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Buprenorphine overdose: How much buprenorphine to OD?

Buprenorphine is an appropriate treatment for people who are dependent on opiates or opioids, such as heroin and prescription painkillers. Buprenorphine works to stop cravings, block withdrawal symptoms, and prevents “dope sickness” as well as  the “high” from heroin and other opioids. But use of buprenorphine requires medical supervision.

So, how much buprenorphine is too much? How can you recognize buprenorphine overdose and who it at risk of OD-ing? Here, we detail symptoms of buprenorphine overdose, define high dosage, and potential profiles of users who typically risk buprenorphine overdose. As always, your questions are invited at the end. We try to respond to all legitimate comments with a personal and prompt reply.

How does unintentional buprenorphine overdose happen?

Buprenorphine is the name for a generic opioid contained in Subotex and Suboxone. Buprenorphine works in a way that binds with specific receptors of the spinal cord, brain and gastrointestinal tract and affects other systems of the body, like those which regulate mood, breathing and blood pressure.

Unintentional buprenorphine overdose rarely occurs. Instead, people can OD on buprenorphine during misuse or unsupervised increase of the recommended dose. Additionally, buprenorphine SHOULD NOT be taken in combination with other central nervous system depressants, including other drugs or alcohol; this combination can increase the risk of adverse side effects, including overdose and death.

Buprenorphine overdose – How much is too much?

Because of its ceiling effect and poor bioavailability, buprenorphine is usually safer in terms of overdose than opioid full agonists. The most efficient effects of buprenorphine  occur in the 16–32 mg dose range for sublingual tablets and while higher doses are unlikely to produce greater effects. Still, intravenous injection of buprenorphine may cause symptoms of overdose.

As with other opioids, buprenorphine can trigger tolerance in its users. The loss of opioid/opiate tolerance is a very dangerous moment for drug addiction treatment patients, because re-introduction of buprenorphine to opioid naive people can cause overdose.  Additionally, you should never mix alcohol with buprenorphine.  When you take more than one central nervous system depressant simultaneously, the effects of both are compounded and can cause overdose or even death.

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Buprenorphine overdose complications

Buprenorphine overdose and possible complications can include:

  • allergic reaction
  • blurred vision
  • confusion
  • death
  • dizziness
  • feeling faint
  • feeling sleepy and uncoordinated
  • hypotension
  • nausea
  • pinpoint pupils
  • problems rationalizing
  • respiratory depression (slower than normal breathing)
  • sedation
  • slowed reflexes
  • slurred speech
  • vomiting

Who is at risk of buprenorphine overdose?

The most common profiles of buprenorphine users reported as overdose cases follow:

  • addicts completing mandatory detoxification or abstinent for a period of time-high risk of relapse
  • opioid naive people re-introduced to buprenorphine without opioid tolerance
  • patients discharged from medical care following any opioid intoxication
  • patients recently released from incarceration
  • people with confirmed medical history of illicit drug abuse and recreational use of medicinal drugs
  • self-administered intravenous buprenorphine users
  • users receiving rotating opioid medication regimes
  • users taking buprenorphine to treat opiate addiction without professional medical supervision

Buprenorphine overdose prognosis

If you experience any of the signs of buprenorphine overdose, immediately contact a medical professional or a clinic. Overdose can carry serious outcomes, too complicated for a nonprofessional individual to handle. Do not take any chances, especially when somebody’s life is on the line.  Buprenorphine overdose deaths can be prevented by treated with naloxone. As a narcotic antagonist, naloxone removes buprenorphine from receptors and reverses respiratory depression, which is the biggest risk to possible fatality. However, we suggest that SEEK MEDICAL HELP in any and all cases of buprenorphine overdose.

Buprenorphine overdose death rate

There are over 17,000 deaths reported annually as the result of opioid analgesic use alone. Overdose deaths have been reported, most involving concurrent use of buprenorphine with central nervous system (CNS) depressants such as benzodiazepines, other opiates, or alcohol. However, there is the chance for under-reported fatalities of buprenorphine, since the statistics have years with not a single reported case of such fatality.

