Mixing Buprenorphine (Suboxone) and Methadone
Unsafe
Buprenorphine can throw anyone with methadone on board into withdrawal. Switching between them needs a prescriber and a taper.
Buprenorphine displaces methadone from the receptor and replaces it with less activity, so this precipitates withdrawal in anyone with a meaningful methadone level. Switching between the two is a clinical procedure with a taper, not something to improvise.
The risk here is to the body — breathing, heart, temperature or organs. Set limits before you start, because this kind of harm does not announce itself in time to react.
Headspace vs physical riskWhat to do
- Say what was taken and how much.Responders need it, and in most US states Good Samaritan laws protect both of you from drug possession charges when you call for an overdose.
- Unresponsive: put them on their side, tilt the head back, and stay until help arrives.Never leave someone alone to “sleep it off”.
- Give naloxone (Narcan) if you have it.It is sold over the counter in every US state and does no harm if opioids turn out not to be involved.
- Never Use Alone 1-800-484-3731Stays on the line and sends help if you stop responding.
- Full steps: what to do if it is already happeningOverdose signs, the recovery position, what to say on the call, and whether you can be charged for making it.
- Poison Control 1-800-222-1222Free and 24/7, for “is this bad?” before it becomes an emergency.
Can you mix Buprenorphine (Suboxone) and Methadone?
MixSafe rates mixing Buprenorphine and Methadone as "Unsafe" — risk of serious physical or psychological harm. Not recommended under any circumstances. Source: MixSafe research. Educational information, not medical advice.
- Buprenorphine
- Partial agonist — displaces other opioids off the receptor
- Methadone
- Long-acting — outlasts its own effects by many hours
- Buprenorphine also called
- subutex, suboxone, bupe, bup, buprenorphine/naloxone, zubsolv
- Methadone also called
- dolophine, methadose, done
- Buprenorphine precipitated opioid withdrawal: Prevention and management in the ED setting. https://www.sciencedirect.com/science/article/abs/pii/S0735675722003126
- Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl. https://pmc.ncbi.nlm.nih.gov/articles/PMC11437388/
- Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl. SAEM. https://www.saem.org/education/substance-use/practice-based-guidelines-buprenorphine-in-the-age-of-fentanyl
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Checking more than two?
Combinations of three or more carry risks that no pair-by-pair chart can show. The checker rates every pair at once and flags the whole-mix ones on top.
Open this in the checkerRelated combinations
All combinations →Rated unsafe. Educational information only, not medical advice. Absence of a documented interaction is not evidence of safety.