What Are the Dangers of Mixing Suboxone & Cocaine?

Suboxone is an opioid depressant medication, and cocaine is a stimulant. Combining them can lead to intense euphoria. Many people mix them to gain that euphoria.  However, using them together can increase the effects of both and can lead to overdose and even death. 

People use Suboxone to address an opioid use disorder (OUD). Some people who enter these programs have a history of using cocaine too. They may continue to use Cocaine while on Suboxone. One study reported that more than 50% of patients receiving Suboxone treatment who also used cocaine prior continued to use cocaine during their treatment.[1]

It is never ideal to mix cocaine and Suboxone. However it is also difficult to treat cocaine use disorder because the medications to do so are not as reliably effective as Suboxone is for OUD. 

Some physicians feel that it is better to at least treat an opioid use disorder even if the person is simultaneously working on a cocaine use disorder, and they continue Suboxone even if the patient is also using Cocaine. Others feel unsafe prescribing Suboxone if the person is continuing to use cocaine. 

If you can’t stop using cocaine while on Suboxone, talk to your treatment team. Different clinics and programs have different policies about using cocaine while also on Suboxone.  The most important thing is to be honest with your treatment team so that they can keep you safe. 

Suboxone & Cocaine: What Are They?

To understand the dangers of mixing these drugs, you should understand what they are and how they work. 

What Is Suboxone?

Suboxone is the brand-name combination of buprenorphine and naloxone. It is the first-line treatment for opioid use disorder (OUD).[2]

Two ingredients work together in Suboxone:

• Buprenorphine is a partial opioid agonist that binds with the opioid receptors in the brain but does not cause intoxication. Instead, it alleviates withdrawal symptoms and cravings, helps maintain physical and emotional stability, and allows people to focus on their recovery.
• Naloxone is an opioid antagonist that blocks the action of opioids. It is included in Suboxone to prevent someone from “getting high” if they attempt to inject the medication. If so, it blocks the effects of opioids in the bloodstream and prevents overdose. 

Suboxone is taken anywhere from once to three times daily, usually as a sublingual dissolving film but sometimes as a tablet. When taken as directed, buprenorphine reduces cravings for opioids like heroin and can block the euphoric effects of these drugs in the event of a relapse.

What Is Cocaine?

Cocaine is a very powerful stimulant drug with a high potential for misuse.[3]

Like many opioids, cocaine is a Schedule II medication in the United States, with a very limited application as a local anesthetic for some eye, ear, nose, and throat surgeries. However, it is more often a drug of abuse, leading to intense euphoric highs with effects such as these:

• Increased physical and mental energy
• Paranoia
• Anxiety
• Insomnia

Misusing Cocaine & Opioids 

The combination of heroin and cocaine abuse is common in the US. The practice of using both drugs together is sometimes called speedballing.[4] A speedball is typically injected, but it may also be snorted. It is extremely dangerous and can quickly cause an overdose. It’s never safe to use illicit heroin or fentanyl, particularly with Cocaine at the same time.

Misusing Cocaine and Suboxone

Even though Suboxone is a less potent opioid, it is still an opioid, and thus it is always risky to take it with Cocaine at the same time. However, some patient may be unable to kick their cocaine habit, and many addiction specialists these days prefer a “harm reduction model”, where they continue to treat opioid use disorder with Suboxone even if the person is using Cocaine, with the hope that treating even one of their substance use disorders is better than not treating any of them just because they are using multiple substances. In these cases, doctors try to educate the patients about the risks of continuing to use Cocaine while on Suboxone, and try to make sure they know how to use it as safely as possible and to look out for risks and warning signs. These include strategies such as trying not to use alone/without supervision, having Narcan readily available, using near medical facilities and knowing how to call for help if there is concern about overdose. 

Suboxone & Addiction Treatment 

Suboxone is not indicated as a treatment for other substance use disorders, like cocaine. However, taking Suboxone can benefit people who struggle with misusing multiple drugs, including opioids and cocaine, as long as the primary substance of abuse is an opioid drug.

A small-scale study examined the combination of buprenorphine and naltrexone in treating cocaine dependence in people overcoming heroin addiction.[5] Researchers found that the combination did help some of the study’s participants use less cocaine. However, this may simply be because people often use all their substances at the same time, so if they were only using cocaine when using heroin, decreasing their heroin use may also naturally provide less opportunities for them to be using Cocaine. 

The results of this study were not conclusive enough to suggest that Suboxone alone is an effective treatment for cocaine use disorder. The primary treatment approach to cocaine addiction remains behavioral therapy, although some medications such as Topiramate have some mild to moderate evidence for being helpful. 

Can You Overdose in Treatment?

It is extremely difficult to overdose when you take Suboxone as directed, even if you use other drugs like cocaine. However, using additional substances always increases the risk of a fatal overdose. 

If you are using other illicit substances while also on Suboxone therapy, please discuss the other substances you are using with your provider so they can keep you safe.

Sources

1. Behavioral Counseling Content for Optimizing the Use of Buprenorphine for Treatment of Opioid Dependence in Community-Based Settings: A Review of the Empirical Evidence. American Journal of Drug and Alcohol Abuse. https://ncbi.nlm.nih.gov/pmc/articles/PMC2274830/. March 2008. Accessed November 2022.
2. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed November 2022.
3. What Is Cocaine? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/cocaine/what-cocaine. May 2016. Accessed November 2022.
4. “Speedballing”: Mixing Stimulants and Opioids, Micromodule. Florida Alcohol & Drug Abuse Association. https://www.training.fadaa.org/Speedballing/Speedballing_PPT.pdf. Accessed November 2022.
5. Combination of Buprenorphine and Naltrexone in the Treatment of Cocaine Dependence. National Institute on Drug Abuse. https://nida.nih.gov/international/abstracts/combination-buprenorphine-naltrexone-in-treatment-cocaine-dependence.2013. 2013. Accessed November 2022.