Buprenorphine overdose amount questions

Still have questions about buprenorphine overdose? In case you have any specific questions related to overdose with buprenorphine, please feel free to post them in the following section. We try to provide you with a personal and prompt response, or refer you to someone who can help.

Reference sources: SAMSHA: Opioid Overdose Toolkit
Centers for Disease and Prevention/ Prescription Painkiller Overdoses in the U.S.
NY State Department of Health/Buprenorphine
US Food and Administration Agency/Medication Guide, Subotex

Photo credit: Joe Wu

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38 Responses to “Buprenorphine overdose: How much buprenorphine to OD?
Yoyoboy
3:02 am March 27th, 2015

How long does it take for subutec affects to stop.. Like how long does it take to feel nirmal again

10:43 am March 27th, 2015

Hi Yoyoboy. The half life of buprenorphine is greater than 24 hours, and may last up to 60 hours. It will be present in the body 2-4 days. It has a slow onset and a longer duration time. But it won’t be too long before the effects subside.

Mel
4:06 pm July 6th, 2015

if someone that isn’t taking opioids but was drinking alcohol was to take one sublingual film (8 mg/2 mg), what would most likely happen, in terms of reaction, side effects, and risk? Might this be considered a potential overdose? Long term damage?

3:02 pm July 21st, 2015

Hi Mel. Taking opiate drugs or medications isn’t recommended after drinking alcohol, at least not until the alcohol gets eliminated from your system. Read more here about the effects of mixing alcohol and opiates: http://alcohol.addictionblog.org/mixing-opiates-and-alcoholic-drinks/.

Smortt
8:33 am August 27th, 2015

My first quetion is how much subutex is too much.? Does it go by body weight? Height?because sometimes i do a little more daily than prescribed. My second question is it it not good that im prescribed ambien and this dose of subutex? 24mg buprenorphine prescirbed a day, 10mg zolpidem(ambien). Thank you for any answers, appreciate it.

Dee
12:24 pm September 26th, 2015

Suboxone has nalaxone in it , Subutex doesn’t . Subutex is generally used with pregnant women bc the nalaxone can harm the baby. Suboxone has a ceiling effect meaning that once it hits that dose it doesn’t work any better than the lower dose. I currently take 16 mg /day and it makes a world of difference when comes to pain control. A lot of people OD on pain medication bc they’re trying to take the pain away and accidentally take to much. Not an issue with Suboxone bc you CAN’T take to much , (remember the ceiling effect?) you may puke. Now , it’s a whole lot different when you introduce ANY benzodiazepines (valium,xanax ,ext) into your system while taking Suboxone . It can cause seizures and death ! That’s no joke either,that is definitely not a good thing to do. I hope this helps and gives you a clear understanding of how Suboxone works. It’s an awesome medication for pain , gave me my life back ,just like it does for someone with addiction problems. But , a word of caution, you need to be completely off of any other opiates for a MINIMUM of 48 hrs. bc Suboxone can cause precipitated withdraw . Meaning that it made you go into withdraw bc the nalaxon is fighting the opiates for your brain receptors.

Dee
12:41 pm September 26th, 2015

Smortt , you shouldn’t be taking the Ambien with the Subutex , it can cause you to have seizures. Subutex doesn’t contain Nalaxon so the potential for overdose is there. You need to let your prescriber of the Subutex know that you take Ambien . They will most likely stop one of the two medicines . Please remember, you can withdraw from the Ambien . Horrible shaking of your hands and massive headaches,along with the fact that you can not sleep for days. Just my experience ?

Elizabeth
7:39 pm December 14th, 2015

I was being prescribed subutex by my dr I was on 1/8mg pill in the morning and 2/2mg pills in late afternoon early evening the pharmacy made a mistake and gave me 8mg pills in the 2mg bottle so instead of 12mg a day I was taking 24mg for a week I went to er for feeling weird but the pharmacys mistake wasn’t realized till next day is there any permanent damage to me physically I should be tested for the only symptoms I feel is the withdrawals now from being on such a high dose back to my regular dose just don’t want to find out later my body was damaged from pharmacys mistakes thanks in advance for any advice you can give me

Lydia @ Addiction Blog
11:58 am December 23rd, 2015

Hi, Elizabeth. Did you ask your doctor about this? I believe that you won’t have any problems, but still consult with your doctor.

