Taking Buprenorphine (suboxone and other brands) is a successful treatment option for many people with opioid use disorder. This discussion focuses on medical (non- psychological/neurological) aspects.
Kidney and liver disease is relevant to many medications as these organs are involved in drug elimination. Fortunately, with buprenorphine there is a good margin of safety with either organ dysfunction. Note: buprenorphine does not cause any problems with kidneys; the story with the liver is more debatable. There have been occasional reports of abnormal liver labs with patients on buprenorphine. Many of these patients have hepatitis C (or other liver disease) so the role of buprenorphine is unclear. As a precaution, many doctors advise occasional testing of liver labs.
Buprenorphine appears safe for the heart. As for the lungs, the main concern is respiratory depression. All opioids can depress breathing – this is, in fact, the cause for opioid overdose death. Buprenorphine is safer than the typical opioid because it has a “ceiling effect”- which means that as dose of the drug increases, the depression effect on breathing reaches a plateau. Of course, this safety feature is not absolute. It’s worth stating, in particular, using sedatives (e.g. xanax, lorazepam) and/or alcohol can interact with buprenorphine to endanger breathing. Also, if a patient has advanced COPD (emphysema) or severe asthma the risk to breathing is substantially increased. Finally, sleep apnea needs separate mentioning – untreated, this illness jeopardizes breathing especially when supine, and also causes daytime drowsiness.
The gastrointestinal symptoms most common with opioids, including buprenorphine, are nausea and constipation. These problems are usually manageable with simple measures. However, if there is pre-existing GI illness, a discussion needs to occur with the prescribing doctor. Bladder function can also be slowed with opioids but this is usually not an issue for the great majority of patients. If there is significant prostate disease or an atonic (lazy) bladder, then urine retention might occur.
Lastly, long term opioids can have effects on hormones. This is a complicated subject – beyond scope of a short article such as this. Suffice it to say, the most common manifestation is low testosterone. However, there is some evidence that buprenorphine, unlike some opioids such as methadone, maintains testosterone.
In short, buprenorphine has risks and side effects, but as mentioned above, it has some advantages as an opioid. Nevertheless , entering a buprenorphine regimen should be done only after a careful consideration of the risks and benefits. Specifically, one must also weigh the risks of buprenorphine against the risks of untreated opioid use disorder. With opioid addiction, there is an increased probability of accidental death, heart valve infection (endocarditis), hepatitis, sexually transmitted disease including HIV, abscess formation and other diseases. Also, the opioid use disorder typically causes chaos in family and social relations and interferes with regular employment. Finally, the disorder can result in criminal actions risking arrest and incarceration.