Is Suboxone Like Heroin? | Find Out Why They Are Different

Heroin is only used as an illicit drug. It has no accepted medical use. 

Suboxone is a medication that is used to help people stop using heroin or other opioid drugs. Suboxone has very low abuse potential and has been shown through multiple studies to help people in addiction recovery control their cravings and avoid relapse. 

Heroin and Suboxone are both members of a class of medications called opioids. Heroin is a full opioid agonist whereas Suboxone (Buprenorphine) is a partial opioid agonist. They are very different medications in terms of how dangerous and risky they are. However, they are both opioid medications, and so they do share some similarities. 

What Is Suboxone?

Suboxone is a combination of the drugs buprenorphine (a partial opioid agonist) and naloxone.[1] It is used as an evidence-based treatment for opioid use disorder (OUD) often as part of a Medication for Addiction Treatment (MAT) program. 

Buprenorphine is a type of drug called a partial opioid agonist. It shares some similar properties to full opioid agonists, such as heroin and methadone, but you can think of it as being less potent than full opioid agonists. Thus, it is strong enough to prevent withdrawal from opioids and prevent cravings, but it tends not to cause the more troublesome side effects of full opioid agonists such as euphoria/”highs”, respiratory depression, and risk of overdose. 

What Is Heroin?

Heroin is an illicit full opioid agonist and common drug of misuse for those who struggle with opioid use.[2] It binds to opioid receptors in the brain and causes intense euphoria, suppressing feelings of pain, reducing a person’s heart rate, slowing their breathing, and changing how they sleep.

Heroin is considered to have a very high level of misuse and addiction potential, with no accepted medical uses. With continued use, heroin presents a very real risk of a person growing physically and psychologically dependent on it. Once this happens, the person may engage in dangerous behaviors while under its influence or in an effort to acquire more of it.

Is Suboxone Treatment Trading One Opioid for Another?

No it is not. This is a common misconception. Suboxone and similar drugs used in MAT often carry a stigma around them, with people claiming they’re “trading one addiction for another.” 

On some level, these concerns are understandable. Suboxone is a partial agonist and works in some similar ways to the types of opioids that people struggling with opioid use disorder often misuse. However, there are some important distinctions to consider.

First, buprenorphine causes some physical dependence, meaning a person may go through physical withdrawal if they suddenly stop taking it, but true addiction to buprenorphine is rare when compared to the addictive potential of full opioids like heroin.[3] By taking the medication as prescribed, this physical dependence is manageable, and a doctor can help a person taper their doses over time if they want to stop taking the drug, thereby helping to prevent physical withdrawal.

Second, these treatments are controlled. Unlike with opioid misuse, a person doesn’t take buprenorphine-based medications whenever they want or feel a strong urge to take them. Instead, the doses are administered on a schedule designed by a medical professional to help a person control their drug cravings and reduce their use of much more dangerous drugs. 

Even if one takes more than their prescribed dose of Suboxone (either by accident or as an attempt to misuse it), they won’t generally experience a particularly intense high or life-threatening symptoms related to their heart or breathing. It is very hard to overdose on Suboxone. This is one of the reasons that Suboxone is considered much safer than full opioids like heroin. [3]

Misuse Potential of Suboxone

Many people wonder if buprenorphine-based medication misuse is common. Specifically, do people take higher doses than prescribed in order to get high, or do they even dissolve and inject the medication in order to get high? [4] 

To answer the first question (do people take higher doses of Suboxone to get high or otherwise misuse the drug?) The answer is usually no: Suboxone has some misuse potential since it has the potential to cause some euphoria, particularly in people who are not tolerant to opioids. However, its misuse potential is limited by two features: its nature as a partial opioid agonist and subsequent “ceiling effect”, and the addition of Naloxone. 

The buprenorphine component of Suboxone is a partial opioid agonist. While it activates the opioid receptors in the brain, it does not do so to the same extent that full opioid agonists do.

The analgesic, euphoric, and respiratory depression affects plateaus at high doses. This is what is called the buprenorphine “ceiling effect.”[4]

The ceiling effect means that Suboxone will produce a certain degree of euphoria and pain relief but that effect will be maximized at a moderate dose and will not continue to increase at higher and higher doses. This minimizes the utility of taking more and more of the medication and dissuades any potential to overdose on the medication. 

To answer the second question (can Suboxone be misused by injecting it?) the answer is also no, because of the addition of Naloxone. Naloxone is an opioid antagonist. If the medication is injected, the Naloxone component becomes active and prevents the action of the buprenorphine, preventing the person from getting high and even from overdosing. 

One review of medical literature from around the world found buprenorphine misuse was most common in places that had a history of a buprenorphine mono-product (without Naloxone) being introduced to market a significant length of time before combination products (such as Suboxone), and where heroin and other stronger opioids are not regularly available. 

The addition of Naloxone to buprenorphine prevents a person from getting high at all or accidentally overdosing if they attempt to misuse the medication by injecting it. The addition of Naloxone is therefore another safety mechanism included in Suboxone to prevent misuse. 

Overall, buprenorphine has a fairly low level of misuse potential and is much less dangerous than commonly misused opioids like heroin, particularly with the addition of Naloxone as an additional safety mechanism and with the ceiling effect discussed above. [4]

Suboxone & Relapse Prevention

When considering whether you want to take Suboxone or engage in any other MAT to help with your addiction treatment, always remember to compare the potential benefits with the potential drawbacks. 

Suboxone is a prescription medication, and it does have some side effects associated with it that are worth talking to your doctor about. However, it has also consistently been shown to help people in addiction recovery.

If Suboxone use helps to prevent a relapse, it may save your life. People who use Suboxone generally are able to avoid use of full opioids much longer than those who attempt an “abstinence only” approach. 

If you have further questions about online Suboxone therapy, reach out to your doctor, or to Bicycle health for more information.

Sources

1. Buprenorphine Sublingual and Buccal (Opioid Dependence). National Library of Medicine. https://medlineplus.gov/druginfo/meds/a605002.html. January 2022. Accessed September 2022.
2. Heroin. National Institute on Drug Abuse (NIDA). https://nida.nih.gov/publications/drugfacts/heroin. June 2022. Accessed September 2022.
3. Is Buprenorphine Treatment Just Trading One Addiction for Another? The National Alliance of Advocates for Buprenorphine Treatment. https://www.naabt.org/faq_answers.cfm?ID=1. March 2008. Accessed September 2022.
4. Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review. Current Drug Abuse Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/. March 2011. Accessed September 2022.