Venessa
10:20 pm December 29th, 2015

Hi, I am just trying to find out as much information on Subutex as possible. My sister who was 37 and her unborn son about 36 weeks passed away on October 10, 2015 of this year. She was prescribed Subutex and Fluoxetine both of which came up in her toxicology/pathology report (both prescribed). She had too much of the Subutex(buprenorphine) <–that is what it was referred to on her report. She was seeing a physician continuously and close to 3 times per week for the treatment and just saw him 2 days before she passed. Her pills were all accounted for and she was taking them as she should have been. Baby per ultrasound was fine and well at that appointment although it was noted my sister complained of swelling of her stomach, lower back pain I am told. She was in a secure environment that was monitored and she had them call an ambulance because she was having a hard time breathing. Upon arrival it was found that her baby died and she had to be intubated and her heart stopped. They restarted it once and lost it again. There are a few other things to this whole situation…but she was complaining about side effects but still another dose was issued. I see that Naloxone is supposed to assist with an overdose? Would this be the same for Subutex? I have yet to see her medical records to see what forms of trying to revive her heart they used. Sounds like it was pretty fast. Its been pretty hard on me and my family. I was her sole source of support. I also researched and saw the doctor not publicly registered on the SAHMSA as an approved provider for treatment? idk just looking at any possible information to help me. thank you

Lydia @ Addiction Blog
7:26 pm January 10th, 2016

Hi, Venessa. I’m really sorry for your loss… such a tragedy. After you get the medical records, I suggest you speak with a coroner or another medical professional about your concerns.

Chris
10:27 am January 24th, 2016

It is very misleading to say suboxone is most effective between 16-32 mg and tends to be a common misconception. Between 16-32 mg is a very very high dose. Even addicts who were doing 300+ mg’s of oxycodone a day for years can be stabilized around 4 mg of suboxone. Suboxone is very strong and has a ceiling effect so upto a certain point you are taking more than can even be effective. Which in my opinion is anything over 8 mg. Doctors today start patients on doses at 8 mg or higher and these individuals end up with an opioid dependence much worse than what they started with.

jennifer
12:22 am February 8th, 2016

I don’t understand the ceiling affect, does taking 8m take away all withdrawals or do you need to take more to feel better.

Brian
8:39 am February 8th, 2016

So how many milligrams of buprenorphine would a 150 pound, white male have to ingest at one time to overdose?

Lydia @ Addiction Blog
8:16 pm February 8th, 2016

Hi, Brian. We are here to help you with addiction issues, not to provide you with fatal dosages (which vary from person to person). Please, think again what you are planning to do…. remember that you are not alone!

5:55 pm February 9th, 2016

Hi Jennifer. The effects of Buprenorphine increase linearly with increasing doses of the drug until it reaches a plateau (which is called the ceiling effect). After this the effects of buprenorphine no longer continue to increase, even if you keep taking more.

Chris
3:04 pm February 27th, 2016

Hi, i feel very lucky to be alive! A “friend” gave me a suboxone and said it would help me to sleep. I assumed it was a sleeping pill. I swallowed it Thursday night to help with my insomnia. It was an 8 mg pill and I have no tolerance for opioids. After swallowing it I laid down to go to bed I never really fell asleep but I did get really tired n loopy and kinda confused. After an hour or two I threw up twice and then went to sleep. I woke up Friday morning at about 8am and felt OK until I stood up and was rushed with nausea and began vomiting. I probably threw up at least every 45 minutes until noon. I snorted some meth to try n feel better and it worked for about 3 minutes later when I was throwing up again. I’ve never felt so dehydrated! My mouth, tongue n throat were dry within a couple minutes of taking a sip of water. I tried another line of meth maybe two hours after the first one and I threw up again. All day long I’ve dealt with the dry tongue mouth n throat and severe nausea that comes and goes. Now it’s almost 5 am on Saturday and my heart has been hurting a little bit like a dull pain. I’m still dealing with the dry mouth but still taking sips of water often. It took me about 30 mins to write this because I keep falling asleep. I have been reading that 2mgs have been enough to kill some people from overdose and I have no tolerance and took 4 times that amount. Did I overdose? Can I still overdose? Or is it ok to fall asleep? I will fall asleep now.

