Opioids After Suboxone Treatment: Risks and Recommendations
Understanding Suboxone and Its Role in Opioid Addiction Treatment
What Is Suboxone?
Suboxone is a prescription medication designed to treat opioid and opiate dependency. And more recently it is also being used to treat dependency on Kratom and the 7-OH (7-hydroxymitragynine) derived from Kratom.
While the terms opioid and opiate are often used interchangeably, there are differences. Opiates are naturally derived from the poppy plant, including substances like heroin and morphine. Opioids, by contrast, are fully or partially synthetic drugs such as fentanyl, oxycodone, or hydrocodone (Volkow et al., 2023).
Suboxone is a synthetic opioid medication combining two active components: buprenorphine, a partial opioid agonist, and naloxone, a full opioid antagonist. The buprenorphine binds to the mu-opioid receptors which assist in stopping the withdrawal and cravings from Opioid Use Disorder. The naloxone component deters the misuse of the medication.
How Suboxone Works
Buprenorphine binds to mu-opioid receptors in the brain, reducing cravings and alleviating withdrawal symptoms without producing the intense euphoria of full opioids. Over time, this stabilization supports neurochemical recovery and decreases the likelihood of relapse (Ling et al., 2020). Naloxone, on the other hand, blocks the euphoric effects of opioids, deterring misuse. If Suboxone is misused, the naloxone can trigger immediate withdrawal, serving as a protective mechanism. Click here to learn more about How Suboxone Works.
Benefits and Side Effects
The main advantage of Suboxone therapy lies in its ability to provide a stable and manageable path to recovery. Research indicates that buprenorphine–naloxone therapy significantly reduces illicit opioid use, overdose, and relapse risk when used under medical supervision (Sordo et al., 2017). There is a version of the medication which does not contain the naloxone, which is Subutex, but this has other concerns such as diversion. It is important Subutex vs Suboxone if you have medical needs for the medication.
Common side effects may include:
Headaches or dizziness
Nausea and constipation
Blurred vision or drowsiness
Insomnia or increased sweating
While these effects can be uncomfortable, they are mild compared to the risks of continued opioid misuse or overdose. Many people experience no side effects or experience them for a very short period. Over-the-counter remedies and physician guidance can alleviate most symptoms of discomfort with this medication.
Risks of Using Opiates or Opioids After Suboxone Treatment
The Danger of "Controlled Use" After Recovery
Some individuals after completing Suboxone treatment mistakenly believe they can resume using opioids “recreationally”. The belief here is that they can on occasion misuse opioids now without the worry of withdrawal. This mindset is highly dangerous and can quickly lead to full active addiction and increased chance of overdose. Following a period of abstinence, tolerance levels decrease, and the same dose that was once tolerable can easily be fatal (Strang et al., 2020). Also, the reward pathways in the brain quickly lead to intense cravings leading to full active opioid addiction.
Even a single use after treatment can rapidly lead to overdose or relapse. The Centers for Disease Control and Prevention (CDC) reports that post-treatment relapse carries a heightened mortality risk due to lowered tolerance and reduced physiological resilience (CDC, 2023).
Fentanyl, Xylazine, and the New Overdose Crisis
The illicit drug market has been overtaken by fentanyl, a synthetic opioid 50 to 100 times stronger than morphine (Drug Enforcement Administration [DEA], 2024). Fentanyl is found in the majority of opioids that are illegally purchased, including what appears to be prescription medication. It is common now that fentanyl (and other possible adulterants) is pressed into what appears to be legitimate opioid prescription medications. These pressed counterfeit tills can be indistinguishable from the real medication, causing someone to be taking unknown and at time fatal doses of fentanyl.
More recently, xylazine, a veterinary sedative, has been found in opioid mixtures. Xylazine is not an opioid and does not respond to naloxone, which renders overdose reversal much harder (NIDA, 2024). Recently medetomidine has been replacing xylazine. This new adulterant is 200 times more potent than xylazine, can cause severe withdrawal symptoms from that veterinary medication on top of the withdrawals from the opioids. Medetomidine and Xylazine are both very dangerous medications that many people may be ingesting without their knowledge.
The combination of fentanyl and xylazine or medetomidine has led to the rise of “tranq dope,” responsible for devastating tissue damage and fatal overdoses across the U.S. (Friedman et al., 2022). These developments make any post-treatment opioid use particularly hazardous, and medetomidine often requires its own detoxification in a hospital or residential setting.
