Roughly 91,799 drug-overdose deaths occurred in 2020 in the US alone, and of those deaths, around 75% were from opioid overdose, making opioids the primary cause of overdose-related mortality in the US (CDC, 2022).
These staggering numbers underscore the urgent need for effective treatments for opioid addiction and abuse, and shockingly, one of the main treatments available is another opioid, Suboxone.
And since they are already proving to be profound therapeutic tools for trauma and PTSD as well as other comorbid conditions for opioid addiction, we have to wonder if psychedelics would be effective for this as well.
For this reason, it’s important to understand whether or not combining psilocybin therapy with Suboxone use is safe when considering it as a treatment for opioid addiction.
In this article we will cover everything you need to know about taking psychedelics while on Suboxone, and whether they are safe and effective together for the treatment of opioid addiction.
What is Suboxone?
Suboxone, a combination of buprenorphine (also known as Subutex) and naloxone, is an opioid medication used for the treatment of opioid addiction and chronic or acute pain.
With “more than 200 opioid overdose deaths each day in the US” (Sivils et al., 2022), Suboxone has become a common and effective treatment for heroin, oxycodone, and fentanyl addictions and withdrawals.
The administration of Suboxone can be sublingual (under the tongue), buccal (in the cheek), injection (intravenous), transdermal (through the skin via patches), or even through an implant, allowing flexibility in how patients receive the medication.
However, it is essential to recognize that Suboxone and buprenorphine are not standalone solutions for opioid addiction; it works most effectively when used in conjunction with counseling and support services.
One crucial aspect of using Suboxone for addiction treatment is timing. To begin Suboxone treatment, individuals must be in the early stages of opioid withdrawal, typically going 12-24 hours without opioid use.
This timing is vital to ensure that the medications can effectively bind to opioid receptors without displacing other opioids, which could lead to acute withdrawal symptoms.
The duration of Suboxone use is personalized for each patient, tailoring the treatment to their specific needs and progress.
Despite its therapeutic benefits, Suboxone has also been associated with recreational misuse. As a Schedule 3 controlled substance, it poses a risk of abuse and dependence.
“Two gold-standard pharmacological treatments exist for opioid dependence—methadone and buprenorphine, both of which are synthetic opiate derivatives. Unfortunately, these common interventions come with high risk of dependence, therefore often trading one addiction for another. There is a clear need to identify more effective interventions for OUD as well as to explore protective factors that may increase the likelihood of abstinence from these addictive compounds” (Jones et al., 2022).
Furthermore, the need to enter withdrawal prior to utilizing Suboxone poses certain issues, so many have adopted microdosing strategies like the Bernese method (Hammig et al., 2016) to mitigate withdrawal symptoms and gradually titrate onto the medication.
Like any medication, Suboxone may come with side effects, ranging from mild to severe (SAMHSA, 2023). Common side effects include:
- nausea or vomiting
- fatigue or drowsiness
- dry mouth
- tooth decay
- muscle aches
- vision disturbances
- problems breathing (respiratory depression)
- itching, pain, or swelling
Furthermore, combining Suboxone with certain drugs can be extremely dangerous, especially alcohol, suppressants, and those which cause drowsiness.
It is crucial for patients to be aware of these potential side effects and communicate any concerns to their healthcare providers promptly.
Probably most important to this conversation is the acknowledgement that deeper healing and treatment is needed, so that whatever underlying trauma, chronic pain, and pre-existing conditions led to the addiction are resolved.
This will help ensure that relapses and additional addictions or self-destructive behaviors do not form once opioid withdrawal begins.
“Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience. A hurt is at the centre of all addictive behaviours.
It is present in the gambler, the Internet addict, the compulsive shopper and the workaholic. The wound may not be as deep and the ache not as excruciating, and it may even be entirely hidden—but it’s there.
As we’ll see, the effects of early stress or adverse experiences directly shape both the psychology and the neurobiology of addiction in the brain.” — In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté.
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Clinical Trials on Suboxone and Psilocybin Mushrooms
Understanding the complex interplay between these substances can help in ensuring the well-being of individuals seeking alternatives to traditional treatments for opioid addiction and chronic pain.