Concerned wife
9:43 am March 2nd, 2016

My husband snorted a white suboxone half of one and a quarter of one and thinks overdosed. I think he is just really high but he has been throwing up but that wasnt until after he drank lemonade and ate potatoe soup. He has been throwing up every twice every 2 hours since like 11pm.

5:06 pm March 3rd, 2016

Hi, concerned wife. Take him into the hospital, just to be sure that he’s okay.

Dee
1:48 am March 4th, 2016

The first Chris : are you a doctor because if your not than you shouldn’t be passing judgement on a doctor who not only went to medical school but also went through ADDITIONAL training to work with Suboxon and Subutex . What degree do you have that lets you say that 2 mg is enough to handle withdraw from 300 mg of oxycontin ? Also , it doesn’t matter what mg your on of anything from Suboxon to Xanax. You can withdraw from very small doses of any medication you take . It doesn’t matter how much you take, it matters more about how long.

Dee
2:33 am March 4th, 2016

Chris #2. Yes Suboxon can make some people sick IF they have taken any ” pleasure ” drugs within the last 72 hrs. That is what was happening to you if you had taken meth any time before the Suboxon . It’s called precipitated withdraw, meaning that the Suboxon was trying to pull the meth off of the brains pleasure receptors. And you kept putting the meth in your system after the Suboxon and MAKEING YOURSELF SICK.It’¡]ⁿⁿ

ann
5:59 am March 7th, 2016

Been o 10mg patches for 4 years and take 20 mg sublingual temgesic for breakout pain as well as 5mg valium. How much more can I take as its not helping the pain. It hurts less to stand but I feel dizzy so have to lie down which makes it hurt more

abitexpedu
5:37 am March 18th, 2016

What’s really messed up is that the advice for overdose (if one can even happen) is to use nalaxone, which has a lower binding affinity to the receptors vs bupe, which means the narcan can not break the subs free from the receptors preventing narcan from reversing overdose. Still where’s the evidence of a bupe overdose death?

David
9:43 pm March 27th, 2016

I missed my Friday pick up due to good Friday holiday. I managed to get 3 8mg I have been snorting its Sunday i have 1 8mg left I was thinking of taking the tablet Monday will that be safe

Smortt
12:43 am March 30th, 2016

Thank you Dee!! Pcp took me off ambien and have’nt had any ambien, trazadone or sleep 😉 lol. Thank you for your answer and does anyone know about how many mgs a 130 pound male would overdose at? I’m also referring to specifically subutex tablets (buprenorphine only). I do not take any benzodiazipines, tranqulizers, or drink alcohol Just always want to make sure i’m never at a dangerous dose.thank you ahead of time for any answers did’nt see any might have missed it if anyone mentioned it then sorry.

robert
8:59 pm April 18th, 2016

I have a very low tolerance to opiates. I was wondering if 1mg of subutex can cause an overdose. I believe i just freak out because i feel messed up and i dont like feeling not normal. Makes my heart pound and hands sweat, and just makes me feel weird. Also im about 150 lbs

Lydia @ Addiction Blog
3:02 pm April 22nd, 2016

Hi Robert. Have you talked with your doctor about your concerns? You may consider speaking with a psychologist.

David
5:14 pm April 22nd, 2016

I have been on subbies for years I been diagnosed with ptsd and it has helped me so much. I think people who suffer from srress disorders should give it a try. I am even now playing guitar something i could never of done before. I have to see doctor’s and mental health nurse every few weeks to keep an eye on me because i had violent out burts which subutex has also cured me. Do not abuse this drug or you willpay the priice ssooner or later. I had terrible withdrawn but back on my normal dose.
I hope doctor’s try using this drug on ptsd sufferers because they work big-time.

ann
1:11 am April 23rd, 2016

Hi
I have been on the patches for 4.5 years for pain management.
I am suffering hair loss, gut problems, hot sweats, rashes from the patches, and a very dry mouth. Are these comomn?
Thanks

