Ask an Expert: Will Suboxone Protect me from Overdose?

By Percy Menzies 07/12/16

There is a lot of confusion about the role narcan (naloxone) plays in the formulation of Suboxone. Our expert clarifies.

Ask an Expert: Will Suboxone Protect me from Overdose?
The short and emphatic answer is: NO

I am a recovering heroin addict who has been on Suboxone for three months now. Although I don’t plan on returning to heroin use, my doctor tells me that if I do relapse, there is an ingredient in Suboxone—the overdose prevention medication Narcan—that will prevent me from overdosing if I use too much heroin for my system. I’m wondering if that is true. Will the Narcan in Suboxone protect me against overdose if I relapse with heroin?

Percy Menzies: The short and emphatic answer is: NO

Suboxone was introduced almost 14 years ago and even after so many years, the role of Narcan in the formulation is poorly understood both by clinicians and patients. Buprenorphine, the active ingredient in Suboxone, is a potent opioid analgesic developed over 30 years ago. Like all opioids it is both effective and abusable, especially if injected. The oral form was found to be effective both as a detox drug and maintenance drug in the treatment of opioid addiction. The major challenge was preventing the oral formulation from being injected.

Naloxone, better known by the brand name Narcan, was developed about thirty years ago to reverse opioid overdoses. Naloxone has been in the news almost daily as a life-saver carried by first responders to restore breathing in opioid overdoses. Some states have made the drug available without a prescription. But naloxone is effective only when administered as an injection or as a nasal spray. Being an opioid antagonist, it instantly and powerfully displaces the opioid from the opiate receptor in the brain, restoring breathing but at the same time throwing the patient into acute withdrawal.  

That unique property of naloxone has been used to prevent the misuse of buprenorphine, i.e. injecting the drug. If the Suboxone is taken as prescribed—dissolved under the tongue—only the buprenorphine gets absorbed while the naloxone exits the body unabsorbed. Preventing abuse by injection is the one and only reason that naloxone is added to the formulation. Since it is not injected or taken intranasally when taking Suboxone and it is not active otherwise, it will have no impact on the subsequent ingestion of heroin or any other opioid.

In conclusion, remember two things about naloxone:

--The naloxone in buprenorphine provides no protection from abusing other opioids like heroin.

--The naloxone does not make Suboxone abuse-proof. The big problem is diversion. Providers should establish healthy checks and balances while prescribing buprenorphine formulations.

Finally, I applaud you on your ongoing recovery and hope that you are involved in a plan of care that keeps you heroin free!

Percy Menzies is the president of Assisted Recovery Centers of America, LLC, a center for the treatment of alcoholism and drug addiction based in St. Louis, Missouri which was established in 2001. Full Bio.

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