Q/A with a person from suboxforum.com:

I have a question regarding suboxone and i cant figure out how to post comments so i figured i would email to see if i can get my questions answered that way.
1) I know that suboxone has some kind of ceiling effect to where if you take too much it is either pointless or does the opposite, Is this true?
2) I am prescribed to xanax and zoloft as well.Will my anxiety medicine or my depression medicine (xanax/zoloft) not work with me being on suboxone? Does it block out benzos like xanax and valium and soma? Or does it just block opiates?
3) My boyfriend is on suboxone as well but I worry that he is abusing it? Can he get high off taking more than his prescribed amount or is it absolutely impossible to get high off suboxone alone?

Xanax bar
Xanax or alprazolam

My Response:

I encourage you to keep fiddling with the site, using the username and password below– you can change the password on the site if you like. That way you can participate in the discussions. But for now, yes, Suboxone has a ‘ceiling’ at a dose of about 4 mg, assuming it is being taken correctly (it has to be absorbed through the mouth; whatever is swallowed is destroyed and inactive). Above about 4 mg there is no more opiate effect; at very high doses (above 40 mg) it starts to ‘block itself’ and have even less effect, so a person can cause withdrawal by taking a real large amount.

The active ingredient in Suboxone is buprenorphine; buprenorphine selectively activates and blocks the mu opiate receptor and will not interfere with xanax or other benzos, and will not interact with soma. BUT… buprenorphine will cause respiratory depression in people who do not have a high opiate tolerance, at least until the person gets used to Suboxone (after a few days). Benzos also depress respiration and there have been deaths from the combination of Suboxone and benzos in people who are naive to one or both of the drugs. Also, Xanax and other benzos cause tolerance even faster than opiates do; the first-line treatment for anxiety is serotonin (an SSRI) and benzos are best avoided by people with addictions.

Benzos will reduce anxiety, at least for a few weeks, but they are very addictive in their own way, and the withdrawal from them can be fatal. The early withdrawal consists of severe anxiety, which patients often misinterpret as their own ‘anxiety disorder’, for which they think they need more benzos… and the cycle continues. All of us opiate addicts are too focused on how we ‘feel’, and benzos only reinforce turning our attention inward, when what we really should be doing is trying to ignore how we feel and instead focus on things ‘outside’ of us. You can tell, I’m sure, that I don’t like benzos. But patients sure love their benzos– patients get more attached to their benzos than to any other med in my experience, and it is very hard to get a person to give them up.

As for your boyfriend, a person can get high off Suboxone if he/she takes it only intermittently and never becomes tolerant to it. That would be very difficult for most addicts to do, as the person would have to take it and then come down, wait a few days, and take it again. Most opiate addicts would not be able to ‘come down’– they would just keep taking it. I cannot imagine how a person could get a high with regular use, as tolerance would prevent it.

BUT… I have had Suboxone patients who (unfortunately) took oxycodone or another agonist while taking Suboxone; they had no effect from the agonist but they still could not stop taking it. It appears silly on the surface, taking something so expensive like oxy and getting no effect, yet not being able to stop. But opiate addiction is complex– it is more than just taking something because it feels good. In fact most addicts will admit that they have not had a ‘high’ in years, but they still have to keep using. Using ‘serves many masters’, and each person may have a different master.

For example, a person who is actively using becomes completely absorbed in the drug– finding it, playing with it, using it, worrying about finding it again… Some people after starting Suboxone have a great deal of anxiety– the way I see it is that suddenly they don’t have the obsession with opiates occupying their minds, so they are free to worry about the other things in their lives. One reason for their use, then, is to reduce anxiety… and perhaps that is what is going on with the people I know who are on suboxone but are still using. By the way, I do not keep people in such a state– I may give the person who uses one more chance, maybe with a higher dose of Suboxone, but if he/she can’t stay clean (and after crossing that line, most do not stay clean) then methadone or residential treatment is their only hope.

I am going to answer your question ‘publicly’ but I will take away your e-mail info. Please continue to visit the site, and post when you get it figured out!


1 Comment

autumnraew · August 14, 2008 at 3:24 pm

I have been an opiate addict for about 5 years now. I started off on prescription pain pills like Vicodin, Percocet, Lorocet, etc.. Then when that wasn’t good enough, I moved onto Oxycontin. I have an extremely high tolerance to pain pills. Last summer I checked myself into a 7 day in-patient detox hospital, and they put me on Suboxone. Starting at 8mg/day and tapering down to 4mg/day. I stayed on the 4mg/day for quite awhile. I then tapered off the Suboxone by myself. It took me about 2 weeks to really start feeling ok. About 3 months after I was clean of everything, I relapsed on Heroin. I did Heroin for about 5 or so months. I was doing about 10 bags/day at $20/bag. When I realized I couldn’t go cold turkey off the Heroin, I reached out for help again. I went back to my Suboxone Dr. and he put me on 16mgs/day to start. I tapered down eventually to 4 mgs/day. I stayed on the 4 mgs for about 5 months and about 4 days ago, I came off of the Suboxone totally again. I tapered of course. Well, when I came off of the Suboxone, I just so happened to run out of my Xanax at the same time. So I was going through Opiate and Benzo withdrawal at the same time. It was pure hell. I thought I was going to lose my mind. I was going to go to the hospital, but thank God my Dr. wrote me a script for 150 0.5 Xanax’s with me taking up to 5 per day. The Xanax is really helping me a lot with the Suboxone withdrawal. But I know it’s just another Narcotic drug, and just another crutch. I seem to be in a vicious cycle here. Should I stay on the Xanax for the time being while I’m coming off the Suboxone? So far, I’ve been taking Xanax for about 4 months. And before when I was a very active drug user, I took benzos whenever I could get them. So I have an extremely high tolerance for them as well. Am I making this worse on myself by continuing to take the Xanax, or is it ok until my Suboxone withdrawal is all gone. I know I can’t come off the Suboxone cold turkey. I’ll have to taper for sure. Any feedback from anyone is greatly appreciated. Thank you.

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