Suboxone and Alcohol: Can You Drink While Taking Suboxone?

It is one of the first questions people ask me, usually with some embarrassment. There is a wedding coming up. A football game. A work dinner. Can I have a beer?

I would rather you ask me than guess. So here is the honest answer.

The short answer

The FDA says no. SAMHSA says no. I say no, and I explain why below.

The Suboxone Medication Guide, the paper that comes with every prescription, says it plainly: you should not drink alcohol or take prescription or over-the-counter medicines that contain alcohol while taking Suboxone, because this can lead to loss of consciousness or even death.

SAMHSA, the federal agency that oversees addiction treatment, gives the same advice to anyone on buprenorphine: do not use illegal drugs, drink alcohol, or take sedatives, tranquilizers, or other drugs that slow breathing.

That is not a moral position. It is a breathing problem.

Why alcohol and Suboxone are a dangerous mix

Suboxone is buprenorphine plus naloxone. Buprenorphine is an opioid. It is a partial opioid, which is a big part of why it is safer than heroin, fentanyl or methadone. It has what we call a ceiling effect on breathing. Past a certain dose, taking more does not slow your breathing much further.

Alcohol takes that safety margin away.

Opioids and alcohol both slow down the part of the brainstem that tells you to breathe. They do it through different switches. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) explains that opioids act on mu-opioid receptors while alcohol acts on GABA-A and NMDA receptors. Hit both systems at once and the effects stack. NIAAA warns that alcohol, opioids and benzodiazepines in combination may have synergistic, rather than simply additive, effects on the brain circuits that keep you alive.

For buprenorphine specifically, NIAAA says the combination with alcohol can lead to low blood pressure, respiratory depression, profound sedation and coma. It also notes that post-mortem studies suggest alcohol lowers the amount of buprenorphine it takes to cause a fatal accidental overdose.

Toxicology researchers have looked at this closely. A 2017 study in Toxicological Sciences reviewed deaths blamed on the alcohol and buprenorphine combination and found that neither alcohol nor buprenorphine alone could explain the death. The two together did. Buprenorphine levels in those deaths were usually in the normal treatment range. In other words, these were not people taking huge doses. They were people taking their medicine and drinking.

The FDA label makes the same point. Many of the reports of coma and death on buprenorphine involved injecting it, or combining it with benzodiazepines or other depressants, including alcohol.

How big is the alcohol problem in overdose deaths?

Alcohol shows up in overdose deaths more often than most people think.

• NIAAA estimates that alcohol played a role in at least 8.4% of emergency department visits and about 16% of deaths from opioid overdose in 2022.
• NIAAA also reports that alcohol plays a role in about 1 in 5 overdose deaths involving prescription opioids (22.1%) and benzodiazepines (21.4%).
• A CDC report found that alcohol was involved in 18.5% of emergency visits for prescription opioid misuse and 27.2% of visits for benzodiazepine misuse.

NIAAA says the risk begins at low doses of both substances. You do not have to be falling-down drunk for this to matter.

What about just one drink?

I get this question more than any other version.

I cannot tell you one drink is safe, because the FDA label does not set a safe amount, and neither does any federal agency. Everybody's tolerance, body weight, dose and timing are different. The risk is highest when someone is new to Suboxone, has just had a dose change, is also taking a sedative or sleeping pill, or drinks more than they planned. And most people who plan on one drink are not the problem. It is the second and third.

There is a second reason I care about this. Drinking is the most common way I see recovery start to slide. Alcohol lowers judgment. Lowered judgment is how someone who has been stable for six months ends up buying a pill at a party that turns out to contain fentanyl. I wrote about how the street supply has changed in the post on cychlorphine in Arkansas.

Hidden alcohol and other things that act like it

The Medication Guide specifically mentions medicines that contain alcohol. Check the label on any liquid medicine before you take it, or ask the pharmacist.

The FDA also lists other drugs that carry the same danger as alcohol when combined with buprenorphine. That list includes benzodiazepines like Xanax, Klonopin and Valium, sleep medicines, muscle relaxants, some antipsychotics, gabapentin and pregabalin, and other opioids. If another doctor prescribes any of these, tell them you are on Suboxone, and tell me.

If you drink a lot, tell me anyway

Some people who come to me for opioid treatment also have a drinking problem. That does not disqualify you from treatment.

NIAAA's guidance to doctors is to weigh the risks and benefits of buprenorphine for a patient who drinks heavily, while keeping in mind the risks of untreated opioid use disorder. Untreated opioid addiction, with today's fentanyl supply, is extremely dangerous. Walking away from treatment because you are also drinking is usually the worst option.

What I need is the truth. If I know you are drinking, we can plan around it: dosing, safety, naloxone at home, and treatment for the alcohol problem too. If I do not know, I cannot help with it.

I am not going to lecture you. I spent years hiding my own addiction as a surgeon. Hiding it did not help me, and it will not help you.

What to do if someone has been drinking on Suboxone

Watch for these signs:

• Very sleepy, hard to wake up, or will not respond
• Slow, shallow or noisy breathing, or snoring that sounds wrong
• Blue or gray lips or fingertips
• Confusion, slurred speech, or passing out

If you see any of those:

1. Call 911.
2. Give naloxone (Narcan) if you have it. It is sold over the counter.
3. Keep the person on their side so they do not choke.
4. Stay with them until help arrives.

Keep two doses of naloxone in the house in case the first is not enough.

If you just had a drink or two and feel fine but are worried, call me. Do not take an extra dose of Suboxone to compensate, and do not take anything to help you sleep.

Planning around events

Here is what I tell patients who have a wedding, reunion or holiday coming up:

1. Decide before you go that you will not drink. It is far easier than deciding at the bar.
2. Have a drink in your hand anyway. Sparkling water with lime ends most questions.
3. Drive yourself so you have a reason not to drink and a way to leave.
4. Bring someone who knows you are in treatment.
5. Call me before or after if you need to. My phone is on.

If you are early in treatment, it helps to know what the first months look like. I cover that in what to expect at your first appointment and how long Suboxone treatment takes.

How I can help

I am a former orthopedic surgeon. I lost that career to addiction, and I recovered. I treat adults with opioid use disorder at 102 E Sunbridge Dr, Suite 3, in Fayetteville.

I answer my own phone 24 hours a day, every day of the year, at 479-856-1505. I will come in at any hour if you need to be seen.

A scheduled visit is $200. An unscheduled after-hours visit is $300. Follow-ups are about every 28 days. I do not bill insurance, but insurance can still be used at the pharmacy for the medication and for lab work.

Your records are protected under HIPAA and 42 CFR Part 2, the federal rule that gives addiction treatment records extra privacy.

Ask me the awkward questions. That is what I am here for.

More reading: What the first visit looks like · What treatment costs · Frequently asked questions