping opioid use. Since buprenorphine is only a partial opioid agonist, people are unlikely to feel euphoria (“high”) from Suboxone when taken as directed.
2. Naloxone: Naloxone belongs to a drug class called opioid antagonists. This ingredient is included in Suboxone to prevent abuse or misuse of the drug.

Off-Label Uses

Sometimes, healthcare providers prescribe medications for reasons outside the FDA's approval. This practice is known as off-label prescribing.

Healthcare prescribers may prescribe Suboxone off-label to help treat pain, particularly in those with a history of OUD or “addictive personality.”

Forms of Administration

The buprenorphine/naloxone combination comes in the following forms and brands:

• Brand-name forms: Suboxone film and Zubsolv dissolving tablet
• Generic forms: Buprenorphine/naloxone film and buprenorphine/naloxone dissolving tablet

Regardless of your specific form or brand, the medication is taken by dissolving it in your mouth. The film may be placed against the inside of your cheek or under the tongue.

Generic drugs are typically less costly than brand-name versions.

Note that these drugs cause different effects when they are given individually. The effects also differ depending on the route of administration.

Buprenorphine in Other Products

Buprenorphine is also available as a single-ingredient drug in various brands and forms, such as Butrans transdermal patch (a form of administration where a patch is placed on the skin to deliver medication through the skin and into the bloodstream) and Sublocade intravenous (IV, into a vein) injection.

Healthcare providers prescribe these drugs to treat pain or OUD respectively.

Naloxone in Other Products

Naloxone also comes as a single-ingredient drug in various brands and forms, including Narcan.

Narcan is used as an emergency treatment for someone experiencing a known or suspected opioid overdose to reverse the effects of opioids.

How Does Suboxone Work?

Suboxone contains buprenorphine, which belongs to a medication class known as partial opioid agonists; this means that buprenorphine attaches to opioid receptors.

However, unlike other opioids, orally dissolved buprenorphine binds to fewer opioid receptors and for a more extended period.

This provides some of the same effects of opioids to avoid withdrawal symptoms but without the "high."

Naloxone belongs to a drug class called opioid antagonists ("blockers"), but it doesn't have a blocking effect when it is dissolved in the mouth.

When dissolved under the tongue, naloxone does not work to block opioid receptors, allowing buprenorphine to provide partial withdrawal relief and decrease dependence.

However, when administered by injection or intranasally, naloxone blocks buprenorphine from working and helps prevent potential overdoses.

In this way, the combination of buprenorphine/naloxone films and tablets discourages abuse of the medication while promoting safe, effective use.

Together, buprenorphine and naloxone combine to reduce an individual's opioid drug dependence and slowly block symptoms of withdrawal to assist in the OUD recovery process.

Dosing Guidelines

Treatment for OUD typically starts with an induction phase at your healthcare provider’s office or a treatment clinic.

Not everyone starts on Suboxone; in some cases, your provider may initiate treatment with a buprenorphine-only regimen.

The details of the initial treatment plan will vary depending on the specific opioid the person is stopping or withdrawing from and whether that opioid is short-acting or long-acting.

For instance, heroin is considered short-acting, while methadone is long-acting.

Suboxone film comes in four different strengths:

• Buprenorphine/naloxone 2 milligrams (mg)/0.5 mg
• Buprenorphine/naloxone 4 mg/1 mg
• Buprenorphine/naloxone 8 mg/2 mg 
• Buprenorphine/naloxone 12 mg/3 mg

Be sure to follow the personalized instructions from your healthcare provider. They’ll help determine the dosage that best manages your symptoms.

The table below shows the general maintenance dosage recommendations for adults taking Suboxone for OUD:

How Quickly Will Suboxone Work?

Suboxone begins working rapidly after it dissolves under the tongue or against the inside cheek. It reaches its full effects within one to three hours.

The onset of action is similar for the film and dissolving tablet versions.

However, during the initial induction phase of treatment, your healthcare provider will have you take one form or the other until you are stable and not switch between the film and tablet or vice versa.

After completing the initial induction phase of treatment, Suboxone maintenance treatment is typically taken once daily as a single dose. Its effects for managing OUD last around 24 hours, but the active ingredients remain in your system for several days.

When Suboxone film is dissolved in the mouth, buprenorphine has a half-life of 24-42 hours, and naloxone has a half-life of two to 12 hours.

For context, a half-life refers to measuring how long your body takes to clear half of a dose from your system.

There is no set limit on how long you can take Suboxone.

