Overdose questions you might be afraid to ask while on Suboxone®

Important: If someone can’t be woken up, is breathing slowly or not at all, or has discolored lips or nails, call 911 and give Narcan® (naloxone) if you have it. Stay with them until help arrives, even if they wake up. 

If someone may have taken too much of a non-opioid medication, such as an antidepressant, call Poison Control at 1-800-222-1222, or call 911 if they collapse, have a seizure, struggle to breathe, or can’t be woken up. If you’re thinking about harming yourself, call or text 988 any time.  If there is any question, call 911 and give Narcan (naloxone) while awaiting assistance.

Overdose and Narcan(naloxone) come up often with our patients and their families. We know these questions aren’t always easy to bring up, so we’ve answered some of the most common ones here in simple terms. Knowing what to do in advance is one of the best ways to keep yourself and the people around you safe.

 Narcan can reverse an opioid overdose, including in someone who takes Suboxone (buprenorphine-naloxone). More than one dose may be needed. Always call 911, even if the person wakes up, because Narcan (naloxone) can wear off before the opioids do. Suboxone (buprenorphine-naloxone) reduces the risk of overdose, but it doesn’t eliminate it. Keeping Narcan somewhere easy to find can help you and the people around you respond quickly in an emergency.

Can you overdose on Suboxone®, kratom or 7-OH, or an antidepressant?

These three questions come up often, and each has a different answer.

Can you overdose on Suboxone?

An overdose from Suboxone (buprenorphine-naloxone) alone is uncommon when taken as prescribed. Buprenorphine has a ceiling effect, meaning its effects on breathing level off at higher doses. This makes a dangerous overdose much less likely than with opioids like heroin or fentanyl.

The biggest concern is mixing Suboxone (buprenorphine-naloxone) with alcohol, benzodiazepines, or other medications that cause drowsiness, as these combinations can dangerously slow breathing. Overdose is also a concern if a child accidentally takes Suboxone (buprenorphine-naloxone) or someone who isn’t used to opioids takes it.

For more information on staying safe, read our guide, “Can you overdose on Suboxone?”

Can you overdose on kratom or 7-OH?

Yes. 7-OH is a very potent, concentrated form of a compound found in kratom, and federal health officials describe concentrated 7-OH products as dangerous opioids.

A CDC review of overdose deaths where kratom was detected found that most involved other substances as well, and fentanyl was the one found most often. If you or someone you live with uses kratom, our guide to kratom overdose risks lists the signs to watch for.

Can you overdose on an antidepressant?

Yes. Taking too much of an antidepressant, such as Zoloft® (sertraline), can be dangerous. If someone has taken too much and is having serious symptoms, call 911 immediately. These include seizures, trouble breathing, collapsing, or being unable to wake up. If the person is awake and not showing serious symptoms, call Poison Control at 1-800-222-1222 right away for guidance. Don’t wait for symptoms to appear. Narcan (naloxone) won’t reverse an antidepressant overdose because it only works on opioids.

 If you’re having thoughts of harming yourself, you can call or text 988 any time for support.

Does buprenorphine make an overdose more likely?

No. Buprenorphine lowers your risk of overdose, though some risk remains. 

In a Massachusetts study of more than 17,000 adults who survived an opioid overdose, people who received buprenorphine in the year afterward were less likely to pass away from an opioid overdose than people who received no medication treatment.

The National Institute on Drug Abuse reports the same pattern: people who get medication for opioid use disorder are less likely to overdose or pass away than people who aren’t in treatment.

A lower risk is still a real one. The risk of overdose increases when you combine Suboxone (buprenorphine-naloxone) with:

• Fentanyl or other opioids: Being on Suboxone (buprenorphine-naloxone) doesn’t make other opioids safe to use.
• Alcohol: It slows breathing on its own, and our guide to Suboxone and alcohol explains why the two don’t mix.
• Benzodiazepines and other sedating medications: These slow breathing too. Suboxone (buprenorphine-naloxone) prescribing information warns that combining them can cause serious breathing problems.

If you’ve used other substances while on Suboxone (buprenorphine-naloxone), tell your QuickMD doctor at your next visit; our guide on what happens if you take opioids while on Suboxone explains what to expect. It’s a safety conversation, and your doctor wants to have it.

What does an overdose feel like?

A person who is overdosing is often too drowsy to notice or understand what’s happening. That’s why the signs other people can see matter most, and why a person who is overdosing usually can’t act for themselves. Make sure the people you live with know where your Narcan (naloxone) is kept. 

