Buprenorphine and Opium: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Buprenorphine
Opium
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Both buprenorphine and opium are opioids, and both can slow down your breathing and your brain. When you take them together, those effects add up. That can lead to heavy drowsiness, very slow or shallow breathing, and in serious cases even loss of consciousness. There is also a small added risk of serotonin syndrome, a reaction that can cause agitation, shivering, fast heartbeat, and confusion.
This is a serious combination, so please don't stop or change either medicine on your own. Talk with your doctor or pharmacist. They have safe ways to handle this, whether that means adjusting doses, choosing a different option, or watching you more closely.
Effect: Additive CNS and respiratory depression plus an increased risk of serotonin syndrome when buprenorphine is combined with opium (a serotonergic opioid CNS depressant).
Mechanism: Overlapping mu-opioid agonism producing additive sedation and respiratory depression, with additive serotonergic activity.
- Direction/magnitude: Pharmacodynamic (additive); risk of profound sedation, coma, death.
- Onset: Unspecified. Evidence: Probable. Severity: Major.
- Management: Avoid concomitant use where possible; cessation or taper of the additional CNS depressant is preferred. If unavoidable, use lowest effective doses and monitor for sedation, respiratory depression, and serotonin syndrome, especially at initiation and dose changes. Discontinue buprenorphine if serotonin syndrome is suspected.
What happens
An increased risk of serotonin syndrome and an increased risk of respiratory and CNS depression
Interaction Deep Dive
When buprenorphine is given together with a serotonergic CNS depressant, the combined effect can produce additive CNS depression along with a heightened risk of serotonin syndrome, respiratory depression, marked sedation, coma, and death. It is better to stop the other CNS depressants than to use them at the same time. Certain situations may call for observation in a higher level of care or for a taper. In other cases, it may be suitable to slowly withdraw the patient from a prescribed benzodiazepine or another CNS depressant, or to reduce it to the lowest effective dose. Should concurrent use be required, watch for sedation, respiratory depression, and the signs and symptoms of serotonin syndrome. Observe the patient closely, especially when starting therapy and when the dose of the serotonergic agent is being adjusted. If serotonin syndrome is suspected, stop buprenorphine and consider alternative approaches to managing anxiety or insomnia21.
Why it happens (mechanism)
Additive serotonergic effects; additive CNS and respiratory depression
How to manage this interaction
The safest approach is usually to avoid taking these two together. Your care team may prefer to taper or stop the extra opioid, or bring it to the lowest effective dose.
- Keep taking both as prescribed unless your prescriber tells you otherwise. Do not stop suddenly on your own.
- If your team decides both are needed, they may monitor you more closely, especially when starting or changing a dose.
- Watch for very slow or shallow breathing, extreme drowsiness, confusion, shivering, or a racing heartbeat, and get help right away if these occur.
- Ask your pharmacist or doctor whether a safer alternative is possible.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) A Swedish epidemiological study reported that patients receiving methadone- or buprenorphine-based medication-assisted treatment (MAT) together with benzodiazepines or other CNS depressants (for example, drugs used to treat insomnia) have an increased risk of death. Between July 1, 2005 and December 31, 2012, the risk of fatal overdose, non-overdose related mortality, and all-cause mortality was analyzed in MAT prescribed patients (aged 18 to 50), comparing periods when CNS depressants were prescribed to periods without CNS depressant therapy. The findings showed a higher risk of all-cause mortality (adjusted hazard ratio (HR) 1.44; 95% CI, 0.93 to 2.23) and non-overdose related mortality (HR 1.74; 95% CI 1.00 to 3.01) with MAT and benzodiazepine treatment; however, these data were not deemed statistically significant. Although the results showed an increased risk of fatal overdose, non-overdose mortality, and all-cause mortality during periods when MAT and non-benzodiazepines were coadministered, only the data for fatal overdose and all-cause mortality were considered statistically significant; HR 2.34 (95% CI, 1.37 to 3.99) and HR 1.33 (95% CI, 1.12 to 2.45), respectively. A comparison between the benzodiazepine cohort and the non-benzodiazepine cohort was not performed because the authors did not adjust for the indication of use for the drugs 3.
b) According to a study using aggregate nationwide death certificate data from 2010 to 2014, 3495 drug overdose deaths were reported in 2014. Methadone and other CNS depressants were often reported as contributors in those deaths. Concurrent alprazolam use was reported in 18.1% of cases, followed by oxycodone (10.1%), cocaine (9.6%), heroin (9%), and diazepam (6.6%). The FDA reported 322 drug overdose deaths in 2014 involving buprenorphine. Of these 322 deaths, 32.9% involved alprazolam, 17.4% involved clonazepam, 11.2% involved diazepam, 11.2% involved heroin, and 9.9% involved fentanyl. The absolute number of methadone-involved deaths was 10 times the number of buprenorphine-involved deaths, although confounding factors and differences in drug utilization were not taken into account. It remains unknown whether the risk of overdose death with concurrent CNS depressant drugs differed between buprenorphine and methadone 3.
Common questions
Can I take Buprenorphine and Opium together?
Combining buprenorphine and opium adds up their breathing- and brain-slowing effects and raises the risk of serotonin syndrome, so avoid using them together and talk with your care team about the safest plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Buprenorphine and Opium interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Buprenorphine and Opium interaction managed?
The safest approach is usually to avoid taking these two together. Your care team may prefer to taper or stop the extra opioid, or bring it to the lowest effective dose. Keep taking both as prescribed unless your prescriber tells you otherwise. Do not stop suddenly on your own. If your team decides both are needed, they may monitor you more closely, especially when starting or changing a dose. Wat… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Buprenorphine or Opium need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: BRIXADI(TM) subcutaneous extended-release injection, buprenorphine subcutaneous extended-release injection. Braeburn Inc (per FDA), Plymouth Meeting, PA, 2023. DailyMed
- Product Information: SUBUTEX(R) sublingual tablets, buprenorphine sublingual tablets. Indivior Inc (per FDA), North Chesterfield, VA, 2021. DailyMed
- US Food and Drug Administration (FDA): Drug Safety Communications: FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressants: careful medication management can reduce risks. US Food and Drug Administration (FDA). Silver Spring, MD. 2017.
Keep reading about Buprenorphine
Keep reading about Opium
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