Is it possible for Suboxone, Subutex, ZubSolv, or Bunavail to cause urinary hesitancy in males and female urinary hesitancy?
Can Suboxone cause urinary retention? Has anyone had trouble urinating after taking Suboxone? This is an excellent question. Most Suboxone doctors would likely answer that they have not heard this complaint before.
Or, at least, they have not heard the complaint of difficulty urinating on Suboxone where it could not be explained by another cause. Urinary hesitancy in males, for example, can often be attributed to BPH, or benign prostatic hyperplasia.
BPH is an enlargement of the prostate, and it is very common in men in their 50s and older. The ultimate solution is a surgery known as a TURP, or transurethral resection of the prostate.
However, before going to surgery, the patient can try different options, such as changing their diet, natural supplements, and medications prescribed by their doctor. Flomax is an example of a medication that makes it easier to urinate for men with BPH.
What about female urinary hesitancy?
Can Suboxone cause difficulty urinating for women? If a woman complains of difficulty urinating after starting Suboxone, we still must consider the possibility of other causes. Could the symptom of urinary retention and urgency be due to a urinary tract infection?
Or, is it possible that the symptoms of peeing problems are related to recent street drug use. Opioids do cause urinary hesitancy as a side effect. When a person is taking large amounts of heroin, fentanyl, oxycodone, or other potent opiate drugs, they may have this symptom, but not think about it in the haze of ongoing active addiction.
It is possible that side effects of street drug use may persist in the first weeks of opioid addiction treatment. So, it is possible that the symptom will subside over time. Still, it is important to consider the possibility of an infection, in men and women, and perform appropriate testing.
Both men and women are susceptible to urinary tract infections, but women tend to get UTIs more frequently. This is due to a shorter urethra, the tube that goes from the bladder to carry urine to leave the body. Regarding Suboxone and urinary tract infections, we must first rule out the UTI before considering any other cause.
An untreated infection could lead to much more serious problems. After the doctor has tested for infections and ruled out this possibility, the next step may be to address possible Suboxone-induced urinary hesitancy.
Why don’t doctors hear patients complaining about trouble peeing from Suboxone more often?
One concern about a symptom not being reported often is that doctors are not asking specifically about certain symptoms. Sometimes doctors tend to just ask, “are you having any side effects?”
The problem with this line of questioning is that patients are not always aware of all of the side effects that might be caused by Suboxone. Some possible side effects include constipation, headache, dizziness, ankle swelling, weight gain, insomnia and sweating. Urinary retention and urinary hesitancy are also side effects of buprenorphine, the active ingredient in Suboxone.
So, if a doctor is prescribing ZubSolv, Subutex, Suboxone, Bunavail, Sublocade, Brixadi, or other forms of buprenorphine/naloxone, or just plain buprenorphine, they should consider listing the common possible side effects individually. I have noticed that when I ask specifically about side effects, I get more positive responses from patients that they have had these side effects.
For example, if I ask, “Are you having any Suboxone side effects?”a patient may answer, “no.” On the other hand, if I ask, “Have you been having difficulty sleeping or excessive sweating since starting Suboxone?” they may then answer “yes.”
Why does buprenorphine cause urinary retention in some patients?
Does Suboxone cause urinary retention because it contains an opioid? Yes, this is most likely the reason for this particular side effect.
Buprenorphine is an opioid. Opioids can cause, as a potential side effect, urinary hesitancy. The issue is that we often like to downplay the fact that buprenorphine is an opioid.
One reason to distinguish bupe from other opioids and opiates is that it is only a partial agonist, while being a full antagonist at the same time. It fully blocks opioid receptors and only partially activates them.
While buprenorphine is categorized as an opioid, it does not act like most opioids. Patients tend not to feel intoxicated by the medication. They are able to function normally with a clear head.
Also, unlike other opioids, patients tend not to develop tolerance. While most opioids stop working after a while, requiring an increase in dosage to get the same effect, buprenorphine usually keeps working fine at the same, or even lower dosages.
Still, we must acknowledge that buprenorphine is an opioid, and may have some of the same side effects of opioids. While the side effects will usually not be as common or as severe as other opioids, they can still occur.
The mechanism for urinary hesitancy is believed to be related to changes in parasympathetic and sympathetic tone of the nerves going to the bladder.
This is caused by buprenorphine being an agonist of the mu opioid receptor. As a result, there can be contraction of the bladder’s detrusor and urinary sphincter muscles. More information on the mechanism of buprenorphine-induced urinary hesitancy is available here.
Is there a way for doctors to treat the side effect of urinary hesitancy caused by Suboxone?
Fortunately, this side effect is usually temporary and will go away with time. As with most side effects, one way to deal with it is for the doctor to decrease the dosage of medication. For example, if a patient is prescribed Suboxone 16 mg daily, the doctor may recommend a reduction to 14 mg or less to see if there is an improvement.
Another way to address the patient’s difficulty peeing from Suboxone is for the doctor to prescribe a medication for the side effect. Of course, the issue with prescribing medication for a side effect is that the new medication may have side effects of its own.
In the case of Suboxone-induced urinary hesitancy, one medication known to help is bethanechol, known by the brand name, Urecholine. Bethanechol is known as a nonselective muscarinic agonist. It helps with emptying the bladder and increasing urination.
There is medication that can help with opioid-induced urinary hesitancy.
After surgery, patients often have difficulty urinating. This may be due to potent opioids, such as fentanyl, given as part of general anesthesia.