These are the most common signs to look for:

• Being very sleepy and unable to stay awake
• Slow or shallow breathing
• Gurgling or snoring sounds
• Lips or nails that look discolored
• Very small (pinpoint) pupils

If you notice any of these, call 911 and give Narcan (naloxone) if you have it. Our guide to the signs of an opioid overdose covers the subtler signs to look for, too.

What should I do if I think I’m overdosing?

Get help right away, even if you aren’t sure.

1. Call 911 now: Don’t wait to see if it passes.
2. Tell someone near you, or make sure the door is open: If you pass out, this lets help reach you quickly.
3. Let someone else give the Narcan (naloxone): You probably won’t be able to give it to yourself during an overdose.
4. Plan ahead: Make sure the people you live with know where your Narcan (naloxone) is kept and how to use it.

What should I do if I think someone is overdosing?

If you aren’t sure, treat it as an overdose. These steps follow CDC guidance:

1. Give Narcan (naloxone) if you have it, and call 911. If someone else is there, one of you can call while the other gives it.
2. Try to keep them awake and breathing.
3. Lay them on their side so they don’t choke.
4. Stay with them until help arrives, even if they wake up.

Does Narcan still work if I take Suboxone?

Yes. Narcan (naloxone) is the medication that reverses an opioid overdose, and it still works for people on Suboxone (buprenorphine-naloxone). Our guide to what naloxone is and how it works covers the basics. When someone on Suboxone (buprenorphine-naloxone) overdoses, other opioids, alcohol, or sedatives are usually involved. 

Narcan (naloxone) can reverse the opioid part of an overdose, but it has no effect on alcohol or sedatives, which is another reason to call 911. In the moment, family members and friends should know these points:

• One dose may not be enough: Buprenorphine attaches tightly and lasts a long time, so higher or repeated doses of Narcan (naloxone) may be needed, according to the Suboxone label.
• Narcan (naloxone) can wear off first: It works for only 30 to 90 minutes, and the overdose can come back once it wears off. That’s why calling 911 matters even if the person wakes up.
• You can give more: If there’s no response, give another dose every 2 to 3 minutes, switching nostrils and using a new nasal spray each time, until help arrives.

If I call 911 for an overdose, will someone get in trouble?

Worrying about the police or getting in trouble is one of the main reasons people wait to call. Several states and Washington, D.C., have Good Samaritan laws that may protect both the caller and the person overdosing from some criminal penalties.

• The details depend on where you live: Each state decides which charges are covered and who qualifies. Some laws protect against arrest, while others only limit charges or prosecution.
• Look up your state’s law now: Searching your state’s name plus “Good Samaritan overdose law” usually brings up the law itself or a health department summary. Knowing ahead of time means you won’t have to wonder about it in the moment.

Whatever your state’s law says, calling 911 is the right choice, because waiting costs time a person may not have.

What changes if I use again or stop taking Suboxone?

After time away from opioids, including after stopping Suboxone (buprenorphine-naloxone), your tolerance drops, so an amount you used before can now cause an overdose.

• Tolerance can drop faster than people expect: Our article on why relapse raises overdose risk explains how this happens. 
• Research on it is limited: A widely cited study in London followed 137 people after inpatient detox. Three died of an overdose within four months, and all three had completed the program.
• Talk to your QuickMD doctor before you stop Suboxone (buprenorphine-naloxone): If you want to stop, your doctor can help you make a plan so you’re not facing that drop in tolerance unprepared.
• If you use again, reach out to your QuickMD doctor: Using again happens to many people in recovery, and your doctor wants to hear from you so they can adjust your care. Keep Narcan (naloxone) where the people around you can find it, too.

If someone you love has overdosed, or you worry they might

Many people start treatment after a family member or friend overdoses, and the fear that it could happen again can stay with everyone in the home for a long time. Keeping Narcan (naloxone) on hand is one practical step you can take to address that fear.

• Keep it where people can find it: If someone in your home takes opioids, keep Narcan (naloxone) nearby and make sure everyone who lives there knows where it is and how to use it.
• Ask for a prescription if you don’t have one: If you don’t have it yet, ask your QuickMD doctor how to get a Narcan (naloxone) prescription.
• Get it quickly: If you’re eligible, your prescription can go to your pharmacy the same day. Family members can usually also buy Narcan (naloxone) nasal spray over the counter at most pharmacies.  Narcan can sometimes be obtained at Fire stations, EMS stations, Police stations, or libraries at a very reduced price.