Opioids have been at the forefront of the overdose crisis plaguing our nation. The figures were already on an upward trajectory but were worsened by the coronavirus pandemic that swept the globe. The longer the lockdowns went on, the more people fell into a deep depression and turned to drugs to self-medicate.
Many people in recovery who relied on Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) also had nowhere to turn, leading to many cases of relapse. Fortunately, drugs like Suboxone were created to save people from opioid addiction. As an opioid itself, it can also lead to addiction, withdrawal, and Suboxone overdose. Below, we’ll discuss the dangers of Suboxone and how you can save yourself from becoming a statistic.
History of the Opioid Crisis
You might be wondering – how did we get here? How did opioids dominate the landscape and cause death on such a massive scale and take more lives in 2017 than HIV or AIDS-related illnesses at the peak of the AIDS epidemic? Well, it began in the late 1980s when pain was recognized as an issue that required thorough treatment. States across the U.S. began passing pain treatment acts that removed the threat of prosecution for doctors who opted for a more aggressive approach to treating pain. In 1995, the American Pain Society launched a campaign that shed light on pain as a “fifth vital sign” that must be monitored and managed, like blood pressure.
Opioids were often prescribed for short-term use after surgery. In the United States, the science supported that opioids were safer and less addictive than previously believed. A New England Journal of Medicine report found that of 11,882 people hospitalized that were taking opioids, a meager four became addicted. However, no evidence supported these claims. Opioids were only addictive when used recreationally, not for treating pain. That was the belief – if we only knew then what we know now. Opioid prescriptions increased throughout the late 1980s and early 1990s. In the mid-1990s, Purdue Pharma released a new drug called OxyContin, which is where it all went downhill.
Purdue Pharma lobbied lawmakers, funded professional and patient organizations, and sent representatives to visit doctors, all while emphasizing safety, efficiency, and minimal addiction risk. However, opioids are ineffective in treating long-term chronic pain as people become tolerant of the drug. However, in a lawsuit in 2007, Purdue admitted it knew the drug was addictive. Government officials took control and cracked down on doctors who prescribed opioids. At that point, people were already addicted, and cutting off their prescriptions didn’t mean they’d stop; it only meant they’d find a new avenue to feed their opioid addiction, which is where heroin came in.
By 2010, heroin addiction had become rampant. Since addicts couldn’t secure prescription opioids any longer, they turned to dealers. Heroin was a less expensive and more potent option, which made sense and hooked a new generation of people. In just a few years, a new illicit opioid swept the scene called fentanyl. Fentanyl is 50 to 100 times stronger than morphine and caused a new wave of overdose deaths. While prescription fentanyl is legitimately used to treat opioid-tolerant pain patients, the illicit version is everywhere. Even drugs that appeared to be other opioids were laced with fentanyl.
Overcoming opioid addiction is challenging but not impossible. Suboxone, often used in medication-assisted treatment (MAT), belongs to a family of medications known as opioid antagonists, the opposite of opioid agonists like heroin, fentanyl, or oxycodone. When you use Suboxone, it negates the effects of other opioid drugs. It prevents them from activating pain receptors, helping to manage cravings, reduce symptoms of withdrawal, and help you through recovery. Unfortunately, as an opioid, it’s still abused. Suboxone overdose is a reality. Learning more about it can save lives. Below, we’ll discuss the steps you can take to prevent it, what to do in the case of an emergency, and life beyond Suboxone.
Opioid Overdose Statistics
From 1999 to 2020, almost 1 million people lost their lives from a drug overdose. A staggering 932,000 people died in that period, with 91,799 cases occurring in 2020 alone, with 75 percent of those deaths involving an opioid. From 2019 to 2020, overdose deaths increased by 31 percent, which isn’t accounting for the carnage to come. Although these figures are devastating, they pale in comparison to what happened in 2021.
The figures were on the rise before the pandemic. However, once addicts and former addicts were locked down, it caused a spike like none we’ve ever seen. Today, a staggering 187 people die each day from an opioid overdose, and for the first time in the history of the United States, more than 100,000 people have died from drug overdose deaths in a single year. Opioids account for a majority of them. Even with drugs like Suboxone primarily used to combat the crisis, these numbers continue to climb.
In 2021, 107,622 people died of a drug overdose, and opioids were 80,816 of them. Alaska witnessed the largest spike in overdose deaths, which rose 75.3 percent. Although overdose deaths were up 15 percent, they increased by half as much as in 2020. We don’t know what’s ahead, but understanding the signs and symptoms of an overdose is a start. Knowing how to help a loved one in need can prevent them from becoming a statistic.
What Is Suboxone?