Kratom and 7-OH
Kratom and 7-OH (7-hydroxymitragynine) are legal substances which have opioid like effects on people. Kratom is starting to be made illegal in some states, counties, or towns. Both of these substances can easily lead a person back into active opioid addiction, or become addicted to these substances themselves. Due to this, it is why Recover Clarity has added these to the list of Addictions We Treat.
7-OH is the most concerning of the two and just recently the FDA has requested this to be labeled as a controlled substance under the Controlled Substances Act (FDA,2025). This alkaloid is naturally occurring in the Kratom plant but at very small levels, unlike the concentrates being sold in many stores. Research is showing that 7-OH can be up to 13 times more potent than morphine and has a strong bind on the mu-opioid receptor sites. This leads individuals to intense withdrawal and cravings from this “legal” addiction.
State-Dependent Learning and Overdose Risk
Another overlooked phenomenon is state-dependent learning which is the tendency to remember information or experiences when in the same physical or emotional state as during the original learning (Overton, 1964). For people with substance use disorder, this means they learn specific patterns of use tied to particular environments or mental states. When relapse occurs in a new environment, the body may react unpredictably to the drug, intensifying its effects and increasing overdose risk. This risk is also the same for those in active addiction when overdose chances are increased when using in new and unfamiliar environments.
Relapse and Return to Active Addiction
Even minimal use after Suboxone treatment can reignite full active addiction. Because opioids alter brain pathways related to motivation and reward, relapse risk remains high even after months or years of sobriety (Koob & Volkow, 2016). Prescribed opioids pose the same risk, therefore, patients should always inform their physicians of any past substance use before accepting pain medications. For some patients Suboxone can be used for pain management in place of other full opioid agonists.
Recommendations for Safe Pain Management After Suboxone
Communicate With Your Physician
If opioids are medically required, for example after surgery or severe injury, it is essential to inform your healthcare provider about your recovery history. Physicians can then prescribe safer alternatives or add safeguards such as limited dispensing, dosage tracking, or medication agreements (SAMHSA, 2023). If you have concerns seeking out additional support from your support systems or from an online addiction therapist can also be of great assistance during this time.
Explore Non-Opioid Alternatives
There are numerous non-opioid pain management options that can be effective:
Physical therapy or occupational therapy
Cognitive Behavioral Therapy (CBT) for pain management
Non-opioid medications (NSAIDs, acetaminophen)
Holistic therapies such as yoga, acupuncture, or mindfulness-based stress reduction
For some patients, buprenorphine (Suboxone) itself can serve as a safe alternative for chronic pain management under supervision (Gudin et al., 2020).
Harm Reduction Strategies
When opioid use cannot be avoided, adopting harm reduction strategies helps reduce risk of relapse and a return to active addiction. Examples include:
Medication control: Having a trusted person dispense doses to avoid misuse. Pharmacies often can assist with this.
Naloxone availability: Always having Narcan (naloxone) on hand in case of overdose.
Support network communication: Alerting sponsors, therapists, and family members when opioids are prescribed.
Harm reduction functions much like a seatbelt, no one plans to crash, but preparation saves lives. Engaging community programs or recovery specialists trained in harm reduction principles can also provide accountability and support (Logan et al., 2021).
Building a Long-Term Relapse Prevention Plan
Why Relapse Prevention Matters
Relapse prevention is an essential component of sustained recovery. Studies have shown that structured relapse prevention plans significantly reduce the likelihood of return to use and improve long-term recovery outcomes (Marlatt & Donovan, 2005). These plans help identify emotional, physical, and mental triggers before a lapse occurs. This should have been part of your after-care plan, which is one part of the comprehensive plan for lasting recovery, you worked through with your recovery treatment team as you were approaching a successful taper off Suboxone.
Recognizing Warning Signs
There are typically four categories of triggers:
Emotional triggers – emotions, either negative or positive
Environmental triggers – commonly known as people, places, and things (situations)
Psychological triggers – deeper issues such as trauma
Behavioral triggers – habits and routines
By journaling moods, behaviors, and stress levels, individuals can detect patterns early and intervene before relapse occurs. It is important to how to identify and avoid addiction triggers.
