How does Suboxone work in the brain?

Dr. Jeffry Junig explains here how buprenorphine (the main psychoactive ingredient in Suboxone) works in the brain.

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How Suboxone works in the brain

In the brain, buprenorphine molecules (the main ingredient in Suboxone) attaches to opioid receptors, which are molecules embedded in the surface of the receiving parts of certain brain cells (the molecules that bind to receptors are called ‘ligands’). Opioid receptors carry out certain actions when activated by any opiate or opioid, whether it is buprenorphine, pain pills, or heroin. But buprenorphine is unique from other opioids in that there is a ceiling to the drugs’ actions.

Once the blood level of buprenorphine is above a certain point, further increases in buprenorphine cause no greater effect on opioid pathways. The effect allows the blood level of buprenorphine to vary from dosing and metabolism of the drug, without causing a change in the activity of opioid pathways.

Finally, opioid pathways fire more rapidly during Suboxone use after receptors are activated. The pathways then activate a number of areas in the brain and spinal cord, with effects on pain sensation, mood, and a wide range of bodily functions.

About the author
Dr. Jeffrey Junig, MD, PhD is a psychiatrist practicing in northeast Wisconsin, in recovery from opioid dependence. He is Board Certified in both Psychiatry and Anesthesiology and holds a PhD in Neuroscience. He writes about buprenorphine at Suboxone Talk Zone, and manages a forum for patients taking buprenorphine called SuboxForum.


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  1. I can tell you all that I was on a 4gram a day heroine addiction when I fotnclean using suboxone through a addiction specialist MD. If you use it as prescribed, follow the instructions of a competent medical professional, and after a year or more (more in my Case considering how deeply addicted I was) then tapering down as suggested, 1-2mg less every 3-4 weeks, It does work! It’s literally a life saver, I would be dead today if I hadn’t found a Doctor who understands that Suboxone should be used as part of a long term treatment plan. I’m not 4 years later down to 2mg a day, orginally starting at 16 mg a day because of how much heroine I was using when I initially tried to get clean.
    I went through a rehab which cost $20,000, and the doctors at this rehab placed me on suboxone then took me off two weeks later, that’s not how the drug is meant to be used, so of course as soon as I got out I went right back to using. The key is LONG TERM, it’s why most rehabs don’t work, it takes long term treatment and dedication to staying clean from the patient.

    It’s been 4 years since I’ve stopped using heroine, the first two years I would think about, and even dream about using. At this point I have no interest whatsoever to ever use again. I’ve mentally made it to the other side, now I just need to finish tapering. And knowing what a struggle it is to get clean I would never ever dream of touching opiates ever again.

    Additionally there’s been a bottle of Vicodin from my husbands surgery in the house, for about a year now, although I asked him to hid it I found it while cleaning. But at this point in my recovery I simply have no desire to back slide, although there is always that small temptation in the back of my mind, I know what that would cost me, and how slippery of a slope it could be. I happier now that I’m clean. I never want to experience the feeling of being “dope sick” ever ever again. As great as opiate might make you feel, there NOTHING worse than being dope sick, and not only does that but the mentality of being an addict, the lying, stealing, hurting the ones you love, absolutely no high in the world is worth all that you lose by being an addict. I would be dead today without the help of a competent MD who specializes in Opiate addiction, and suboxone, in my believe a miracle drug. My Dr along with Suboxone and my will to get well saved me. I would never go back. And I’m so grateful everyday that I’m clean.

  2. Also Erica, as long as your being drug tested according to state regulations, then you should be able to get a months supply at a time. I’m not sure if the laws are different in Canada, but in the US if your providing clear UA (urinary analysis) you can be provided with as many as 2-3 months supply, it sounds like you have a bad Dr. as I described before as to the medical recommendation for coming off Suboxone, tapering down by 1-2 mg every 3-4 weeks, if you save the small amounts you aren’t taking you’ll have extra meds on supply should your doctor be neglecting, or mess up your subscription. Since you can only be either supplied 8-2mg or 2mg strips or tablets I would assume you must be in the 8-2mg category, which mean you simply need to cut off a small piece of the tablet, cutting more every 3-4 weeks. Simply think of it as an 8mg dose, then cut the pill. Slowly tapering is the only real way to get off suboxone. And can be done by you, regardless of what your doctor says, although a good MD would sugggest the same. If your doctor refuses to slow you to taper off, which I have trouble believing, then you can do it yourself. However if your addmitidly turning to heroine when you run out of suboxone, then you probably need to stay on suboxone, perhaps look for another doctor. But you shouldn’t try to quit suboxone while your still in a mental state where you’ll easily turn to heroine when you don’t feel good. Your a mom, maybe it’s time to think about your child, and not your own self interest. You stated that you can’t rake care of your child while throwing up because your detoxing, well heroine is most definitely not the answer, what happens if you get too high and over dose, or worse leave anything in hands reach and your child puts some tar or powder in their mouth and dies??? Suboxone doesn’t get you high, and your probably in a mind set while in it that you can keep your beds away from your child, when your getting high you could fall asleep and wake up to a dead child. What’s more important, the feeling you get from the drugs or your child?

