Suboxone is a medication prescribed for opioid use disorder (OUD) to manage withdrawal and cravings, while cocaine is a potent stimulant. The concurrent use of these substances is a concern because individuals in OUD treatment may have a history of or continue to use cocaine. This combination poses unique health risks and can complicate recovery efforts.
The Pharmacological Interaction of Suboxone and Cocaine
The interaction between Suboxone and cocaine is not a matter of one canceling out the other; they operate on different brain systems. Suboxone’s primary ingredient, buprenorphine, is a partial opioid agonist. It binds to the brain’s opioid receptors less intensely than full agonists like heroin, which alleviates withdrawal and cravings without producing a significant high.
The second component, naloxone, is an opioid antagonist included to deter misuse. If Suboxone is injected, naloxone can trigger immediate and unpleasant withdrawal symptoms in someone with an opioid dependency. When taken as prescribed under the tongue, the naloxone has minimal effect, allowing the buprenorphine to work.
Cocaine functions through a different mechanism as a powerful central nervous system stimulant. It blocks the reuptake of neurotransmitters like dopamine, leading to an accumulation of these chemicals in the brain. This causes the intense euphoria and energy associated with its use.
A dangerous misconception is that Suboxone can block cocaine’s effects. This is pharmacologically impossible because the drugs act on distinct neural pathways: opioid receptors for Suboxone and dopamine transporters for cocaine. The drugs operate in parallel, subjecting the body to conflicting signals and creating a hazardous state.
Health Risks of Concurrent Use
Combining a stimulant like cocaine with Suboxone introduces health risks from their competing effects, with the most immediate danger being immense strain on the cardiovascular system. Cocaine increases heart rate, blood pressure, and body temperature, while buprenorphine can also affect the heart’s rhythm. When used together, these compounded effects elevate the risk of a heart attack, stroke, or dangerous arrhythmias, even without a prior history of heart problems.
Another risk is the masking of overdose symptoms. The buprenorphine in Suboxone can cause respiratory depression, a dangerous slowing of breathing. Cocaine’s stimulant properties can counteract this, making a person feel alert while their respiratory system is compromised, preventing them from seeking help as their breathing slows to a critical level.
The conflicting signals sent to the brain can also trigger neurological and psychological effects. The combination of a stimulant and a depressant can increase the likelihood of seizures. Psychologically, this mixture can amplify anxiety, paranoia, and agitation, and in some cases, lead to psychosis with hallucinations.
Impact on Opioid Use Disorder Treatment
Using cocaine while in a Suboxone program for OUD undermines treatment goals. Suboxone provides stability for recovery, and introducing a powerful stimulant disrupts the equilibrium that medication-assisted treatment establishes.
Cocaine use complicates recovery by intensifying cravings for both cocaine and opioids. The high from cocaine can make the stability from Suboxone feel insufficient, creating a desire for more potent euphoric effects. This increases the risk of relapsing back to opioid use, defeating the purpose of the treatment.
Cocaine use impairs judgment and decision-making, making it harder to adhere to a treatment plan, attend therapy, and make positive behavioral changes. This cognitive impairment makes it more difficult for an individual to engage in the changes necessary for long-term recovery. Individuals who use cocaine during OUD treatment have a higher likelihood of dropping out of their programs.
Active cocaine use can also strain the relationship between a patient and their provider. Physicians may feel it is unsafe to continue prescribing Suboxone due to the health risks involved. This can lead to difficult decisions about continuing treatment under a harm reduction model or discharging the patient, potentially leaving them without support.
Treatment Approaches for Co-Occurring Use
Addressing concurrent Suboxone and cocaine use requires an integrated treatment approach. Because the substances affect different brain systems, treatment must handle both opioid and stimulant use disorders simultaneously, as focusing on only one is often ineffective.
Integrated treatment programs are considered the most effective model. These programs incorporate therapies and strategies for both OUD and cocaine use disorder within a single, cohesive plan. This avoids the fragmentation of care that can occur when a person has to seek help from separate providers for each issue. Honesty with the treatment team is paramount so they can provide the safest and most effective care.
Behavioral therapies are a foundation of treatment for co-occurring disorders. Cognitive Behavioral Therapy (CBT) helps individuals identify triggers for substance use and learn new coping skills to manage cravings and avoid relapse. Contingency Management, which provides tangible rewards for abstaining from substance use, has also shown effectiveness in treating cocaine use.
A common question is whether Suboxone can treat cocaine addiction. Currently, no FDA-approved medications exist for cocaine use disorder. While some research has explored buprenorphine’s potential to reduce cocaine use, it is not a standard or approved treatment. Therefore, a person may continue Suboxone for OUD, but it is not a treatment for cocaine use.