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Suboxone and Stimulants (Adderall or Meth): How Dangerous?

Buprenorphine is a partial opioid agonist. It was approved by the U.S. Food and Drug Administration (FDA) for use in the treatment of opioid addiction, similarly to how methadone is used, in 2002. Unlike methadone, buprenorphine is less likely to lead to intoxication, but it still reduces withdrawal symptoms in those who struggle with addiction to opioids like heroin or OxyContin.

Buprenorphine is most often prescribed under the brand name Suboxone, which is a combination of buprenorphine and naloxone that adds a tamper-proof element to the medication. Suboxone and related buprenorphine-based products are the first opioid treatments that can be dispensed from physicians’ offices, as long as the physician has undergone specific training. This allows more people to access opioid addiction treatment because they do not have to register at a methadone clinic.

If you receive a prescription for buprenorphine to ease your body off opioid dependency, it is important to let your physician know about any other substances you may be taking, prescription or illicit. It is also important to avoid taking potent drugs (whether prescription or illegal) while on Suboxone unless you have a physician’s permission to safely mix prescription drugs.

Mixing central nervous system (CNS) depressants like the buprenorphine in Suboxone with any other drug can be risky, and it may cause an overdose, increased blood pressure and heart rate, and other problems. If you struggle with substance abuse and are trying to abuse Suboxone with other drugs, especially stimulants (either prescription drugs like Adderall or illegal substances like methamphetamine), this could result in serious harm.

Stimulant Drugs Are Widely Abused

Stimulants are designed to increase the amount of dopamine in the brain, leading to greater alertness, higher energy, improved mood, reduced appetite, and reduced need for sleep, among other side effects. Both prescription and illicit stimulants are abused by many people in the United States, but two of the more widely abused drugs are Adderall, a prescription drug, and methamphetamine, which is mostly found from illicit sources. 

Adderall
This prescription stimulant is a combination of amphetamine and dextroamphetamine that treats people who have attention deficit hyperactivity disorder (ADHD). The medication is sometimes also used to treat people who have narcolepsy. For those who need the medication, the access to dopamine allows them to focus, stay awake, and balance their mood; however, many people abuse Adderall, often because they mistakenly believe it is a performance-enhancing drug.

Starting in the 1990s, students began getting Adderall from their peers with ADHD and using the drug to stay up all night studying or writing papers. They believed the increased focus on their work would improve their grades while allowing them to wait until the last minute to cram for important tests or exams. As the generation who grew up abusing Adderall for enhanced performance enters the workforce, they have continued this trend and are now working high-stress jobs and long hours while illegally taking this medication.

Although Ritalin is also widely abused for these reasons, Adderall is prescribed more often than Ritalin, so more people have access to it for nonmedical reasons. Adderall remains the most abused prescription stimulant in the United States. 

Methamphetamine
While methamphetamine is a Schedule II drug, meaning there are some prescription uses for pharmacy-grade methamphetamine, it is notorious as a dangerous stimulant that leads to multiple sleepless days, psychotic symptoms, self-harm and aggression toward others, and damaged teeth.

Meth abuse rose to prominence in the 1990s. Its popularity declined before it rose again in the early 2000s. It appears, unfortunately, to be returning to prominence as super labs in Mexico send more inexpensive and pure meth into the U.S.

Meth has neurotoxic effects, causing the brain to rapidly become dependent on it. With consistent abuse, it damages dopamine receptors to the point that depression may become a permanent feature in someone overcoming addiction to the drug. It may also lead to a condition similar to Parkinson’s disease.

Meth is rarely abused as a performance-enhancer, like Adderall. Instead, it is abused for recreational reasons; users want to feel happier and more energetic. 

The Dangers of Mixing Stimulants and Depressants

In the case of both prescription and illicit stimulants, like Adderall and meth, the person abusing the drug may become anxious, paranoid, twitchy, or achy. They may want to avoid the comedown symptoms, and this means they may take a CNS depressant, most often alcohol, to calm their nerves. Other commonly abused CNS depressants mixed with stimulants include benzodiazepines, which are anti-anxiety medications, and opioids, especially heroin. Sometimes, a person may mix the stimulant and depressant, hoping to get the best effects of both while taking the edge off the negative side effects. This does not work, and the practice is extremely dangerous.