  3. @Erica if you have the will to do so you can get off suboxone. You simply taper down. The last 2mg is the hardest. If your complaining that Dr’s won’t help you get off suboxone than that malpractice, but also your fault… you simply have to taper down, my recommendation would be 2mg every 3 weeks or so, take a longer taper if you need to. But it’s not the doctors fault. A slow taper won’t be painful, and doesn’t require the doctors help, you simply take less then prescribed. Take a little less every 3-4 weeks as time goes on. Like I said the last 2mg will be the hardest, but turning to Heroine is t the answer for you or you children. Take some accountability for your self. I’ve just explained how you can get off suboxone. Don’t believe me ask your MD.

  4. I’ve taken Suboxone for years through an addiction specialist MD. I was originally addicted to pain meds after a serious injury, after a year or so it progressed to using heroine. Suboxone was a life saver for me. With the correct medical assistance and a Dr. who understands that it isn’t meant to be used for a month and then cuts you off and send you into the world without developing the proper coping skills to deal with addiction it can be the best way I’ve come across to “get well”.

  5. Anyone from Canada here ?, I left everything in mtl when I was pregnant to come to Ottawa to get clean. Although then got turned away by 3 or 4 Dr’s over the month whow would sag I was “too high risk for them” . If you are pregnant and addicted to herion or down if you stop and you withdrawal you will have a miscarriage. Then the system throws you away and everyone who doesn’t understand thinks your doing the wrong thing while your trying to do right. I’ve been on suboxon ever since a month after when I found the right office.3/4 years. my kid is tworking now, and I find it so hard. My biggest flaw as a mother is depending on this. And not being able to function when the Dr’s get lazy. I don’t know how many times they have messed up my scripts. Once they were gone over a week . You are forced to try and find something when you can take care of your kid puking. I try to get morphine but sometimes there’s only herion. But so many people are dying. I lost two in one day. With babies or kids they ween you off morphine. We used to have a service for adults but mayor Jim Watson took it away n fights against harm reduction and now we’re in a crisis and nothings being brought. I’ve asked for years to start getting off this stuff. I wasn’t allowed to go to family funerals cause I wasn’t allowed enough med to go. I’m doing everything right and still get treated like I’m at the start of my journey. We need a way to get off this. Has anyone we end off with stuff? Plz share. Dr’s won’t help me.

  6. If you’re considering long term use of suboxone just know that there are no withdrawals on this earth that can compare to this drug imo. Opiate wds last a week AT MOST. Sub wds you don’t peak in utterly intolerable discomfort until 2 weeks in. It is a miracle drug but as serious as I can be if you are wanting to get off of opiates then do not use this for more than a week at a time tops and even then start off w your highest dose and gradually work down and just deal with the mental aspects of stopping opiates, do not blindly create or replace it with another uncomparable dependency, no matter how convenient and easy it sounds at the moment. Subs are by far one of the hardest things to break from physical dependency.

    1. Hi, Arashad. I’d suggest you contact our trusted treatment provider to learn more about your treatment options. The number is displayed on the site. Good luck!

    1. Hello Shelly. There is no general timeline, but suboxone maintenance treatment for opioid addiction can last for at least a year, up to two-three years. When a person develops coping skills, new positive behaviors and builds a new lifestyle, doses can start to be gradually reduced. This gradual tapering, eventually ends with a complete cessation of suboxone treatment.

  7. I just started using suboxone on Tuesday night I have not sleep in 4 nights I no that this is a side effect but I am getting scared I am over medicated by my dr

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