Are there anxiety meds that can be taken with Suboxone?

Suboxone is a popular medication used in the treatment of opioid addiction. Often used during medication-assisted treatment (MAT) as an FDA-approved drug, Suboxone helps manage drug cravings and reduces withdrawal symptoms. A common symptom of opioid use is anxiety. Even when taking opioids as prescribed, anxiety can occur. The severity of anxiety depends on factors such as the type of opioid taken, the number of opioids taken and the length of time opioids have been taken.

Research has found over 60% of people with opioid use disorder (OUD) also have anxiety-related mental health conditions. With such a significant amount of people in treatment for OUD also suffering from anxiety, are there anxiety meds that can be taken with Suboxone?

A white bottle of Buprenorphine and Naloxone with orange pills laid out questions if anxiety meds can be taken with Suboxone.

Opioid Use Disorder

Opioids are powerful prescription painkillers that if misused, could become highly addictive. Opioids produce a euphoric, “feel good” sensation in the brain. Oftentimes, OUD develops from dependence on a prescription drug written by a trusted medical provider. Commonly known addictive opioids include codeine, fentanyl, hydrocodone and oxycodone.

In OUD treatment, withdrawing from opioids can cause symptoms such as sleeplessness, muscle aches, diarrhea, vomiting anxiety. Short-acting opioids such as tramadol, tend to cause the most severe forms of anxiety during the detox and withdrawal process. In some cases, withdrawal anxiety can last anywhere from 5 to 14 days after initial opioid treatment has ended. As an effective form of medication management to help patients feel more comfortable during the detox phase of treatment, FDA-approved medications such as Suboxone have proven highly effective in decreasing opioid cravings.

What is Suboxone?

Suboxone is a brand of medication that is a mixture of the popular ingredients naloxone and buprenorphine. It is often prescribed as MAT for OUD because it is similar to opioids in that it activates the opioid receptors without causing the desired euphoric effects.

Buprenorphine acts as a partial opioid agonist and helps lower the effects normally experienced with opioid use. The active ingredient naloxone produces uncomfortable withdrawal symptoms if medication is misused. Together both active components trick the brain and remove the positive associations experienced with opioids. According to the National Institute on Drug Abuse (NIDA), Suboxone has been clinically proven to significantly minimize opioids use and cravings in OUD patients.

What is anxiety?

Anxiety is one of the most common mental health disorders that can affect people experiencing withdrawal symptoms from alcohol, opioids and other types of mind-altering substances. Anxiety is characterized by feelings of fear, dread, and uneasiness. Those who suffer from anxiety experience intrusive thoughts or concerns that can cause them to unreasonably worry about factors that are out of their control. Severe forms of anxiety can affect a person’s ability to perform basic functions and participate in daily life activities.  

Symptoms of anxiety:

  • Dizziness
  • Weakness or lethargy
  • Sweating
  • Difficulty concentrating
  • Difficulty sleeping
  • Rapid breathing
  • Increased heart rate

There are a variety of methods used to treat anxiety. Cognitive behavioral therapy (CBT) is an effective form of treatment. This type of psychotherapy can help patients identify the root causes of their mental health disorder and learn effective coping techniques to help manage distressing feelings.

Another popular treatment for anxiety is prescription medications. The most common being benzodiazepines (benzos). Benzos are a class of sedative medications that are central nervous system depressants. Common brand names include Valium, Xanax, Ativan and Klonopin.

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Can anxiety medication be taken with Suboxone?

For those who are experiencing symptoms of anxiety during opioid withdrawal treatment, the usage of benzos in combination with Suboxone could have serious complications. It is considered a risky combination of medications if not properly and carefully managed by a medical professional. Almost one-third of patients on Suboxone are also prescribed benzos.

In 2016, the FDA started requiring pharmaceutical brands to provide more warning labels for the combination usage of opioid medications and benzos. According to a 2019 study, 17% of opioid overdose deaths also included the usage of benzos. There is a high increase in the risk of overdose death from using anxiety meds with Suboxone. Studies have shown a person is three times more likely to overdose and die with this pairing of drugs.

Opioids and benzos both produce similar effects on the body. They both produce sedative effects. Mixing anxiety medications such as benzos with Suboxone can increase sedative respiratory depression. This slows down and suppresses breathing and can lead to hypoxia, which is when the brain gets deprived of oxygen.

Benzo and Suboxone interactions:

  • Suboxone and Ativan – Ativan is an anti-anxiety medication also known by its generic name lorazepam. In combination with Suboxone, there is a risk for extreme sedation, risk of respiratory depression, coma and even death. Other anti-anxiety medications such as Xanax and Klonopin, produce similar reactions.
  • Suboxone and Ambien – Ambien is commonly used to treat people with insomnia as a result of severe anxiety. Because both of these substances are central nervous system depressants, there is an increased risk of respiratory distress.

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We specialize in treating addiction and other co-occurring disorders, such as PTSD. Our Admissions specialists are available to walk you through the best options for treating your addiction.

Are there alternative methods for treating anxiety for those in OUD treatment?

Because of the high risk of overdose death combining Suboxone with anti-anxiety medications and other benzos, health advocates are calling for safer alternative treatment methods. They say other options should be explored in order to reduce the risk of fatal treatment. Some have suggested switching to selective serotonin reuptake inhibitor (SSRI) medications to treat anxiety for patients in OUD treatment. Unlike benzos, SSRI medications do not provide immediate pain relief. It works at a slower pace to gradually help ease symptoms of anxiety.

People suffering from opioid addiction can find help with a trusted drug and alcohol treatment program such as Hotel California by the Sea. The prescription drug addiction treatment centers are equipped with knowledgeable clinicians implementing highly effective treatment methods. The combination of medication-assisted treatments and rigorous addiction therapies provides a well-rounded treatment plan. For clients experiencing anxiety during their opioid addiction treatment, inpatient detox and residential programs offer a full spectrum of treatment options. Treatment for OUD can be very dangerous and it is important to be under the guidance and care of an experienced prescription drug addiction treatment program such as Hotel California by the Sea.


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