In this article, I’m going to answer the common question Is Suboxone an opioid? I was totally astonished when I worked as a counselor at an Opiate Treatment Program (OTP) and despite lots of people working there, the receptionists directed EVERY call about Suboxone to me.
The other counselors and even the Clinical Director (CD) and Clinical Supervisor (CS) unfortunately didn’t even know how to describe Suboxone to people that called who were interested in signing up for treatment.
So I graciously took all the calls about Suboxone and would explain in simple terms what Suboxone is, how it works, and why it helps so many people.
It’s been about five years since I left the counseling profession and just under four years since I started this Blog and became an Opiate Recovery Coach, and I still notice there’s a LOT of confusion about this topic of what Suboxone really is.
Is Suboxone an opioid?
The short answer is “yes.”
But it’s a lot more complicated than that, and I want to set the record straight and provide you with a detailed yet easy-to-comprehend overview of Suboxone’s opioid properties while also debunking two common Suboxone misconceptions.
Thus, if you’re ready to learn why Suboxone is an opioid and exactly what it’s created from (which is very interesting!), then continue to read on, as we explore this fascinating medication that has helped countless individuals (myself included) over the past 15+ years…
Table of Contents
Is Suboxone an Opioid? Suboxone Overview
Is Suboxone an opioid? As I stated earlier, the short answer is yes, but now we’re going to dive deeper into this topic. I’ll do my best to keep the explanations simple and I’ll also provide visual aids and bullet-point lists to help you comprehend the concepts. I’m a visual learner and you may be one too.
Suboxone is a prescription medication containing two drugs:
Note: The ratio of these drugs in the Suboxone formulations is 4:1 buprenorphine-naloxone. The most common dosage (though not the only one available) is Suboxone containing 8 mg buprenorphine with 2 mg naloxone.
Buprenorphine is a controlled substance and semi-synthetic opioid. Buprenorphine attaches and binds to the same opioid receptors in the brain and other parts of the body that drugs like heroin, oxycodone, hydrocodone, morphine, and other opioids bind to.
Once it attaches to these opioid receptors, buprenorphine mimics the effects the drugs I just mentioned produce (though it’s not as powerful).
For this reason, buprenorphine is referred to as a “partial opioid agonist.”
Here is the biochemistry definition of the word agonist: “A substance that initiates a physiological response when combined with a receptor.”
The other opioid drugs I just mentioned are known as “full opioid agonists,” because they activate the opioid receptors in a stronger and more complete way than buprenorphine. See the illustration below.
Naloxone is the other drug present in Suboxone. Naloxone is a pure opioid antagonist. Here is the biochemistry definition of antagonist: “A substance that interferes with or inhibits the physiological action of another.”
You may have heard of a “naloxone shot” (brand name “Narcan Injection”) which is the drug given to people that overdose on opioids because an injection of naloxone puts the opioid-user into instant withdrawal, thus saving them from health issues and death.
Naloxone used intravenously will lead to the opioids in a person’s receptors being immediately “kicked out” by the naloxone, and for this reason, it can save lives by preventing people that have overdosed from dying.
My life was saved by a getting a naloxone shot after I took a lethal, synergistic dosage of methadone and Valium together. I had overdosed and was about a minute or two away from death when an ambulance arrived on the scene and an EMT gave me a naloxone shot and thus saved my life.
You can read my full story here if you’re interested.
At this point, you may be wondering why naloxone was put into the Suboxone formulation if buprenorphine is an opioid and the point is to keep the opioid drug in the receptors, and not to push it out of the receptors.
I promise there is a really good reason for naloxone being added to the Suboxone medication. Used intravenously, such as with a naloxone shot, naloxone works amazingly well.
But used sublingually (under the tongue), as it’s used in the Suboxone formulation, naloxone has basically no bioavailability.
This means that when you use Suboxone sublingually as prescribed, you only get the opioid effects from the buprenorphine, and you don’t experience effects from the naloxone.
Naloxone was added to the Suboxone medication to deter people from injecting Suboxone. Subutex, a brand name medication that only contains buprenorphine without the addition of naloxone, can be injected and thus abused.
If an individual injects Suboxone, the addition of the opioid antagonist naloxone will now be bioavailable and will cause the person to get VERY sick as they will go into an immediate naloxone-precipitated withdrawal, which is way worse than the normal acute opioid withdrawal.
Speaking of precipitated withdrawal, this is a great chance to teach you about two common misconceptions about Suboxone.
Common Suboxone Misconceptions
Most people (even many treatment professionals) believe the following two Suboxone misconceptions:
- Suboxone Misconception #1: If you use Suboxone too soon after your last dose of an opioid, the naloxone in the medication will cause you to go into precipitated withdrawal.
- The Truth: Used orally, the naloxone present in Suboxone has basically no bioavailability and thus cannot cause a precipitated withdrawal. Naloxone needs to be used intravenously or as a nasal spray (brand name “Narcan Nasal Spray”) to work.
