Risks of Mixing Subutex and Alcohol

Subutex (generic name buprenorphine) is an opioid that is commonly prescribed to manage chronic pain or to be used in treating opioid dependence with opioid substitution therapy (OST). The underlying theory of OST is that by substituting an opioid like heroin or oxycodone with an opioid that is long-lasting and that does not deliver the same euphoric high, cravings and withdrawal symptoms can be minimized without furthering the addictive cycle. Subutex essentially tricks the brain into thinking that it has the drug it wants, but the person taking the Subutex doesn’t experience a high. The goal of opioid substitution therapy is not to prevent opioid use, but to control the potentially devastating consequences of opioid addiction.

Subutex is successfully used in OST, but if it is combined with alcohol, the results can be fatal. According to the Centers for Disease Control and Prevention, in 2010, 18.5% of opioid-related emergency department visits involved alcohol, and 22.1% of opioid-caused deaths involved alcohol. People with alcohol use disorders should be especially cautious of taking Subutex; studies have shown that increased binge drinking frequency has been shown to significantly increase the rate of prescription opioid misuse, and an estimated 36% to 45% of people who misuse prescription opioids have comorbid alcohol use disorders.

Why Do People Combine Subutex and Alcohol?

One of the most common reasons that people combine Subutex and alcohol is to relieve chronic pain. A recent study found that 63.4% of people who reported opioid misuse cited pain relief as their primary motive. Alcohol and opioids have pain-relieving qualities, but as tolerance to the drugs develops, the pain will return, which may lead some people to increase their drug usage. Even for someone who does not normally mix Subutex and alcohol, chronic pain may be a sufficient driver for them to combine the drugs.

Recreational mixing of Subutex and alcohol is done to achieve a sense of euphoria that cannot be achieved using either drug alone. Alcohol enhances Subutex’s ability to activate the endogenous opioid system, which increases the pleasurable and rewarding physical and psychological sensations that opioids can deliver. There is also evidence that alcohol may inhibit opioid metabolism, which will prolong the opioid high.

Effects of Combining Alcohol with Subutex

Opioids and alcohol are both central nervous system (CNS) depressants, meaning that they reduce overall brain activity and promote sedation. Subutex is a “partial opioid agonist” at the mu-opioid receptor (MOR), meaning that it activates cells that have MORs. MOR-expressing cells inhibit activity in the respiration center, so the presence of opioids causes inhibition of the respiratory center, leading to shallow and infrequent breathing. Alcohol enhances the effects of an inhibitory neurotransmitter called GABA, which is also able to inhibit activity in the respiratory center. When they are taken together, Subutex and alcohol act synergistically, that is, their effects are greater than what would be expected if you added the effects of alcohol with the effects of Subutex when used independently.

The pleasant feeling that is associated with combining Subutex with alcohol can be accompanied by other, less-pleasant side effects. Alcohol can increase the severity of common Subutex side effects including:

• Headache
• Dizziness
• Lack of coordination
• Irregular heartbeat
• Nausea or vomiting
• Lightheadedness
• Fainting

Subutex and alcohol have dose-dependent effects, meaning that the more you consume, the stronger the effects will be.

Risks of Mixing Subutex with Alcohol

Mixing Subutex with alcohol is incredibly dangerous. As described, opioids and alcohol both inhibit activity in the brainstem’s respiratory center, which controls breathing. Either alcohol or Subutex can cause potentially lethal inhibition of respiration but, because they act synergistically, they have a substantially stronger effect on breathing than either could have alone.

Alcohol and opioids both promote sedation and reduce consciousness. Subutex is a powerful pain reliever that promotes an overall perception of wellbeing, so someone with dangerously shallow and irregular breathing may not be consciously aware that they need oxygen. The consequences of oxygen deprivation may include coma, brain damage and death.

Importantly, Subutex has a half-life of up to four days. This means that someone who binge drinks even a couple of days after taking Subutex is still at risk for opioid and alcohol-induced adverse effects.

A long-term risk that is associated with the co-use of Subutex and alcohol is liver damage. It is well known that chronic alcohol use disorders are associated with liver damage, and the damage can be exacerbated by buprenorphine use, especially when taken at high doses.

Treatment for Subutex and Alcohol Addiction

Opioids and alcohol are both powerfully addictive drugs that have unique challenges associated with recovery. Even moderate alcohol use disorders can have dangerous withdrawal symptoms that are made worse by simultaneous opioid withdrawal. It is strongly recommended that anyone who is struggling with polysubstance abuse undergo a professional evaluation before attempting to quit. The safest and most reliable way to overcome the detox and acute withdrawal stages of recovery is to participate in a rehab program that offers medically assisted detox.

Contact The Recovery Village Ridgefield to speak with a representative about how professional addiction treatment can address a substance use disorder and any co-occurring mental health disorders. You deserve a healthier future, call today.