Rodney
5:42 am May 16th, 2016

My girlfriend missed two days of methadone treatment and took one 10mg tablet of methadone and tablet of naloxone, it was orange, round, imprinted AN 415. Then I guess read that she should’ve let it dissolve under her tongue and took another one. Is she in any danger. She says she’s feeling restless but fine but I’m scared

Mishele
9:49 am May 20th, 2016

I am very sure I have too much subutex in my system. I checked out that COWS test. It was not helpful. I have been on sub for 8 months now, we from 4mg to now 8mg. last week I have sooo tired. I want to sleep all the time. this is a different side effect for me. so my ? is, do I just stop taking the medication all together and wait untill I feel bad again? or do I keep it in my system, but only take like 2mg tomorrow/ Probably not yeah? it has a shelflife, and the 2mg will just build on what is already in my system, correct?

Dee
9:15 pm May 20th, 2016

Rodney, she should have just taken the methadone. The orange pill your talking about was probably Suboxon. It’s a mixture of bupenorphine and naloxone. And should b dissolved under the tongue. Suboxon is used to treat addiction to the opiates. Methadone is an opiate and is commonly used to replace another addiction. She should have taken one or the other not both. Naloxone counteracts the effects of opiates so she may not feel the effects of the methadone. Hope she doesn’t miss any more of her doses.

Shane
5:53 pm May 24th, 2016

My sister died about two months ago from an od on suboxone. She was presctibed a months supply of 8mg films twice daily, for a total of 56 films for a 28 day period. She had been on suboxone treatment for two years. They said that she had taken the entire prescription of 56, 8mg films, diluted them in water and drank it. I am so distraught over her suicide and still undure as to why she would do this to herself and to her family and especially her children. My question is, how could her od even be possible when suboxone has buprenorphine AND naloxone in it. From what ive read the naloxone counteracts the buprenorphine and prevents an od by knocking the bupe off the opiod receptors. Please help me better understand this. Also, they informed that nothing else was found in her toxicology report that could have contribited to her death other than the total of 448mgs of suboxone.

Lydia @ Addiction Blog
5:13 pm June 1st, 2016

Hi Shane. I’m really sorry for your loss… I suggest you speak with a coroner or another professional about your concerns. Wish you peace!

David
12:44 am June 10th, 2016

I am a hydrocodone addict. My doctor prescribed me suboxone 8mg/2mg and instructed me to take one film in the morning and one film in the evening. I have only been taking one film a day and have not taking any other medications. I feel light headed and drowsy but cannot sleep. I am experiencing urine retention but I experienced urine retention while on hydrocodone as well. All my lab work was good. Am I at risk of overdose by taking one film a day with no additional medication dispite my above symptoms. This is only me 2nd day on suboxone.

Lawka
5:47 pm June 27th, 2016

From 2013 to until now,I use 60 mg ( early morning 20mg=a bottle/ after lunch 20mg/ evening 20mg ) of buprenorphine injection. I don’t want to continue use it any more. however, if I don’t use it , I cannot work , I cannot sex with my girl until her orgesm.So I have to use it again again and again. Please give me a way to cutout it and the way to control loosing sex.

mac
10:24 pm August 9th, 2016

My hisband who had no previous opiate addictions became addicted to soboxone in prison. He was realeased on a friday morning, took an 8mg sub, 3grams of coke and some diazipam (unknown amount) on saturday n he didnt wake up on sunday. Myself im left with no drug addictions, no drink peoblems… 3 young kids who worshipped their daddy n not a friend in the desert coz no one will tell me where he got the drugs. Cheers for listening… Had a hard day needed to vent this somewhere

Clark
6:44 pm August 30th, 2016

my daughter has been using drugs for 10 years, she is now 24 and gets meds from a pill pusher doctor. She took seven subotox in 2 days. Last night I thought she had overdosed and was scared to death. She was freezing, barely conscious, speaking incoherently , her back was hurting, could hardly walk. I got her to bed, but was afraid to go to sleep. I am at my wits end!

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