- The truth is that buprenorphine has a VERY STRONG binding affinity but low intrinsic value at the mu opioid receptors. Thus, if you’ve been taking a full opioid agonist like hydrocodone, oxycodone, heroin, or methadone, the buprenorphine will “kick out” the full opioid agonists from your receptors and not activate the receptors with the same amount of power (since buprenorphine is only a partial agonist and not a full agonist).
- This results in a net decrease in opioid receptor stimulation and activation, leading blood-opioid concentrations to fall below the required level to satisfy your opioid-dependent neurons, thus causing a buprenorphine-precipitated withdrawal syndrome.
- Suboxone Misconception #2: It is the naloxone present in Suboxone that will block out the effects of other opioids if you use other opioids while you’re already taking Suboxone.
- The Truth: Since naloxone isn’t bioavailable when used sublingually, it can’t be the naloxone that blocks out the opioids.
- However, since buprenorphine has such a high binding affinity for the mu opioid receptors, it’s actually the buprenorphine which effectively blocks out any other opioids from getting in the receptors and thus prevents a “high” from other opioids while a person has adequate levels of buprenorphine in their opioid receptors.
The following visual aid will help you understand this concept more fully.
Is Suboxone an Opioid? Types of Opioids
So at this point, either your brain is hurting or you’ve digested this information well. In either case, the following definition of “opioid” along with a bullet-point breakdown of the broad classes of opioids should solidify your understanding of this concept.
An opioid is any agent that binds to opioid receptors (protein molecules located on the membranes of some nerve cells) found principally in the central nervous system and gastrointestinal tract and elicits a response.
There are four broad classes of opioids:
- Endogenous opioid, naturally produced in the body, endorphins
- Opium alkaloids, such as morphine and codeine (which are naturally occurring from the opium poppy plant)
- Semi-synthetic opioids such as heroin, oxycodone, and buprenorphine
- Fully synthetic opioids, such as methadone, that have structures unrelated to the opium alkaloids
As you can see in the bullet-point list above, buprenorphine is an opioid in the specific category of “semi-synthetic opioids.”
Here is the definition of the term semi-synthetic: “(of a substance) made by synthesis from a naturally occurring material.”
So to sum things up, buprenorphine is not a naturally occurring opiate such as morphine and codeine which are both present in the opium poppy plant. However, buprenorphine is a drug created by scientists that used some of the natural alkaloids present in the opium poppy. Buprenorphine is a semi-synthetic analogue of thebaine.
Thebaine, also known as “codeine methyl enol ether,” is an opiate alkaloid which is a minor constituent of opium. Thebaine is chemically similar to both morphine and codeine but has stimulatory rather than depressant effects, which could be a reason why so many people report getting energy from Suboxone.
While thebaine is not used therapeutically, it is the main alkaloid extracted from Papaver bracteatum (Iranian poppy) and can be converted industrially into a variety of compounds, including oxycodone, oxymorphone, and yes…buprenorphine.
Is Suboxone an Opioid? Putting it all Together
Well, this was certainly a much longer article than I intended. But I really wanted to be diligent. You now have my full permission to consider and refer to yourself as an expert on Suboxone! And you certainly know the answer to the question “is Suboxone an opioid?”
Here’s a helpful checklist review of the key concepts of this topic:
- Suboxone itself is not an opioid as it’s merely a brand name for a medication that contains two drugs (buprenorphine and naloxone).
- Buprenorphine is, in fact, an opioid, and since it’s the main ingredient in Suboxone, many people are comfortable just saying “Suboxone is an opioid,” which is totally fine.
- Technically, buprenorphine is a semi-synthetic opioid which is a derivative of thebaine.
- Thebaine is chemically similar to morphine and codeine, and all three of these opiate alkaloids occur naturally in the opium poppy plant.
- Thebaine is converted industrially into a variety of compounds, including oxycodone, oxymorphone, and buprenorphine.
- Buprenorphine is considered a sustained-action (aka long-acting) opioid because the effects come on very slowly (slow onset), and the buprenorphine wears off very slowly as well (slow offset), making it an ideal Opiate Replacement Medication for Medication-Assisted Treatment of opioid use disorder and opioid dependence.
- However, since buprenorphine is an opioid, this means that while the user gets temporary relief while taking Suboxone, getting off the medication can be very hard since it’s still an opioid, and a powerful one at that.
Is Suboxone an opioid? The short answer is yes. And now you know the looooooooong answer as well. By the way, if you read every word of this article instead of just skimming it, you’re a total nerd like me. But even if you just skimmed this dense article, I love you anyway. 🙂
If you want to learn more about this topic, I encourage you to check out this article: Difference Between Opioid and Opiate: The Best Definition You’ll Ever Read.
Additionally, if you’re interested in learning more about opiate addiction and recovery, make sure you check out the Opiate Addiction Support Online Course Collection, which has some free courses that you’ll totally LOVE.
If you have any comments or questions on the topic of Is Suboxone an opioid, please post them in the comment box below.