Suboxone is a combination formulation of the drugs buprenorphine and naloxone. It is an addiction treatment medication used to manage opioid dependence. Its two primary pharmaceutical components have distinct mechanisms of action, but work together to help people attempting to quit using certain illicit and prescription opioid drugs.
Suboxone consists of:
- Buprenorphine, a partial opioid receptor agonist drug, which reduces opioid cravings and prevents acute opioid withdrawal.
- Naloxone, which blocks opioid receptors. It is included in the formulation to discourage misuse of Suboxone and to prevent other opioid abuse while taking the medication. Naloxone also minimizes the potential of overdose while taking the drug.
Benzodiazepines are a class of central nervous system depressant medications used to treat anxiety and panic disorder.
Common benzodiazepines include:
- Alprazolam (Xanax).
- Clonazepam (Klonopin).
- Diazepam (Valium).
- Lorazepam (Ativan).
These medications work by effectively reducing and slowing neuronal activity in the brain, resulting in sedative and relaxing effects.
Using Suboxone and a benzodiazepine at the same time has been found to be associated with more accidental injuries and an increased number of visits to the emergency room. This drug combination can be deadly.
It’s important to let your doctor and pharmacist know if you’re taking any of these drugs. Never combine any drugs unless it’s a combination your doctor has approved.
Mixing Suboxone and Benzodiazepines
Polydrug use is a growing problem. The co-abuse of Suboxone and a benzodiazepine can cause dangerous side effects that people may not be fully aware of. Despite the risks, this particular drug combination is relatively common.A study published in April 2007 in the journal Addiction discussed the problem of many people using both Suboxone and benzodiazepines. Two-thirds of the participants in the study used these drugs together.The researchers noted that treatment programs that use Suboxone need to manage this drug-combination issue. The study explained that mixing Suboxone and benzodiazepines can be a problem when people are in opioid dependence treatment because more than one drug is being used at the same time.
The prevalence of this particular substance combination merits extra concern, especially because both Suboxone and benzodiazepines are available with a prescription, and Suboxone is used to treat addiction, where co-abuse counteracts the person’s recovery.
Co-Abuse of Suboxone and Benzodiazepines
Co-abuse may also arise from legitimate medical use of these drugs. Some people recovering from opioid addiction who are using Suboxone as part of their treatment may also be prescribed a benzodiazepine medication to alleviate anxiety in some circumstances. Doctors treating these people must be aware of all medications being taken to prevent such an occurrence because this prescription combination is strongly ill-advised.
The co-abuse of Suboxone and a benzodiazepine has not been found to have an effect on opioid treatment outcomes. However, abusing these drugs may simply be a case of substituting one abused substance for another.
In order to help minimize this risk, addiction treatment professionals should find alternative methods of treating anxiety in people who take Suboxone, such as prescribing medications with little or no abuse potential or introducing behavioral therapy.
It’s also important for people in addiction treatment who take Suboxone to be honest with treatment professionals because of the potentially fatal consequences of taking Suboxone and a benzodiazepine together.
Side Effects of Mixing Suboxone and Benzodiazepines
Using Suboxone and benzodiazepines together exacerbates central nervous system depression. Side effects of mixing these drugs may include:
- Deep sedation.
- Lowered blood pressure.
- Respiratory depression.
Combining these drugs can make a person very drowsy with significantly slow reaction times, which can lead to accidents. Driving is especially dangerous while under the influence of Suboxone and benzodiazepines. Each of these substances has its own risks and side effects, and when used together it increases the potential for life-threatening consequences.
Research exists on the potentially dangerous side effects of mixing Suboxone with benzodiazepines:
- A review published in January 2010 in the American Journal on Addictionfound an association between intravenous (IV) injection of combined Suboxone and benzodiazepines and toxicity or death.
- A study published in September 1998 in the journal Addiction found that six people in France died from a combination of Suboxone and benzodiazepines.
- A study published in March 2012 in the European Journal of Clinical Pharmacology discovered that benzodiazepines were involved in many deaths associated with Suboxone.
- A study published in September 2008 in the journal Basic & Clinical Pharmacology & Toxicology discovered that not all types of benzodiazepines resulted in serious consequences when taken with Suboxone. However, the study noted that the drug combination can lead to respiratory failure when Suboxone is taken with high doses of benzodiazepines.
Suboxone and Other Benzodiazepines
Other benzodiazepine drugs that can interact negatively with Suboxone include:
- Chlordiazepoxide (previously branded as Librium).
- Triazolam (Halcion).
- Oxazepam (previously branded as Serax).
- Estazolam (ProSom).
- Quazepam (Doral).
- Temazepam (Restoril).
- Flurazepam (previously branded as Dalmane).
- Midazolam (Versed).
Talk to your doctor and pharmacist about the safety of taking any of these drugs or any other benzodiazepines with Suboxone.
Suboxone Deadly Interactions With Other Drugs
Suboxone and benzodiazepines not only cause deadly interactions with each other, but they also can do so with other drugs.
Benzodiazepines can also be dangerous when taken with alcohol because both act similarly on the same neurotransmitter system in the brain. This drug combination can result in seriously sedative effects and result in death.
Suboxone can magnify the drowsiness commonly associated with a number of drugs, including over-the-counter varieties. This can result in profoundly diminished coordination and reaction times and dangerously impaired levels of alertness. Some of these drugs include:
- Pain medications.
- Muscle relaxants.
Because interactions with these drugs are so potentially dangerous, it’s important for you to be open with your doctor about any medications you take. This includes herbal medicines and over-the-counter medicines in addition to prescription medicines and street drugs.
If you’re taking Suboxone with a benzodiazepine, talk to your doctor about whether the combination you’re taking is safe. If you know someone else who’s combining these drugs, encourage them to get help.
- Center for Substance Abuse Research. (2013). Benzodiazepines.
- Schuman-Olivier, Z. Hoeppner, B.B., Weiss, R.D., Borodovsky, J., Shaffer, H.J., & Albanese, M.J. (2013). Benzodiazepine use during buprenorphine treatment for opioid dependence: Clinical and safety outcomes. Drug and Alcohol Dependence. 132(3). pp. 580-586.
- U.S. Food & Drug Administration. (2015). Medication Guide: Suboxone.
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