“Oh my god, I feel normal”: This is Your Brain on Suboxone

If you’ve been struggling with opioid addiction or have a family member mired in addiction, chances are you’ve heard of Suboxone.

Maybe you’ve heard it’s a “miracle drug,” allowing folks with OUD (opioid use disorder) to kick heroin or pills for good, without suffering the unbearable withdrawal that drives addiction.

Or maybe you’ve heard Suboxone just shackles opioid users to yet another drug.

Is either true?

For anyone whose life has been devastated by opioid addiction, Suboxone is surely closer to a miracle — even if, like most patients, you need to take it for years, perhaps forever.

“Suboxone is quite impressive: A person who’s writhing and puking and sweating and looking like hell stops feeling sick literally within minutes,” says Shawna Laursen, M.D., a veteran emergency-room physician and medical director at Ideal Option.

A day later, when patients return for their second dose, they tell Laursen, “Oh my god, I feel normal.”

It’s this “normal” feeling — freedom from diarrhea and vomiting, from cravings and the relentless compulsion to seek opioids — that makes recovery possible.

“You just don’t have the anxiety and cravings that make you spend your rent money and destroy your life and relationships,” says Greg, an Ideal Option patient now many months sober after a lifetime of drug abuse.

Greg adds: “Suboxone allows me to think about my day and my life and to stay in the present. You don’t get high at all. You just get to think.”

Suboxone combines two drugs: buprenorphine and naloxone (commonly known as Narcan). Buprenorphine, the dominant component, suppresses withdrawal and cravings, while naloxone stops patients from abusing the medication.

Here’s a closer look at the unique way Suboxone works on the brain, offering relief from addiction and the promise of a fresh start.

How Suboxone Works

Nerve cells in the brain are outfitted with opioid receptors — think of them as microscopic docking stations. These receptors draw in the body’s natural opioids, such as the endorphins released during exercise or sex, as well as manufactured opioids, such as heroin, oxycodone, and hydrocodone.

When opioids bind to these receptors, this triggers a surge of dopamine, a chemical involved in the brain’s pleasure and reward system.

Problem is, when you shoot heroin or pop Oxy, the surge becomes a flood.

And when your brain is flooded with dopamine day after day, year after year, circuits go awry. The brain demands more and more opioids, developing extra opioid receptors to accommodate the daily deluge.

If, one day, you don’t do that shot of heroin?

“You have a bunch of receptors that are wide open and screaming,” Dr. Laursen explains. “That’s what withdrawal is.”

But buprenorphine changes all that.

Though buprenorphine is classified as an opioid, it’s a weak one. Buprenorphine molecules fill those screaming opioid receptors but without triggering a high.

“Some people feel a very slight pleasurable sensation, but most report that they just feel normal or more energized,” says Dr. Laursen.

Just as important: taking more buprenorphine does not produce more pleasure. And when you’re on buprenorphine, taking a stronger opioid like heroin doesn’t bring euphoria, either.

“Nothing really happens because the receptors are already full,” Dr. Laursen explains.

A dose lasts 24 hours, so when you take buprenorphine daily, as instructed, your opioid receptors are continually filled and you avoid withdrawal symptoms and cravings.

The second component of Suboxone, naloxone (Narcan), serves just one function: to deter people from injecting or selling the medication.

You probably know Narcan as the drug injected by emergency responders to reverse opioid overdoses and save lives. Taken this way, Narcan instantly boots opioids off the receptors, restoring breathing while sending the person who overdosed into severe withdrawal.

When a low Narcan dose is combined with buprenorphine to form Suboxone — a film that slowly melts under the tongue — very little is absorbed into the bloodstream, so the Narcan won’t trigger withdrawal.

“But if you melt Suboxone in a spoon and inject it into the veins,” Dr. Laursen says, “ the Narcan can cause immediate and dangerous withdrawal symptoms” — an unappealing side effect for anyone looking to get high.

Want to Avoid Relapse? Stick with Suboxone

At Ideal Option, the most common question new patients ask is: How soon can I get off Suboxone?

The honest answer: not soon.

“Most people will be on it for many years or they are going to relapse,” says Jeff Allgaier, M.D., Ideal Option’s chief medical officer and co-founder. “That’s the reality.”

If you were addicted to pills for three years, you can probably taper off Suboxone in three years. But if you’ve been using opioids for decades, you’ll likely need it for the rest of your life.

This does not mean you are addicted to opioids and have traded one drug for another.

“It just means you’re dependent on a medication the way a diabetic is dependent on insulin,” says Dr. Laursen.  

Patients can safely reduce their Suboxone dose within a few months and then settle on a low maintenance level. This is because the brain gradually sheds the extra receptors it had developed in response to the daily dopamine flood.

“The brain says, ‘I don’t need all these receptors and reabsorbs them,” Dr. Laursen explains. “So, you don’t need the dose you were taking before. You won’t notice the difference between taking 8 mg and 6 mg.”

But if you quit Suboxone before your brain has shed all the extra receptors and has otherwise been restored, you’re almost certain to relapse.

“OUD is a chronic disease of brain chemistry, and you haven’t fixed the baseline disease,” Dr. Laursen says. “You’ve just treated the symptoms.”

With OUD, your brain has been rewired in a way that not only warps your judgment and self-control but also leaves you to prone to relapse at the slightest reminder of opioids.

“Seeing a needle or the house where your dealer lives, even smelling something you’d previously associated with using – all these can trigger cravings and relapse,” Dr. Laursen explains. “It becomes impossible to say no.”

Unless you’re taking Suboxone, that is. With your opioid receptors continually filled, you’re far better equipped to walk away at the sight of a needle or the memory of using.

What if you can’t walk away?

Suboxone will rescue you in that regard, too.

The medication blocks most other opioids — heroin, Vicodin, oxycodone — from locking into the receptors, so you won’t get high. Rather than sink back into addiction, you’ve bought yourself time to evaluate your actions.

What you choose to do with this time — whether you keep working to rebuild your life, with counseling or another type of support — will determine your long-term success.

“You may get to a level where your brain is happy but your life is still falling apart,” says Dr. Laursen. “Maybe you still don’t have a job and have all these bills and have to spend three months in jail. Maybe you don’t have the stable interpersonal connections that keep you from relapsing. That’s why you need to stay on a low dose of Suboxone.”

Dr. Allgaier urges people with OUD not to fixate on tapering off the medication.

“If you have to take a pill to feel normal for the rest of your life, versus using all sorts of drugs and committing crimes,” he says, “that’s what you do.”