Scientific data and research on the safety of taking psilocybin while on Suboxone, specifically in the context of treating opioid use disorder, tells us a few things.
Firstly, while the available research shows promising results in the potential therapeutic benefits of psilocybin and psychedelics for opioid use disorder, it’s essential to approach these findings with caution.
Further rigorous clinical trials and research are needed to establish the safety, efficacy, and long-term effects of using psychedelics as a complementary or alternative treatment for opioid addiction and chronic pain.
A clinical trial—which is currently underway—plans to provide 2 doses of psilocybin to adults who have active opioid use disorder and who currently use buprenorphine-naloxone (Suboxone).
They hypothesize that “co-administration of oral psilocybin with a buprenorphine-naloxone formulation will not cause signs and symptoms of opioid withdrawal” nor “opioid intoxication”
Their aim is to “characterize adverse events associated with adding two psilocybin doses to a stable buprenorphine-naloxone formulation…evaluate the effect of psilocybin treatment on the effectiveness of a buprenorphine-naloxone maintenance therapy…evaluate the effect of concurrent buprenorphine-naloxone use on the effects of psilocybin therapy…[and] to describe any changes in self-efficacy, quality of life, pain.”
And while this study is scheduled to complete in December of this year, it is the first of its kind to be conducted on Suboxone use in conjunction with psilocybin administration.
As we await the results for this trial, we know from the 2022 study by Jones and colleagues that “classic psychedelics [were linked] to lowered odds of opioid use disorder across a broad spectrum of diagnostic criteria, but specifies that this link only exists for psilocybin, and not for LSD or phenethylamine psychedelics (mescaline and peyote).”
“Lifetime psilocybin use was associated with lowered odds of OUD. No other substances, including other classic psychedelics, were associated with lowered odds of OUD. Additionally, sensitivity analyses revealed psilocybin use to be associated with lowered odds of seven of the 11 DSM-IV criteria for OUD.”
These powerful findings mirror many of the other conditions and disorders which are proving to be treatable with psilocybin assisted therapy. You can find a list of those conditions below, and many of them are comorbidities for OUD:
Aside from psilocybin mushrooms being useful in preventing and treating symptoms of opioid use disorder, there is no evidence suggesting one way or the other whether or not combining it with Suboxone is safe.
Are Suboxone and Magic Mushrooms Safe to Take Together?
The combination of Suboxone (buprenorphine-naloxone) and psilocybin, a psychedelic compound found in magic mushrooms, is an area where safety implications have not been fully explored or understood.
The interactions between these substances are complex and may lead to unpredictable effects, including potential risks and adverse outcomes, so caution should be exercised with proper medical supervision.
On the other hand, research on psilocybin has shown promising results in reducing the risks of opioid dependence and abuse.
Studies have indicated that psilocybin, along with other classic psychedelics, may have potential therapeutic benefits in addressing various forms of substance use disorders, including opioid addiction.
The effects of psilocybin on altering patterns of thinking and enhancing emotional processing may contribute to reducing the desire for opioids and facilitating personal growth and insight.
While the research on psilocybin’s potential benefits in opioid addiction treatment is still in its early stages, the findings suggest that it could serve as a valuable alternative and supplementation to medications and traditional therapies.
Both psilocybin and buprenorphine have unique mechanisms of action, and while there may not be direct interactions, there are potential concerns regarding their effects and safety when taken together.
Buprenorphine: Buprenorphine is a partial agonist at the mu-opioid receptor, and its effects are complex. It acts as an opioid receptor agonist but also has antagonist properties, and its actions plateau at higher doses. The ceiling effect on respiratory depression is one reason it’s considered safer than full agonists like methadone. It can also interact with various enzymes and drugs, affecting its levels in the body.
Psilocybin: Psilocybin interacts with serotonin receptors, primarily the 5-HT2A receptor. It produces hallucinatory effects and has been studied for its potential in treating depression and other mood disorders. It can affect brain dynamics, functional connectivity, and emotional processing.
Given their distinct mechanisms of action, there isn’t an obvious direct pharmacological interaction between psilocybin and buprenorphine. However, opioids can have a slight dampening effect on psychedelics, and these effects may apply to suboxone as well.
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