Why is bethanechol not prescribed more often for urinary hesitancy? If a patient goes home from surgery and then cannot pee easily, why doesn’t their doctor provide this medication? And, why don’t Suboxone doctors prescribe bethanechol for urinary retention and hesitancy?
Maybe the issue is that this side effect is not taken seriously enough by doctors. Are doctors asking their patients about difficulty urinating when they are prescribed opioids? What about Suboxone doctors? Are they asking?
While bethanechol may cause additional side effects, if doctors prescribe it at low dosages, the chance of any problems with side effects will be reduced. Also, bethanechol treatment does not have to be a long-term solution. Most likely, the issue will resolve on its own in time.
Could stigma against opioid-addicted patients be part of the problem?
Another issue that may be involved is the stigma against people who take opioids and people who are addicted to opioids. Doctors are affected by the opioid stigma, even doctors who treat opiate addiction.
Imagine, in a busy methadone clinic or Suboxone clinic, a patient complains of difficulty peeing, and they believe the problem is due to their treatment medication. It is possible that clinic staff, counselors, and even doctors, will dismiss the symptom as unrelated. Or, they may just recommend that the patient see their primary care doctor.
Now, in the primary care, family doctor office, the patient is again faced with addiction stigma. The family doctor may believe that the patient cannot be taken seriously because they are simply an “addict.” The doctor assumes that it is probably a sexually transmitted illness or a urinary tract infection.
While it is important to evaluate the patient for these other conditions, it is also important that doctors and clinic staff take patients seriously. Side effects are real and they do occur. We must listen to what patients are trying to tell us.
When patients complain about side effects, sometimes doctors and their staff have a tendency to think that the patient is lying and trying to get away with something. This is particularly true with addiction patients.
Why don’t doctors take their patient’s complaints about side effects more seriously?
I have heard doctors, even addiction treatment specialists, make comments about how the thing they hate most about treating addiction is how patients always lie. This was a common theme in the television show, House M.D. In the program, Dr. House would often comment that patients always lie.
The fact is that patients do not always lie. While active addiction does cause people to lie at times, doctors can establish a trusting relationship with their patients when they are willing to listen to their patients and have open communication.
If a patient reports that they have urinary retention from their Suboxone weeks after starting the medication, the doctor may question why they suddenly started having a side effect after being on a stable Suboxone dosage. Because of this discrepancy, the doctor may doubt the patient and wonder why they are suddenly reporting a difficulty peeing from Suboxone.
Before doubting the patient, the doctor should consider the possibility that the patient may have had urinary hesitancy from their Suboxone for the entire course of taking the medication. It is possible that they simply tolerated the side effect until it became unbearable.
How can doctors do a better job of helping patients with side effects from Suboxone?
It is important that we address Suboxone side effects when they occur. Treating addiction is a delicate process. We can inadvertently lose patients from engaging in addiction treatment and recovery when they are scared away.
Patients are often scared away by issues that may arise at the very beginning of treatment. One of the most concerning Suboxone reactions that doctors try to avoid is known as precipitated withdrawal. Precipitated withdrawal is an opioid withdrawal syndrome that occurs when a patient takes Suboxone too soon after quitting opioids.
Usually, the time between stopping opioids and starting Suboxone or Subutex is about 18 to 24 hours. If a patient is given Suboxone right after stopping heroin, fentanyl, or pain pills, they will likely go into precipitated withdrawal.
While not precipitated withdrawal is usually not physically dangerous, it can be extremely unpleasant. After experiencing it, a patient may decide that Suboxone or Subutex is not a good option for them. They may even return to using illicit opioids.
Fentanyl analogs sold as heroin on the streets are complicating early Suboxone treatment.
With synthetic fentanyl analogs on the street being sold in place of heroin, the difficulties in helping patients through precipitated withdrawal are even greater. Because of the way fentanyl analogs linger in a person’s system for days, precipitated withdrawal can occur unexpectedly, even if the patient waits well past the usual 24 hours.
With caring, trust, and communication, a doctor can work closely with their patient and help them through this sometimes difficult transition. The same goes for other side effects and adverse reactions. We do not want patients scared away from treatment during the early stages of recovery when they are most vulnerable.
After getting a patient through the induction process, helping them to go from quitting street opioids to taking Suboxone successfully, we must monitor closely for any issues with side effects. What if a patient has an uncomfortable side effect, such as insomnia, sweating, constipation, or urinary hesitancy? Could a side effect lead a patient to quit treatment and go back to using opioids?
Patients on Suboxone are often under pressure from all directions.
Family, friends, co-workers, and society in general, can send an anti-Suboxone message, openly, or subliminally. They hear so many conflicting messages about people who quit opioids without medical treatment and how they should not get hooked on Suboxone.
Suboxone treats addiction, it does not get people addicted. When someone sticks with Suboxone treatment for a long enough period, they often no longer have cravings for opioids, even when they finally stop taking Suboxone. Suboxone treatment works.
As addiction treatment doctors, it is our job to take our patients seriously. When a patient complains of a symptom, such as urinary hesitancy, it is important to listen and consider options to treat the side effect. Our job is to help our patient through early recovery and into long-term, stable treatment.
We do not want to pile on with the rest of society adding to the stigma that addiction treatment patients often face. Addiction treatment professionals must stand up for patients and be their advocates. Medication side effects are real, but they can be managed. With open communication, doctors can be for their patients, providing proper treatment to help them get past Suboxone side effects.