Can you overdose on Suboxone (buprenorphine/naloxone)?

From the Guidelines

Yes, it is possible to overdose on Suboxone (buprenorphine/naloxone), though it's less likely than with full opioid agonists like heroin or oxycodone. Suboxone contains buprenorphine, a partial opioid agonist, which has a "ceiling effect" that limits its respiratory depression effects even at higher doses. However, overdose risk increases significantly when Suboxone is combined with other central nervous system depressants like alcohol, benzodiazepines, or other opioids.

Key Points to Consider

• Signs of Suboxone overdose include extreme drowsiness, pinpoint pupils, slowed or stopped breathing, blue-tinged lips or fingernails, and loss of consciousness.
• If overdose is suspected, call emergency services immediately.
• Naloxone (Narcan) can reverse opioid overdose effects, though higher or repeated doses may be needed for buprenorphine overdoses compared to other opioids, as noted in studies such as 1.
• People with lower opioid tolerance, such as children or opioid-naïve individuals, are at higher risk of overdose even with therapeutic doses.
• Always take Suboxone exactly as prescribed, store it safely away from others, and never combine it with other substances without medical supervision, as emphasized in guidelines like 1.

Preventing Overdose

Preventing overdose involves a thorough risk assessment, urine drug screens prior to prescribing or represcribing, and patient education about overdose risks, as discussed in 1. The use of an opioid treatment contract and more frequent clinical follow-up may also be necessary for patients at higher risk. Expanding access to naloxone has been shown to significantly reduce opioid overdose fatalities, highlighting the importance of having naloxone readily available for patients on opioid therapy, including those on Suboxone, as supported by 1 and 1.

Clinical Considerations

Clinical characteristics predictive of opioid overdose risk include a history of prior overdose, substance addiction, health problems associated with respiratory compromise, and concurrent prescription of medications with respiratory-depressing effects, as outlined in 1. Renal or hepatic dysfunction and central sleep apnea also increase the risk for overdose. Prior suicidal thoughts or attempts and a diagnosis of major depression are additional markers for elevated risk of overdose.

Conclusion is not allowed, so the response ends here.

From the FDA Drug Label

OVERDOSAGE Clinical Presentation Acute overdose with buprenorphine can be manifested by respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, and, in some cases, pulmonary edema, bradycardia, hypotension, hypoglycemia, partial or complete airway obstruction, atypical snoring, and death Treatment of Overdose In the case of overdose, priorities are the reestablishment of a patent and protected airway and institution of assisted or controlled ventilation, if needed

Yes, you can overdose on Suboxone (buprenorphine/naloxone). Symptoms of an overdose may include:

• Respiratory depression
• Somnolence progressing to stupor or coma
• Skeletal muscle flaccidity
• Cold and clammy skin
• Constricted pupils
• Pulmonary edema
• Bradycardia
• Hypotension
• Hypoglycemia
• Partial or complete airway obstruction
• Atypical snoring
• Death Treatment for an overdose involves reestablishing a patent and protected airway, instituting assisted or controlled ventilation if needed, and administering an opioid antagonist such as naloxone 2.

From the Research

Overdose Potential of Suboxone

• Suboxone, a combination of buprenorphine and naloxone, has a reduced overdose potential compared to full opioid agonists like methadone 3.
• The partial opioid agonist properties of buprenorphine contribute to its lower risk of overdose.
• However, cases of opioid toxicity have been reported in pediatric patients after exposure to Suboxone, highlighting the potential for overdose in certain populations 4.

Risks and Adverse Effects

• Suboxone can produce opioid toxicity via sublingual absorption or ingestion, particularly in children 4.
• Adverse effects of Suboxone, including central nervous system depression and respiratory depression, have been reported in pediatric case studies 4.
• Additionally, Suboxone has been implicated in triggering serotonin syndrome, a potentially life-threatening condition, in rare cases 5.
• The naloxone component of Suboxone, intended to prevent misuse, may also contribute to adverse effects, including increased risk of overdose and death in some cases 6.

Reversal of Opioid Overdose

• Suboxone has been used to reverse heroin overdose in some cases, highlighting its potential as a treatment for opioid overdose 7.
• The sublingual administration of buprenorphine/naloxone may be an effective means of reversing opioid overdose, although more research is needed to fully understand its efficacy and safety in this context.