Suboxone is a medication that the U.S. Food and Drug Administration (FDA) approved for the management of opioid use disorder (OUD). It was developed as an alternative to methadone and comes as a sublingual film that dissolves under the tongue with a combination of buprenorphine and naloxone. Suboxone is primarily used to reduce withdrawal symptoms for those in treatment and manage cravings for opioids once they leave detox.
Although Suboxone itself is an opioid and attaches to opioid receptors in the brain, it does not fully activate them. It works by blocking the receptors in the brain that crave opioids but does not activate them to cause a high. If you were to take a drug like oxycodone while on Suboxone, the opioid receptors are blocked, meaning you will not experience any euphoria or high from it.
Suboxone is 80 percent buprenorphine and 20 percent naloxone. Buprenorphine, the primary ingredient, is an opioid partial agonist, meaning it affects the same part of the brain as oxycodone, heroin, or fentanyl. However, it’s more targeted. Naloxone is an opioid antagonist and prevents the high if buprenorphine is abused or if other opioids are taken. Without the euphoric sensation, the incentive to abuse the drug is much lower, making it ideal for MAT.
Suboxone is designed to be tamper-proof. When used as prescribed, it releases buprenorphine into the body slowly to ease cravings and prevent strong withdrawal symptoms. If you attempt to bypass the time-release part of Suboxone by injecting the drug or using it in a manner not intended, you won’t get a rush because of the buprenorphine. Instead, the naloxone will bind to the opioid receptors instead, forcing you into immediate withdrawal. While it’s not dangerous, per se, it’s extremely uncomfortable.
For that reason, you might believe you can’t overdose on Suboxone. Since professionals use it to battle addiction, mitigate withdrawal symptoms, and keep someone comfortable during treatment, it may not sound like an opioid that’s contributed to the overdose crisis and hundreds of thousands of deaths. However, can you overdose on Suboxone?
Can You Overdose on Suboxone?
In short, the answer is yes – you can overdose on Suboxone. However, as mentioned above, Suboxone was designed to be tamper-proof and purposely uses a combination of buprenorphine and naloxone. Naloxone is the active ingredient in Narcan, which is used to reverse opioid overdoses in medical emergencies, so it sounds like Suboxone has overdose prevention built into itself, right?
For someone tolerant to opioids, Suboxone overdose generally isn’t a concern. However, those who stumble across the drug and misuse or abuse the medication without tolerance are putting themselves at an increased risk of an overdose. When it comes to opioids, prescription or illicit, you must approach them with an understanding that overdose is possible. Drugs like Suboxone come with a specific dose and method of use. Ignoring these warnings can lead to a dangerous outcome.
Suboxone Tolerance and Dependence
Suboxone and methadone were designed with drug addiction in mind. These medications were developed to help people who have struggled with addiction to prescription or illicit opioids. When an individual is given a prescription for these medications, doctors assume they’re tolerant of the effects of opioids and that they’re trying to get on the path toward a better life.
Drug tolerance refers to the body adjusting to a specific amount of a substance in your system and no longer responding to it. For example, if you’re prescribed 10 mg of oxycodone after an accident or surgery, you will likely react to the medication and feel its effects. After a week or two, the pain-relieving properties or rush you felt on day one would feel like nothing on day eight or nine. To combat this, you might consider taking more or doubling the dose to feel its effects. You might even take the same amount more often than prescribed. Unfortunately, this is a slippery slope as it can lead to physical dependence or a fatal overdose.
Physical dependence is the next step before developing a full-blown opioid use disorder (OUD). It refers to the body needing a specific level of a drug, like opioids, to feel “normal.” For example, suppose you’re tolerant of 20 mg of oxycodone but start taking 40 mg to feel the effects and continue to do so over time. In that case, you’ll need 40 mg to feel normal. If you take less, you won’t feel anything – you could even still experience withdrawal symptoms or extreme cravings for oxycodone. People who become dependent on these medications need help tapering off these substances, allowing their bodies to detox slowly.
After taking some time to taper, an individual might take a large dose of Suboxone and feel high from it. It’s also possible for someone using Suboxone as prescribed to relapse and fall back into their addiction patterns. Those who have struggled with heroin, opioid painkillers, or fentanyl for a prolonged period may return to consuming these drugs even when they’re taking Suboxone, which can also lead to a fatal overdose because too many opioids are in their system.
Although Suboxone doesn’t produce any effects, you’re at risk of potentially severe withdrawal symptoms upon cessation. Even if you’re using the medication as prescribed, this can be an outcome when you decide to stop taking it. Withdrawal can even occur when you miss a dose. Opioid dependence is common with the long-term use of these drugs, regardless of whether you’re following the prescribing guidelines.
Symptoms of Suboxone withdrawal are similar to other opioids. They include the following:
- Runny nose
- Muscle aches and pains
- Nausea and vomiting
- Teary eyes
- Tremors or twitching
If you use Suboxone to treat opioid addiction, withdrawal symptoms should be less severe than what you’ve experienced before. However, it also depends on how much Suboxone you’re taking and whether you taper or stop cold turkey.
