Suboxone is a medication that helps people recover from opioid use disorder (OUD). Both Suboxone and benzodiazepines (often called benzos) cause central nervous system (CNS) depression. Combining these types of drugs in high doses can cause a person’s breathing to slow or stop. For example, combining high doses of Suboxone, which is a partial opioid agonist, and Xanax (alprazolam), a type of benzodiazepine used to treat anxiety, can be risky. The Food and Drug Administration (FDA) released a warning about the danger of this in 2016.
It’s common for people with OUD to have mental health conditions like anxiety. In fact, 33% of adults in the United States who have a mental health condition also have a substance use disorder, according to the 2023 National Survey on Drug Use and Health. Managing anxiety symptoms is critical for success with treatment goals. There are other types of anxiety medications that don’t have the same risks. However, they aren’t effective for everyone. People beginning treatment for OUD may not have the time to experiment with new anxiety medication.
There is some risk that taking a medication for OUD (MOUD) with Xanax could slow or stop your breathing. However, the risk is lower than it would be with purer forms of opioids like heroin or morphine. For many people, the benefits of using a MOUD during recovery along with the risks are preferable to the alternatives, which would be to continue opioid use, stop taking their anxiety medication, or attempt recovery without MOUD.
The FDA has changed its stance on combining CNS depressants since 2016. There are many reasons why people take benzos, opioids, and MOUD. These drugs can also have both positive and negative effects that change over time. Doctors are better able to help people manage the risk of taking these medications together. More of them are willing to prescribe Suboxone for people who take Xanax.
It’s important to understand your individual risks when taking any new medication. Tell your doctor about any prescribed and recreational drugs you take before taking a new medication. It’s helpful to find a care provider you trust so you can be fully honest about your health history.
In this blog post, we’ll talk about the risks and benefits of taking Suboxone and Xanax together and when it’s OK to do so.
Is it safe to take Suboxone and Xanax together?
There is a slight risk of unwanted effects when taking Suboxone with benzos. There have been cases of respiratory depression. However, it’s generally safe under a doctor’s guidance. Suboxone has a lower risk of breathing issues and overdose than methadone. People in treatment also work closely with a care provider who manages their dosage.
The FDA still requires a boxed warning about the risks involved. The warning was revised to include more information about managing these medications. In 2017, the FDA issued another statement urging caution about refusing MOUD, reasoning that “the harm caused by untreated opioid addiction can outweigh [the] risks.” When people don’t receive treatment, they’re no less likely to keep using opioids with benzos. The statement stresses that working closely with a professional can lower these risks.
What are the risks of taking Suboxone and Xanax together?
Taking too much Suboxone with Xanax or other benzos can cause symptoms similar to opioid intoxication or overdose. Both types of drugs depress the central nervous system. People may lose consciousness, have trouble breathing, or stop breathing. People may also have a slower reaction time or impaired motor skills when taking these medications. You should monitor how you feel before driving or using heavy machinery and be very careful. If you’re sleepy, tired, or moving more slowly than usual, it’s best not to drive.
Suboxone and benzos are not the only types of drugs that cause CNS depression. Prescription opioids and certain antipsychotics, muscle relaxants, sleep aids, and tranquilizers have the same risks. People should also avoid drinking alcohol when taking these medications.
If a person has trouble breathing or loss of consciousness from Suboxone and Xanax, Narcan (naloxone) won’t reverse their symptoms. Narcan doesn’t have any effect on slowed breathing from benzos, alcohol, or other types of non-opioid drugs.
If you notice any of these symptoms in a loved one taking Suboxone with Xanax or benzos, seek emergency medical care right away:
- Extreme sleepiness
- Loss of consciousness or awareness
- Confusion or delirium
- Unresponsiveness
- Slowed or difficult breathing
- Blue lips or skin
Why is Suboxone usually safer than other MOUD for opioid use?
Buprenorphine is the main ingredient in Suboxone. It’s a long-acting partial opioid agonist. That means it only partially activates opioid receptors. These are cell proteins in the brain and central nervous system. They’re involved in pain control, emotion regulation, and other functions. Because it’s only a partial agonist, buprenorphine doesn’t cause as much sedation, respiratory depression, or overdose. This benefit is sometimes called a “ceiling effect.”
Suboxone also contains some naloxone, known as Narcan. On its own, naloxone is used to stop opioid overdoses. However, in Suboxone, its main use is to deter people from injecting or snorting their medication. If a person takes too much Suboxone at once, the naloxone will kick in and they’ll start having intense withdrawal symptoms.
Suboxone’s ingredients work together to reduce and prevent withdrawal symptoms and cravings. It doesn’t make you feel “high.”
Methadone is another popular MOUD, but it’s a full agonist. It’s only distributed in daily clinics, which can be a barrier for many people. Suboxone is safer and more effective for most people. There are some exceptions — for instance, for people who have severe lung disease or trouble breathing, those who have severe liver impairment, and those who are allergic to it. You may only start taking Suboxone once you’re having mild to moderate withdrawal symptoms. If you have too much of an opioid like heroin or fentanyl in your system, taking Suboxone could lead to intense withdrawal symptoms.
Where can I get safe Suboxone treatment if I’m taking Xanax?
Many outpatient clinics, like Groups, will work with people who want to begin recovery while taking Xanax. However, each one has its own unique treatment philosophy. Some may be more hesitant to prescribe Suboxone if you’re taking Xanax. There are other anxiety medications that are similarly effective and may be safer to take with Suboxone. There are also some cases when taking both Xanax and Suboxone may be the best course of action. Your care provider can help you explore your options and manage your individual risks.
Your primary care doctor, psychiatrist, or other care provider might not be able to prescribe Suboxone. This is because doctors need a DEA license to prescribe it legally. If you’re working with other care providers, you can usually sign a release form that allows them to share information. This can help ensure that your treatments don’t conflict with each other.
Groups can safely manage Suboxone treatment for people taking Xanax
At Groups, each of our members gets personalized treatment through a provider and a licensed counselor. Your care team can help you determine if Suboxone is right for you and manage your medications throughout treatment. You can also give and receive support with others who are in recovery during group sessions. Suboxone treatment, counseling, and group support make up our comprehensive approach to recovery.
Our goal is to provide treatments that support the life you want to live. We know that deciding what’s best for you is a complex process with many variables. Establishing trust between yourself and your care providers is critical for your success. We don’t punish people or kick them out of our program for using opioids. This helps encourage honesty so we can have deeper, more productive conversations.
Are you looking for an OUD recovery program right now? Give our Recovery Support Specialists a call today for more information. Let’s talk about the support you need to reach your goals for recovery and live your best life. If Groups doesn’t offer treatment in your state, you can locate other treatment options here.
