What can Happen if you Mix Heroin and Subutex?

What can happen if you mix heroin and Subutex? The answer to this isn’t that simple. There could be a number of different effects from mixing these two drugs, ranging from no effect at all to extreme sedation to death. To understand this better, you must first understand the differences between the narcotic in Subutex, called buprenorphine and heroin.

What is Buprenorphine?

Buprenorphine is a semi-syntheric opioid derived from thebaine, an alkaloid naturally present in the opium poppy. Heroin is the same in this regard in that it’s also semi-synthetic, prepared by acetylating morphine, but the two drugs have one key difference: Buprenorphine is a partial narcotic agonist, which means it can only partially activate the brain’s opioid receptors, the mu, the delta and the kappa receptors. This partial activity limits buprenorphine’s ability to cause euphoria substantially. Heroin is a full narcotic agonist, activating the brain’s opioid receptors totally.

There is another major difference, too. Buprenorphine has a much higher affinity for the opioid receptors, especially the mu, which is the one most associated with euphoria, sedation and overdose, than most other opioids, including heroin. Affinity means that the buprenorphine molecule has a higher preference for the opioid receptors. This means that if both buprenorphine and heroin are present in the brain at the same time, the buprenorphine will be able to push the heroin molecules off the receptor sites or prevent them from binding at all. Since only one molecule can occupy a receptor at the same time, the buprenorphine will tend to prevent any high that would otherwise be produced by the heroin.

Assuming equipotent doses are taken of the two drugs, the most likely outcome would be that the person will experience only the effects of the buprenorphine. This is also called a blockade effect, and it’s one of the main reasons why buprenorphine is used for medication-assisted treatment or MAT for maintenance of former opioid abusers. The buprenorphine will block any other opioid effect for as long as several days. This is because buprenorphine is very long-acting, while heroin is not. It takes the body about 36 hours just to eliminate one-half of a buprenorphine dose. In contrast, heroin’s half-life is measured in minutes. After that, it’s converted back to morphine in the body.

Subutex and Suboxone: What’s the Difference?

Subutex is never used for MAT because it’s a single-drug product containing only buprenorphine. It could be crushed, mixed with water and injected intravenously, greatly increasing its power to cause euphoria. This is why only Suboxone is used for MAT. It contains buprenorphine, too, but it also contains naloxone, an opioid overdose antidote drug. The naloxone prevents abuse of the buprenorphine. Subutex is available for people who take buprenorphine for pain, not for opioid abuse maintenance.

The Opioid Blockade

Since buprenorphine has such a powerful affinity for the opioid receptors, and it’s so long-acting, it would likely prevent any high from heroin. Addicts know this, and unless they’re serious about recovery and using Suboxone for MAT, avoid buprenorphine in all its forms like the plague. Buprenorphine has little appeal for an opiophile, anyway, because it’s really not much fun and creates little to no euphoria for a regular opioid abuser with a high opioid tolerance. Anyone who takes buprenorphine, perhaps for relief of withdrawal symptoms and then later ingests heroin will this out the hard way.

Not only does the buprenorphine prevent any high, wasting the heroin and making the abuser very mad, but the effect will persist for at least 24 hours and can last much longer, up to several days. As long as the buprenorphine is occupying the brain’s opioid receptors, nothing else can. That is, except for naloxone. Naloxone has an even higher affinity for the opioid receptors than buprenorphine does. It will kick the buprenorphine off the receptors, reversing any effect almost instantly. If the individual is opioid-dependent, this will cause an immediate, full-blown, untreatable and most unpleasant opioid withdrawal reaction. If the person isn’t physically dependent on opioids, there won’t be any withdrawal reaction. The withdrawal reaction happens because the addicted person’s brain has become dependent on opioids to function.

Mixing Opioids

The buprenorphine molecules will eventually drop off the receptors on their own. It takes awhile, but it will happen. However, some people don’t want to wait and try to overcome the blockade with very high doses of heroin or some other powerful opioid. This is very, very dangerous. It could force a shutdown of the breathing reflex in the brain, causing the person to stop breathing and die.

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