A friend sent me a link to an article that suggests an anti-smoking effect from naltrexone.   Naltrexone is an opiate antagonist similar to naloxone (the second ingredient in Suboxone);  naloxone is active intravenously, and naltrexone is active orally. 

Suboxone talk
Effects on Smoking or Pipe Dream?

Naltrexone is indicated for treatment of cravings in alcoholism;  it is also used (but not ‘indicated’) for early treatment of opiate addicts in traditional recovery, as a ‘back-up plan’–  an addict knows that even if he DID use, the effect would be blocked.  Naltrexone is NOT that helpful for opiate cravings, which is why there is a niche for buprenorphine to fill.

A couple weeks ago I read a study that found increased release of endorphins in the brain of rats after they were given alcohol;  the endorphins were released in parts of the basal forebrain that have been shown to be involved in addictive behaviors.  This fits nicely with the effects of naltrexone on alcohol cravings.   Buprenorphine is a ‘partial agonist’, meaning it has both activating and blocking activities at opiate receptors.  In other words, buprenorphine has a ‘naltrexone-like’ effect at opiate receptors–  suggesting a role for buprenorphine in the treatment of alcoholism. 

Consistent with that idea, a number of my patients taking buprenorphine report less interest in alcohol and less drinking since starting Suboxone.  This is a nice ‘side benefit’, as there is something called ‘cross addiction’ where stamping out the addiction to one substance can result in a new addiction in a different substance;  I believe that the effects of buprenorphine on alcohol cravings helps prevent patients from changing substances when they start Suboxone.

Now there is evidence that patients on Suboxone are more likely to stop smoking– consistent with the belief that there is a common pathway through the front part of the brain for most if not all addictions.  If the naltrexone effect holds to be true, it would be possible that buprenorphine could work in a similar fashion, as is the case with alcoholism.  What do the smokers think?

If you smoke and take Suboxone, have you noticed any change in your smoking habits since starting Suboxone?  Any reduction in the pleasure you get from smoking?  Have you been smoking fewer cigarettes per day?  More?


jamez70 · April 6, 2009 at 6:23 pm

I am a smoker (2 packs/day). Suboxone didn’t really make a difference in my craving or use of tobacco. I’d say the only medication that actually did make a difference in my tobacco use was Clonidine, which I took for high blood pressure. I’d smoke less and for some reason just not really want to smoke when I was taking Clonidine.
Its puzzling why nicotine is so hard to stop. The withdrawal isn’t nearly anything like opiate withdrawal. But, I have heard that nicotine has many properties that contribute to its addicting nature.
How does Naloxone/Naltrexone work to prevent cravings for alcohol or tobacco? Is it all in opiate receptors? I figured nicotine/alcohol was more complicated than that. I figued for alcohol, antabuse would be the best way to avoid drinking because you’d become deathly ill if you drank then (my alcoholic mother took that years ago, and accidentally drank once, that wasn’t a pretty site)

Dason · April 6, 2009 at 6:32 pm

Three months on sub and it definitely has reduced myn desire to drink. I was never a heavy or problem drinker. But I clearly notice a lessened desire for even a beer or glass of wine with a meal, which used to be routine.

jp04 · April 6, 2009 at 7:03 pm

It’s interesting this topic came up because I was just thinking about the effects of suboxone on my smoking habit.
I’ve noticed an increase in smoking since starting suboxone. I used to smoke about a half pack each day and now that I’ve started Suboxone it’s been about a pack a day.
Now, granted I’ve only been on suboxone since february so I can’t say if this is a long term change. Quitting smoking is a goal of mine and it would be great if suboxone does help, but at this point I havn’t noticed a change…

blc · April 6, 2009 at 8:14 pm

It would be wonderful, but I don’t find it to be true. I am a 2+ pack/day smoker and have been on suboxone for over two years. I am prescribed to take an 8mg tab in the morning and another 8mg tab in the evening (although I’ve read in your blog you recommend taking the sub only once per day – something I am considering and will discuss with my Dr.) Anyway, I pretty much chain smoke after taking my sub dose in the morning, then seem to taper off a bit until taking my afternoon dose, at which time I begin chain smoking for a few hours after taking my second sub dose. I actually crave the cigarettes more immediately after taking the sub dose, and think the reason a few hours later I don’t is that I am stuffed with nicotine. It seems that the cigarettes taste much better after my sub dose.
I am trying to quite smoking, and am using Commit lozenges, with limited success. I’ve made it a day or two then slip. I tried the pill (can’t think of the name right now) which actually made the cigarettes taste foul and made me a bit nausious, and that was effective for nearly 3 weeks until I ran out of the pills and resumed smoking full-time. If I am unable to quit with the commit, I may try and go back on the pill. Chantix… uh, that’s the name of it, or something like that. Thanks for your posts, Dr… I read your blog religiously, as do several members of my family, who I’ve given the link so they can better understand the nature of both the disease of addiction as well as the nature of suboxone as long term treatment. I only wish my sponsor were so enlightened… luckily, he has also become one of my best friends, so while he insists sub is just a crutch, we agree to disagree about that, and it doesn’t effect the other areas of my program, i.e. stepwork, which is the main reason I have a sponsor. Look forward to ready your future posts, and perhaps a book.

jamez70 · April 6, 2009 at 10:28 pm

Hey Dr Junig, if you’re see this..
I saw blc’s comment about Chantix, and I read reports about psychosis/hallucinations involved with Chantix use. Is this true?! Maybe its not so safe after all if it is. I’d be interested to hear your thoughts on Chantix. Maybe its off the subject but interesting anyway.

