Suboxone is a prescription medication used to treat opioid addiction. When used as directed, it relieves the symptoms of opioid withdrawal without getting you high. Suboxone also reduces opioid cravings, which goes a long way toward preventing relapse. Many recovering addicts take it for months, or even years, after they stop getting high.
While it doesn’t get you high, Suboxone is still an opioid, which means that you will experience withdrawal symptoms if you try to quit cold-turkey.
Overview
The way Suboxone works is a little complicated, so let’s break it down. Think of the opioid receptors in your brain like a light switch. First, you touch the light switch, then you flick it on.
Heroin, morphine, and prescription opioids are what’s known as full opioid agonists. They bind to the opioid receptors in your brain and turn your lights on.
Suboxone is a combination of two drugs: Buprenorphine and naloxone.
Buprenorphine is what’s known as a partial opioid agonist. Think of this as your opioid dimmer switch. It binds to your opioid receptors and dials up the brightness, without turning the lights on completely.
Naloxone is an opioid antagonist, which means that it binds to the opioid receptors but doesn’t turn them on. Naloxone acts like a hand over your “light switch,” preventing other opioids from flicking the switch on and getting you high.
If your “light switch” is already turned on, naloxone will shut it off. Naloxone was added to Suboxone to prevent diversion and misuse. This means that if someone injects Suboxone when they have opioids in their system, it can cause them to enter withdrawal immediately. When used as directed sublingually, the naloxone is not absorbed.
You should not begin taking Suboxone until all other opioids are out of your system. Suboxone is most effective when taken after you begin experiencing withdrawal symptoms (lights out). The buprenorphine in Suboxone will dial up the lights enough to stop your withdrawal, but not enough to get you high.
Abruptly quitting Suboxone can cause the same symptoms as traditional opioid withdrawal, but they are typically less severe.
You may experience sweating, anxiety, agitation, muscle aches, and an upset stomach. Rather than quitting cold turkey, clinicians typically advise slowly tapering down your dose. By slowly dimming the lights, your withdrawal experience should be relatively smooth.
The most common complication of opioid withdrawal is relapse. Relapse is more common when withdrawal symptoms and cravings are severe. A combination of tapering, medication management, and counseling can help improve your odds.
Signs and Symptoms
If you are using Suboxone as directed for the treatment of opioid addiction or to treat pain, you can expect to experience withdrawal symptoms if you miss a dose or try to quit cold-turkey.
Opioid dependence occurs with any long-term opioid use, regardless of whether you are following a doctor’s orders. Once you become physically dependent on a drug, you experience withdrawal symptoms when it leaves your system.
Suboxone causes most of the physical symptoms typical of opioid withdrawal. These include:
- Muscles aches and pains
- Sweating
- Chills
- Stomach cramps or diarrhea
- Nausea or vomiting
- Tremors or twitching
- Anxiety
- Restlessness
- Runny nose
- Teary eyes
- Gooseflesh
If you take Suboxone to treat opioid addiction, then your withdrawal symptoms should be less severe than what you have experienced in the past.
To get a better idea of how mild to moderate opioid withdrawal symptoms compared to more intense symptoms, you can check out the Clinical Opiate Withdrawal Scale (COWS).
Health professionals use this scale to determine the severity of opioid withdrawal syndrome.
The timeline of Suboxone withdrawal will also be a bit different than your past experiences. Buprenorphine is a long-acting opioid, which means withdrawal symptoms can take several days to appear.
Suboxone withdrawal typically begins within two to four days, peaks around days three to five, and resolves within seven days. Sometimes, however, psychological symptoms can linger for several weeks. This may include depression and an inability to experience pleasure.
The psychological challenges associated with withdrawal are not always caused by withdrawal itself. Withdrawal can trigger the return of mental health problems that were muted by drug use, such as anxiety and depression.
After withdrawal, people are also forced to take a good look at the damage that their drug addiction has wrought. It is not unusual to struggle with issues of guilt and regret. Figuring out how to get your life back on track can feel overwhelming and emotionally exhausting. That’s why it’s so important to reach out for help.
Coping and Relief
The most effective way to treat Suboxone withdrawal is to avoid it in the first place. You can avoid the symptoms of withdrawal by working with your doctor to taper down your dose. Tapering means gradually reducing your dose over time. If you have been acquiring your Suboxone illicitly, you will want to find a doctor to help your taper.
Suboxone tapering schedules typically take place over the course of seven to 28 days.
Some studies have shown that overall success (measured by a period of prolonged abstinence) tends to be better with a shorter, seven-day taper. Other studies have found that withdrawal symptoms are managed best by a slow, flexible tapering schedule. With a flexible taper schedule, your doctor can slow the dose reduction if you experience any uncomfortable symptoms.
If you are still struggling with withdrawal despite the Suboxone taper, your doctor may recommend one or more support medications.
Also if you are struggling with Suboxone withdrawal, consider the following tips:
- Drink more fluids than usual during withdrawal to prevent dehydration.
- Eat a well-balanced diet to keep your vitamin and electrolyte levels up.
- Work closely with a doctor, counselor, or physical therapist to develop new ways of coping with pain during and after withdrawal.
- Practice relaxation techniques (meditation, listening to music) to help you deal with anxiety and agitation.
- Try mild to moderate exercise to help you deal with restlessness.
- Find something else to focus on during withdrawal, such as a television show, book, or hobby.
- Get support and encouragement from a local community group or Narcotics Anonymous (NA) meeting.
Warnings
Opioid withdrawal is often unpleasant, but it is very rarely dangerous. When it comes to Suboxone, complications are even more unlikely. Still, it is important to work closely with a medical professional during your Suboxone taper.
The biggest threat to people withdrawing from Suboxone is the risk of relapse.
Relapse is common among people with opioid use disorders and is generally considered a normal part of the recovery process. But people who have been taking Suboxone are typically further along on the path to recovery. A relapse at this point can be both dangerous (because your tolerance will have plummeted) and discouraging.
If you have been acquiring your Suboxone illicitly or do not have a close relationship with your doctor, it can be tempting to try tapering down on your own. This is inadvisable for several reasons. Tapering on your own increases the likelihood of failure. Unsuccessful attempts to quit are discouraging and psychologically distressing.
If you are quitting Suboxone because you’re pregnant or breastfeeding, you should definitely talk to a doctor. Suboxone is not recommended for pregnant women, so it’s great that you’re considering stopping. Depending on your situation, your doctor may recommend an accelerated taper or a switch to buprenorphine, which have been proven safe to use during pregnancy.
Long-Term Treatment
Opioid use disorders are notoriously difficult to beat. It is not uncommon for someone to make it through detox successfully only to relapse a few weeks later. But if you have been using Suboxone to treat your addiction, you are already ahead of the game. Suboxone allows you the time to develop a long-term treatment strategy without being distracted by the discomfort of withdrawal.
After Suboxone, a long-term treatment plan should focus on preventing future relapse. Talk therapy plays a very important role in relapse prevention. Once you come off Suboxone, you will have beaten your physical dependence on opioids, but not the psychological aspects of addiction.
Talk therapy can help you figure out why you began abusing drugs in the first place. You can learn to identify specific situations and feelings that have led you to use in the past. Identifying these triggers helps you recognize and eliminate the negative thought patterns that cause you to make poor decisions.
Research shows that combining talk therapy with medication management is more effective at treating opioid addiction than medication alone.
There are many ways to explore talk therapy. You might consider working one-on-one with a psychologist or mental health counselor in private practice. You can meet with a mental health or addiction counselor at a local community clinic. Or you can explore group therapy programs, which are offered at many hospitals, clinics, and addiction treatment facilities.