One of the more infamous concoctions of stimulants and depressants is a speedball; cocaine and heroin are dissolved together and injected intravenously. This combination is often used by people who struggle with heroin addiction, who do not want the extreme sedative effects of a large dose; they use cocaine to increase their alertness. Sometimes, people add heroin, or another sedative, to cocaine to avoid the intense anxiety or aggression associated with cocaine highs.

Although cocaine and heroin is a common mixture, there are other combinations. More people are combining meth and heroin, as meth has become less expensive and more available. There are no news reports of Adderall being mixed with heroin, but it is possible these drugs or a prescription opioid have been combined as a type of speedball.

There are many possible effects of mixing depressants and stimulants.  Among them are:

  • General confusion
  • Incoherence
  • Blurry vision
  • Stupor
  • Paranoia
  • Drowsiness
  • Lack of sleep
  • Other mental impairments
  • Uncontrolled motor skills, leading to dangerous falls
  • Risk of death from cardiovascular failure
  • Nausea and vomiting
  • Respiratory failure
  • Sudden death

Knowing that a full opioid agonist like heroin or methadone is dangerous to mix with stimulant drugs, some people may assume that mixing a partial opioid agonist like Suboxone is less dangerous. This is not the case. There are still many harmful consequences of mixing stimulants like meth or Adderall with Suboxone.

There are few studies or reports of people mixing Adderall or meth with Suboxone, but one study examining the effect of buprenorphine and methamphetamine in rats found that, when administered alone, either drug provided some anxiety-reducing effects; however, when combined, the two drugs caused anxiety in the rats.

A different study examining the combination of morphine, the original synthetic opiate, and methamphetamine in rats found that the two drugs combined stimulated several behavioral changes, consistent with those seen in humans who abuse speedballs; however, the effects were dose-dependent, suggesting that lower doses may cause less intoxication. It is important to note that this does not mean they are safer drugs to abuse. Again, in combination, stimulants and depressants of any kind are very harmful.

Although Suboxone has a partial opioid agonist in it rather than a full opioid agonist, mixing the drug with stimulants can cause severe side effects.

Sources

(May 31, 2016). Buprenorphine. Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved November 2018 from https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine

(January 2018). Is It Safe to Use Stimulants with Other Medications? National Institute on Drug Abuse (NIDA). Retrieved November 2018 from https://www.drugabuse.gov/publications/research-reports/prescription-drugs/stimulants/it-safe-to-use-stimulants-other-medications

(April 28, 2014). What is Adderall (Adderall XR)? Everyday Health. Retrieved November 2018 from https://www.everydayhealth.com/drugs/adderall

(October 19, 2016). Millennials Took Adderall to Get Through School. Now They’ve Taken Their Addiction to the Workplace. Quartz.com. Retrieved November 2018 from https://qz.com/812604/millennials-took-adderall-to-get-through-school-now-theyve-taken-their-addiction-to-the-workplace/

(October 29, 2013). Methamphetamine. Center for Substance Abuse Research (CESAR). Retrieved November 2018 from http://www.cesar.umd.edu/cesar/drugs/meth.asp

(2010). Do You Know … Cocaine. Centre for Addiction and Mental Health (CAMH). Retrieved November 2018 from https://www.camh.ca/-/media/files/guides-and-publications/dyk-cocaine.pdf

(June 26, 2013). Real Teens Ask About Speedballs. National Institute on Drug Abuse (NIDA) for Teens. Retrieved November 2018 from https://teens.drugabuse.gov/blog/post/real-teens-ask-about-speedballs

(August 10, 2017). The Effects of Methamphetamine and Buprenorphine, and Their Interaction on Anxiety-Like Behavior and Locomotion in Male Rats. Neuroscience Letters. Retrieved November 2018 from https://www.ncbi.nlm.nih.gov/pubmed/28698151

(April 22, 2011). Powerful Behavioral Interactions Between Methamphetamine and Morphine. Pharmacology, Biochemistry, and Behavior. Retrieved November 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197716/

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