leba · April 6, 2009 at 10:56 pm

I’ve also found that I smoke more right after I take my Sub. I’ll always smoke a cigarette before taking it, in an effort to kill the taste, and afterwards I’ll tend towards smoking more cigarettes. I smoke half a pack a day. My theory is one addiction at a time.
Also, it’s possible to inject Suboxone. For two months, this was how I administered it to myself. It doesn’t work any better through the IV route, and eventually I gave up doing it because my veins were closing and it was becoming very arduous. I really don’t recommend that anyone use it this way. The only reason that I did was simply because, well, I’m a junkie and I like putting needles in my arms. Really there’s no advantage to taking that way at all. And strangely enough, even through IV I can still taste/smell the artificial lemon as soon as its in my veins.
Just FYI.

johnpal716 · April 8, 2009 at 6:55 am

i have noticed a similar effect as someone else listed above… that taking the suboxone increases my desire to smoke. i’m not sure if it’s psychosomatic, but it seems to be similar to when i was using. when i began bottoming out on the opiates, i had quit smoking for almost a year, and then i would only smoke when i was high on opiates. it was an overwhelming compulsion to smoke, one after the other, and then when i wasn’t high anymore, the desire completely faded. as my opiate use rose to every minute of every hour, so did my smoking. now it seems that the mild opiate effects of the suboxone (whether they are “real” or not) have a similar effect for me, though not as strong. i am trying to quit, apparently not hard enough. i smoke about a half pack a day.
thanks as always.

modega · April 10, 2009 at 7:11 pm

I start therapy on suboxone a few months ago. Before this, my smoking depended on my daily dosage of opiates. I was prescribed oxycodone 30mg instant release tablets twice daily, and if I were to abuse them, I would easily smoke a pack. However, on days I did not abuse them, I could get by on half a pack.
When I tried to go cold turkey, I would smoke maybe 1-2 cigarettes a day, they repulsed me. Now on suboxone, I was on 8mg a day for a week, 6mg a day for a week, and now I am doing maintenance at 4mg. Right after dosing, I tend to chain smoke, as it increases the little euphoria that the suboxone provides. After the feeling starts to taper, I slow down. I am smoking about the same amount now, but binge smoking for an hour, and than smoking rarely after that.

Matt2 · April 14, 2009 at 3:03 pm

I actually did notice a decrease in the desire to smoke. My experience was that when I was going through withdrawals (when I was still using obviously I smoked more) not sure if it was an effort to help with withdrawals or what. Anywho I quit smoking after 9 years a little over a month ago. I feel great! Up to 3.75 miles jogging 5 days a week oh and I finally broke a 7 min mile which was never possible smoking! With so many reporting the opposite effect I’m kind of second guessing that it helped but who knows. The mind is a powerful thing 🙂 I’m just glad I finally quit.

mattyr9 · April 15, 2009 at 5:34 pm

Been on Suboxone for 15 months and I can say with confidence the medication has had ZERO impact on my smoking habit (1 pack/day).
However, I have noticed that my desire/cravings to even have a single drink have been really impacted by my Suboxone treatment. I never had a physical addiction or any problems with alcohol (opiates were the love of my life), but during college I did binge drink and really enjoyed having enough alcohol to seriously impair my judgement.
Since starting on the Suboxone, my desire to even have just one beer while watching the game or a glass of wine at Thanksgiving dinner is pretty much non-existent. On the very rare occasion that I go out with friends, I will order a beer and find myself switching to a soda after just 1 or 2 sips of the beer. I thought it was just me, but I have heard from many other Suboxone patients and a good number of them report the same results relating to their alcohol consumption…

Larsy1566 · April 19, 2009 at 3:40 pm

Since I’ve been on Suboxone (about 5 months) for depression I’ve been chain smoking like crazy. I can actually sit and smoke a whole pack while just sitting out in the garage listening to talk radio. I never really did this before, only when I used to drink occationally to self medicate myself from being depressed. Everytime I would drink, I would drink until I got so drunk I would pass out, but I smoked the whole time while drinking. Since being on the suboxone I do not have an urge to drink at all but this chain smoking is killing me. My family is so upset. They tell me to come in the house constantly and I tell them just one more. I am only on 2 mgs of suboxone in the morning and 1 mg. at night and it helps my depression dramatically. If I don’t stop this chain smoking, I am going to get sick. I need to tell myself that I am lucky to feel better and smoking is not doing me any good. It’s just so hard though. I crave the cigarettes like crazy. My husband and family want me off of the suboxone because they do not believe taking an opiate for depression is the answer. This morning my husband agreed to keep me on the suboxone (he gives it to me) if I start taking care of myself, which means staying out of the garage and getting more involved with life. I would rather stay on the suboxone and quit the smoking. I was in the hospital for a couple of weeks a few months ago and could not smoke and I did just fine although I could not wait to get home to have a cigarette. I am the girl who the doctor is talking about in the first part of the blog. The girl who is taking suboxone for depression and wonders if anyone else is taking it for the same reason. I am being prescribed it by a psychiatrist and I see a therapist once a week. I tried every antidepressant there is and nothing helped except for this suboxone which I believe has saved my life. Thank you.

tallienjuice · May 3, 2009 at 6:17 pm

I have been on Suboxone for going on my third week and have noticed that I smoke more than what I did before taking it.

Wordsworth · January 4, 2010 at 10:32 am

Yes, Suboxone makes you want to drink less, but WHY on Earth would you want to take something that gives you a MONTH OF WITHDRAWALS to stop smoking less?
It’s an opiate, a strong one at that (30x the strength of morphine), that builds up in your system and turns on you after time.
This is a BAD, BAD idea. And you may ask, how do I know? Well, I’ve gotten ON and OFF Suboxone 4 times, and had 2-3 weeks worth of intense withdrawal (every bit as bad as OxyContin) every time.

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