Some people work with their healthcare provider to slowly taper off the medication over time, while others may require long-term treatment to avoid relapse.

Continue taking it as long as you and your healthcare provider feel that the medication is beneficial for you.

Side Effects and Precautions

Like other medications, Suboxone may cause side effects.

Common Side Effects

The more common side effects are usually mild, including:

• Numbness or burning sensation in the mouth
• Mouth irritation
• Headache
• Nausea or vomiting
• Insomnia
• Constipation
• Excessive sweating
• Dizziness

Severe Side Effects

Less commonly, Suboxone may cause severe side effects, such as:

• Dental or tooth problems, such as tooth decay or abscesses
• Dangerously slow breathing, also known as respiratory depression
• Insufficient hormone production
• Problems with fertility
• Liver problems, including liver failure
• Allergic reaction

Some people may be more prone to severe side effects with Suboxone. As such, healthcare providers may not prescribe the drug in certain situations.

They may monitor you very closely if you have certain conditions or factors.

The following people should exercise caution or possibly not take Suboxone, depending on their healthcare provider’s discretion:

• Older adults
• Children
• People with pre-existing liver problems
  

Safe Consumption Guidelines

The typical maintenance dosage of Suboxone is one dose each day. Note that other forms of buprenorphine have different dosing schedules.

For example, with the buprenorphine transdermal patch, you apply the patch to your skin every seven days.

Regardless of the form you take, be sure to follow the exact directions from your healthcare provider.

To ensure proper absorption of Suboxone film, allow the film to dissolve wholly and slowly under your tongue or against the inside of your cheek.

Don’t cut, swallow, or chew the film. Wait to eat any food or drink anything until the film dissolves entirely. And be sure to wait at least an hour after taking Suboxone to brush your teeth.

People taking Suboxone should not drink alcohol. Consuming alcohol with Suboxone is dangerous and should be avoided due to the serious risk of severe side effects.

Potential for Interaction

Additionally, certain other medications interact with Suboxone; talk with a healthcare professional about all other medications you take, as some may interfere with Suboxone.

While not a complete list, the following types of drugs can interact with Suboxone:

• Benzodiazepines, such as Ativan (lorazepam) and Xanax (alprazolam). With Suboxone, benzodiazepines may result in severe respiratory depression (dangerously slow breathing), which can be fatal.
• Medications that affect liver enzymes include Nizoral (ketoconazole) or Dilantin (phenytoin). Depending on the medication, these interactions result in a reduction or increase in Suboxone’s effects, which can lead to withdrawal or overdose in some situations.
• Certain antidepressants, such as Lexapro (escitalopram) or Cymbalta (duloxetine). With Suboxone, these medications may raise the risk of serotonin syndrome (SS).
• Monoamine Oxidase Inhibitors (MAOIs), such as Zelapar (selegiline). When taken with Suboxone, MAOIs may induce SS or opioid toxicity.
  

Efficacy

Clinical trials of buprenorphine/naloxone have proven effective in treating OUD.

In a clinical trial, participants received buprenorphine/naloxone or placebo over four weeks.

Participants taking buprenorphine/naloxone used opioids significantly less than those taking a placebo, based on the results of urine screening tests throughout the trial.

These results reflect buprenorphine/naloxone’s short-term effectiveness in quickly reducing withdrawal symptoms and helping combat relapses.

Longer trials have also shown buprenorphine/naloxone’s efficacy. 

In a 17-week trial comparing buprenorphine/naloxone to placebo followed by a detoxification period, those receiving the medication experienced less overall opioid use and were more likely to continue rehabilitation therapy.

Summary

Suboxone (buprenorphine/naloxone) is a prescription medication that you dissolve sublingually (under the tongue) or buccally (against your inner cheek).

It’s used to treat opioid dependence, also known as opioid use disorder or OUD. Suboxone works by easing the symptoms of opioid withdrawal.

The drug is prescribed as part of a comprehensive treatment program that includes counseling and psychosocial support for managing OUD.

Suboxone’s buprenorphine ingredient helps reduce cravings while limiting the withdrawal symptoms associated with this transition.

Suboxone also contains naloxone, an opioid “blocker” that has little to no effect when dissolved orally but is included to deter people from misusing or abusing Suboxone.

If you take Suboxone or buprenorphine/naloxone or use other opioids, talk to your healthcare provider or pharmacist about getting Narcan nasal spray.

It can be used in an emergency to reverse the effects of opioids. In an overdose situation, prompt administration of naloxone can restore normal breathing, a potential overdose, and may prove life-saving.