What to Do if a Relapse Happens
It is important to know that relapses are not a failure. It is a signal for intervention and to get back on the path to recovery. Immediate steps should include:
Contacting a sponsor or therapist
Attending support meetings
Resuming therapy sessions
Communicating openly with healthcare providers
Re-entering a treatment program or telehealth support system can quickly restore accountability and reduce harm. Having to start treatment again is not a failure but a sign of strength and a way to quickly get back on your journey of recovery.
Support Systems and Community Resources
Peer Support Groups
Peer recovery programs and support groups remain a great option for some in support of sustained recovery. Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) are among the most recognized. For individuals who prefer secular (non-religious) approaches, NA Agnostica and Secular NA provide alternative support structures.
Peer-based programs empower individuals in recovery to mentor others, a model proven to enhance engagement and lower relapse rates (Tracy & Wallace, 2016). To locate programs nearby, individuals can visit the SAMHSA treatment locator or contact local Drug and Alcohol Commissions.
Online and Telehealth Recovery Options
Telehealth recovery has expanded rapidly, offering accessibility and anonymity for those in rural or stigmatized regions. Online groups, therapy sessions, and telehealth recovery treatment enable ongoing contact with peers and professionals, crucial in preventing isolation, a major relapse trigger.
Holistic and Behavioral Recovery Tools
Integrating holistic methods into recovery strengthens resilience. These include:
Cognitive Behavioral Therapy (CBT) for negative thought management
Stress reduction and mindfulness training
Exercise and nutrition programs to boost mental and physical health
Interpersonal skills training to repair relationships and build community
Collectively, these strategies enhance quality of life and protect against relapse.
Key Takeaways: Safeguarding Recovery After Suboxone
Suboxone remains one of the most effective medications for treating opioid dependence.
Post-treatment recreational opioid use, even “just once”, poses a severe overdose and relapse risk.
Emerging drugs like fentanyl and xylazine make recreational or unmonitored use far more dangerous than in the past.
Effective communication with physicians and use of harm reduction practices can protect recovery progress.
Sustained recovery relies on relapse prevention planning, peer support, and holistic wellness.
References
Centers for Disease Control and Prevention. (2023). Understanding relapse and overdose risk. CDC. https://www.cdc.gov/
Drug Enforcement Administration. (2024). Facts about fentanyl. https://www.dea.gov/
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2023). Prevention and treatment of opioid misuse and addiction: A review. Annual Review of Medicine, 74, 75–90. https://doi.org/10.1146/annurev-med-042921-014315
FDA. (2025, July 29). FDA and Kratom. U.S. Food and Drug Administration. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom#:~:text=What%20can%20happen%20if%20a,medical%20examiner%20or%20toxicology%20reports.
Friedman, J., Montero, F., Bourgois, P., Wahbi, R., Dye, D., Goodman-Meza, D., & Shover, C. L. (2022). Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug and Alcohol Dependence, 233, 109380. https://doi.org/10.1016/j.drugalcdep.2022.109380
Gudin, J. A., Fudin, J., Schatman, M. E., & Cleary, J. P. (2020). Buprenorphine for pain management: A systematic review. Postgraduate Medicine, 132(4), 285–293. https://doi.org/10.1080/00325481.2020.1756509
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760–773. https://doi.org/10.1016/S2215-0366(16)00104-8
Ling, W., Mooney, L., & Hillhouse, M. (2020). Prescription opioid abuse, pain and addiction: Clinical issues and implications. Drug and Alcohol Review, 39(2), 153–165. https://doi.org/10.1111/dar.13015
Logan, D. E., Becker, W. C., & Curran, G. M. (2021). Integrating harm reduction into opioid treatment and recovery. Translational Behavioral Medicine, 11(4), 1119–1128. https://doi.org/10.1093/tbm/ibab021
Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press.
National Institute on Drug Abuse. (2024). Emerging trends in the xylazine and fentanyl overdose crisis. https://nida.nih.gov/
Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ, 357, j1550. https://doi.org/10.1136/bmj.j1550
Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Clinical guidance for treating opioid use disorder with buprenorphine. U.S. Department of Health and Human Services.
Strang, J., McCambridge, J., Best, D., Beswick, T., Bearn, J., Rees, S., & Gossop, M. (2020). Loss of tolerance and overdose mortality after inpatient opiate detoxification: Follow up study. BMJ, 326(7396), 959–960. https://doi.org/10.1136/bmj.326.7396.959