Mixing Buprenorphine and Opioids
- Buprenorphine also called
- subutex, suboxone, bupe, bup, buprenorphine/naloxone
- Opioids also called
- opiate, opiates, opioid, heroin, dope, smack
Unsafe
Buprenorphine outcompetes heroin, oxycodone and morphine at the receptor while producing much weaker signalling than they do, so taking it on top of a full agonist can trigger precipitated withdrawal within the hour — sudden, severe, and not something that can be dosed away by taking more of the original opioid. In the other direction, using a full agonist while buprenorphine is on board mostly wastes it, and the temptation to keep escalating to overcome the blockade is how people overdose once the buprenorphine finally clears.
The risk here is to the body — breathing, heart, temperature or organs. Set limits before you start, because this kind of harm does not announce itself in time to react.
Can you mix Buprenorphine and Opioids?
Risk of serious physical or psychological harm. Not recommended under any circumstances.
- Buprenorphine
- Partial agonist — displaces other opioids off the receptor
- Opioids
- Full agonists — heroin, oxycodone, morphine
- Buprenorphine precipitated opioid withdrawal: Prevention and management in the ED setting. https://www.sciencedirect.com/science/article/abs/pii/S0735675722003126
- Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl. https://pmc.ncbi.nlm.nih.gov/articles/PMC11437388/
- Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl. SAEM. https://www.saem.org/education/substance-use/practice-based-guidelines-buprenorphine-in-the-age-of-fentanyl
Checking more than two?
Combinations of three or more carry risks that no pair-by-pair chart can show. The checker rates every pair at once and flags the whole-mix ones on top.
Open this in the checkerRelated combinations
All combinations →Rated unsafe. Educational information only, not medical advice. Absence of a documented interaction is not evidence of safety.