Subutex (Buprenorphine) Addiction: Signs and Side Effects of Subutex Abuse

Subutex is the brand name for a prescription medication containing buprenorphine, which is a partial opioid agonist used for opioid addiction treatment and pain management, depending on the formulation. Taking this medication as directed by a physician isn’t Subutex abuse, but the opioid can still be addictive. Even prescription use following a doctor’s orders can lead to dependence in some people.

Subutex isn’t the same thing as Suboxone, although both contain buprenorphine and are used in medication-assisted treatment for opioid use disorder. However, Suboxone also contains naloxone to help deter abuse. Because of this, there’s a higher risk of Subutex abuse than Suboxone abuse.

Although Subutex is a legitimate prescription medication, it’s also sold illicitly in various forms. Street names for the drug include bupe, subs and subbies, but these pills may be counterfeit. Often, street pills contain other substances, leading to unpredictable and riskier side effects when used.

This article discusses what leads to Subutex addiction, how Subutex side effects might impact you and what withdrawals might look like. The guide focuses on addiction signs and health effects rather than rehab or treatment options.

Buprenorphine does the same thing that other opioids, including heroin or prescription pain meds, such as hydrocodone, do by binding to opioid receptors in your brain. The effect is that your brain is “tricked” into believing the craving for opioids is met, which can reduce withdrawal symptoms. However, use of Subutex outside of a medically controlled environment or in higher doses than prescribed can lead to problematic patterns.

Individuals may use Subutex outside of medical guidance or in doses higher than prescribed as they seek stability, manage stress or try to avoid uncomfortable withdrawal symptoms. However, reliance on it can create a pattern that’s difficult to break. The brain can begin to associate Subutex use with feeling safe or okay, and not using can cause new withdrawal symptoms and make it feel impossible to stop using.

Tolerance can also develop with regular misuse or even prescription use. Someone may need more Subutex or more frequent doses to feel the same effects. When they stop using it, withdrawal symptoms can start quickly, creating a cycle that prompts them to use it again or to increase use.

Buprenorphine, the active ingredient in Subutex, has something called a ceiling effect. If you take Subutex beyond a certain dose, you don’t continue getting an increased opioid effect. While this ceiling effect may help limit Subutex abuse (using Subutex outside of prescription guidelines), harmful use is still possible. Using it with other substances, such as alcohol, other sedatives or benzodiazepines, can increase the risks for harm.

Substance abuse and addiction aren’t the same thing, although misuse can lead to an opioid use disorder (OUD). Subutex misuse is the technical term for what some people call Subutex abuse; it refers to using the drug outside of medical guidance.

Examples of misuse include taking extra doses of a drug prescribed to you without talking to medical professionals first, using someone else’s prescription or taking the drug in a manner other than intended. For example, snorting or injecting buprenorphine would be misuse.

Addiction, or opioid use disorder, occurs when misuse escalates to compulsive use. Someone with Subutex addiction may have intense cravings and withdrawal symptoms that draw them back to using even when they can see the harm caused by misuse, and they might be unable to stop using it.

The line between misuse and addiction can blur gradually. What starts as using Subutex to get through a rough withdrawal patch can develop into a pattern that’s difficult to break without getting help in inpatient or outpatient addiction treatment programs.

Even when used as prescribed, Subutex can lead to physical and psychological dependence. Misusing Subutex substantially increases the risks of dependence.

Physical dependence develops when your body adapts to buprenorphine use and starts to expect a certain amount of the drug in your system. When you reduce doses or stop taking it, you can experience withdrawal symptoms as your body reacts to a different amount of the substance.

Psychological dependence causes you to feel like you can’t function normally without a certain amount of Subutex. You might need it to sleep, manage stress or just get through the day.

Dependence doesn’t mean you have an opioid use disorder. However, as Subutex use escalates, you can become more dependent on the substance, leading to compulsive and uncontrolled use related to addiction.

Because this medication is used in addiction treatment, signs of problematic use can be harder to recognize. The person using Subutex, friends and family members and even clinicians must pay close attention to use patterns and effects, making medical oversight important.

Opioid use disorder involving buprenorphine does occur, and behavioral signs are often the first indication of developing addiction.

Behavioral signs of addiction can include:

• Taking more Subutex than prescribed. Adding a single extra dose one week isn’t necessarily a sign of addiction, but consistently using more than directed signals escalating and potentially compulsive use.
• Running out of Subutex early and seeking more. If you’re running out of your prescription early on a regular basis, it can be a sign of misuse. Seeking Subutex from multiple sources, especially if you engage in risky behavior, such as stealing medicine from someone else or forging prescription documents, is a sign of compulsive use.
• Hiding Subutex use. Concealing how much and how you’re taking Subutex can indicate awareness that use has become problematic.
• Continuing to misuse Subutex despite harmful outcomes. Ongoing misuse in the face of worsening health problems, strain on relationships or an inability to maintain performance at work or in school is a common sign of addiction.