Buprenorphine has a long half-life of 24 to 42 hours, meaning a person who becomes addicted to Suboxone or misuses the drug won’t experience withdrawal symptoms until much later than other opioids. How much Suboxone was used, how long it was taken, the individual’s age and weight, as well as liver function, play a role. Withdrawal can last up to nine days, but symptoms might linger for two to five weeks. When you stop using a drug, you lose your tolerance, meaning taking the dose you once used could lead to a fatal overdose.
What Are the Signs of a Suboxone Overdose?
An overdose of any drug has the potential to be fatal. Those who misuse or abuse Suboxone are at an elevated risk of overdose. The misuse of Suboxone is accompanied by withdrawal symptoms, including body aches, vomiting, nausea, indigestion, diarrhea, anxiety, and depression. These are more common to occur with Suboxone than an overdose, but that doesn’t mean it’s impossible. Any drug you abuse runs the risk of an overdose.
Since overdoses can occur, knowing the signs and symptoms can prevent unnecessary death. Overdose symptoms are similar to other opioids, and you must pay attention to the following signs:
- Excessive drowsiness when dangerous amounts are consumed
- Blurred vision
- Foggy vision
- Foggy mental cognition
- Slowed, shallow breathing
- Breathing that stops
- Bluish lips or fingernails
- Pale skin
- Clammy skin
- Pinned pupils or erratic eye movements
- Collapsing as a result of impaired functions
With all opioid overdoses, getting help should be the first thing on your mind. Anyone who exhibits the symptoms listed above is at risk of losing their life. The sooner you call 911, the sooner they get help, meaning the chances of developing long-term or potentially permanent damage are negated. While death is the most pressing concern, someone that sustains permanent damage from not getting help will destroy the quality of their life.
Fatal Suboxone Overdose
Accidental Suboxone overdoses typically occur when the drug is misused by injecting or snorting it. Beyond misuse, Suboxone, as a depressant, does not mix well with other depressants or sedatives. If you drink alcohol or take benzodiazepines, using Suboxone can also lead to a fatal overdose. Alcohol is especially dangerous because even with an otherwise low alcohol-by-volume content, these drugs potentiate one another, meaning the side effects are enhanced, even with small doses of each.
This isn’t a problem facing those who only abuse Suboxone. Even when used as prescribed, mixing the medication with benzos or alcohol can lead to fatal outcomes. The real risk comes from the increased chances of respiratory depression. This typically occurs with more potent opioids but can, too, with Suboxone when mixed with other depressants.
How to Treat a Suboxone Overdose
If you witness any of the Suboxone overdose signs listed above, you must call 911 right away. Some people might wait to see if they can treat it themselves or if it gets better on its own, but if you’re wrong, it could mean long-term permanent damage or, worse, death. Many people also fear calling emergency services because they believe they can get in trouble. However, law enforcement will not charge someone who reaches out for help. Below, we’ll explain the steps to take if someone overdoses on Suboxone.
Call Emergency Services
Before you do anything, pick up the phone and call 911. An operator will walk you through what you must do to ensure the individual is cared for before the first responders’ arrival. They will ask you questions about how tall the person is, their weight, when Suboxone was taken, if it was taken with other drugs or alcohol, and when it was last taken. If you have their prescription, please hand it over to the paramedics or firefighters.
Evaluate Signs and Symptoms
The 911 operator will instruct you to wake the person up by speaking loudly or rubbing their breast bone hard with your knuckles. If they’ve overdosed on Suboxone, their body will be limp, and they won’t respond to external stimuli. They might also appear pale and blue, breathe shallowly, and have pinpoint pupils. You must also check their heart rate to ensure the heart is beating. If they have any of these symptoms, they will die without help.
Start First Aid (If Trained)
If you’re trained in first aid, administer CPR and make sure to roll the person on their side. This will keep their airway open and save them from choking on vomit. Continue monitoring their condition until help arrives.
Who’s at Risk of a Suboxone Overdose?
Although Suboxone overdose is rare when compared to other opioids, the odds aren’t zero, even when taken as prescribed. You’re at risk of a Suboxone overdose if you meet the following criteria:
- You take more than one medication, which increases the chance of an adverse drug interaction.
- You take Suboxone with other sedatives, alcohol, or opioids.
- You started taking Suboxone but were unaware it could result in a potentially fatal overdose when misused.
- You stop using Suboxone and start taking it again and didn’t realize the previous dose is now too high due to your tolerance lowering.
It’s important to have all of the information in hand before taking Suboxone. Speak to your doctor to determine if it’s right for you. This one conversation can prevent you from becoming a statistic. If you can’t stop on your own, help is available. Don’t wait – talk to someone now.