Subutex withdrawal can make you feel like you have a bad flu or similar virus, as you may experience fever, chills and body aches. At the same time, the withdrawal period is characterized by restlessness, anxiety and intense cravings for buprenorphine.

Buprenorphine is a long-acting ingredient, which means it stays in your body for up to a few days. Withdrawal symptoms typically don’t start until 24 to 48 hours after your last dose. Symptoms typically peak around the third day and last for up to 10 days, although some people experience lingering symptoms for longer.

Common Subutex withdrawal symptoms include:

• Sudden or extreme changes in mood
• Anxiety, agitation and irritability
• Fever-like symptoms, including temperature changes, sweating and chills
• Stomach distress, including nausea, vomiting or diarrhea
• Problems sleeping
• Muscle aches or generally feeling achy or tired
• Cold-like symptoms, such as a runny nose or watery eyes
• Strong cravings that feel impossible to ignore

The severity of withdrawal symptoms depends on factors such as how much Subutex you were taking, how long you were using it and whether you mixed buprenorphine with other substances.

Subutex misuse can cause a range of physical and cognitive side effects. While buprenorphine’s ceiling effect helps reduce risks, unsafe side effects are still possible. Risks increase when it’s combined with other substances or used outside of medical guidance.

Physical Side Effects

Common side effects of Subutex misuse can include sedation, slowed breathing and dizziness. Digestive issues, such as nausea and constipation, are common.

The risk of overdosing increases when it’s combined with alcohol or sedatives, and injecting Subutex can increase poor outcomes. According to data published by the National Library of Medicine, injecting Subutex is associated with a higher rate of liver injury, especially when someone has a mitigation factor, such as a hepatitis C diagnosis. Snorting buprenorphine can also cause nasal tissue damage and increase the risk of infection.

Mental and Cognitive Side Effects

Cognitive and psychological effects of Subutex use can include:

• Brain fog
• Poor concentration
• Irritability
• Mood instability

Anxiety between doses can be more common as dependence develops, and some people experience depression, particularly if they reduce their intake. Escalating misuse over time can lead to impaired daily functioning, poor decision-making and an inability to manage stress without it.

Opioid use disorder involving Subutex can affect people from all backgrounds. Several factors increase the likelihood that buprenorphine misuse might escalate into addiction. These factors include:

• Prior opioid or substance use history. If you have a previous substance use disorder diagnosis or have misused substances in the past, you may be at a higher risk of developing compulsive Subutex use.
• Co-occurring mental health conditions. Anxiety, depression and a history of trauma are often linked to higher rates of opioid misuse and addiction.
• Use of Subutex to cope with day-to-day life. Relying on buprenorphine to manage stress, emotions or sleep can lead to faster tolerance building and dependence.
• Polysubstance use. Regularly mixing Subutex with benzos, alcohol or other substances can increase risks for overdose and addiction.
• Genetics. Individuals with a family history of addiction may be more prone to developing substance use disorders.

Circumstances can also impact your risks of Subutex addiction. For example, if you have easy access to more buprenorphine, such as through friends or illicit street purchasing, it increases the risk that periodic misuse may escalate to chronic misuse.

Opioid use disorder is diagnosed by a doctor or other healthcare provider using evidence-based approaches. They typically evaluate patterns of use and misuse over time, rather than a single incident of Subutex misuse, to arrive at a substance use disorder diagnosis.

When evaluating someone for Subutex addiction, clinicians consider how use has affected daily life, physical health and relationships. They also consider whether someone has intense cravings or an inability to control Subutex use.

Mental health screenings are also standard with most addiction assessments. Anxiety, depression and other mental health disorders are closely linked with opioid use in many cases, and it’s important to understand co-occurring diagnoses for proactive treatment planning.

Opioid medication misuse, sometimes referred to as substance abuse, isn’t uncommon, and it can happen and build into addiction gradually. This cycle doesn’t mean someone’s broken or beyond help, and Subutex addiction isn’t a personal failure. It’s a condition that may benefit from professional support and treatment.

Some signs it might be time to get help for Subutex addiction include escalated use, mixing it with other drugs and taking risks to get or use it. If you’ve tried to quit or cut down on Subutex but can’t do it on your own, substance use support resources are available.

Help.org is a free, confidential resource that lets you find Subutex addiction treatment centers that may be right for you. You can search for inpatient detox locations, rehab centers or outpatient treatment programs.