Suboxone is a medication used to treat opioid use disorders, specifically in medication-assisted treatment (MAT). Medication-assisted treatment involves the use of a drug that is specifically designed to treat withdrawal symptoms either by making cravings manageable or making relapse more distasteful.
Suboxone contains two active ingredients: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist. This means that while it’s in the opioid category of drugs, it’s not as effective in activating opioid receptors as full opioid agonists like morphine or oxycodone. Buprenorphine is also unique in another way. It has an “effects ceiling,” which means its effectiveness has a limit. Taking more of the drug will not increase its potency after a certain point. This makes buprenorphine overdose and intoxication less likely than it might be with other drugs.
Naloxone is an opioid antagonist, which means it binds to opioid receptors, but it doesn’t activate them. The drug can also kick opioids off their receptors and block them, stopping their effects. Naloxone is also sold as an opioid overdose antidote called Narcan. Suboxone is administered sublingually, or under the tongue. This method introduces buprenorphine into the bloodstream by absorption through glands at the bottom of the mouth. However, naloxone can’t get to the bloodstream through this method, allowing the buprenorphine to bind to receptors and take their effects.
Buprenorphine can help people with opioid dependence avoid cravings and withdrawal symptoms without causing intoxication. If someone wants to increase the potency of buprenorphine by taking Suboxone in a way that isn’t prescribed, the naloxone might become active. This can kick opioids off their receptors, causing immediate withdrawal. Suboxone treatment typically involves daily administration, but if someone were able to get multiple doses, they might be able to abuse Suboxone for a euphoric high. However, Suboxone abuse is difficult and uncommon.
Using Suboxone to treat opioid use disorders can get people out of a pattern of active addiction, it can help them to get and keep jobs and tend to other important responsibilities, and it can ease cravings and symptoms. However, it doesn’t stop opioid dependence. Instead, it replaces dependence on more harmful drugs. MAT is often used with the goal of eventually weaning users off the drug. This usually involves a gradual tapering period, but it might still cause some withdrawal symptoms.
The buprenorphine in Suboxone binds to and activates opioid receptors throughout the body. High doses can create feelings of anxiolysis, euphoria, and sedation. Long-term use can cause your body to get used to the drug, causing a chemical dependence to form. When you stop using or if you cut back, you may start to feel uncomfortable withdrawal. Since opioids affect receptors all over the body, the symptoms you experience may affect the whole body. Opioid withdrawal is often compared to the flu because it often produces symptoms like nausea, muscle aches, and fever. Other Suboxone withdrawal symptoms can include:
The Suboxone withdrawal symptoms you experience and the timeline on which you experience them depends on certain factors. The length of time you were dependent on opioids, the size of your usual dose, and the size of your most recent dose can all impact your Suboxone withdrawal timeline. However, you are likely to go through withdrawal on the following timeline:
Your first symptoms will appear within the first day after you stop using Suboxone. However, they may appear as early as 12 hours after your last dose. The first symptoms are typically mild and often feel like you’re coming down with a cold.
During the first three days of your withdrawal, symptoms will start to intensify until they reach their peak. Peak symptoms are usually the most severe and can include fever, nausea, and vomiting.
After your symptoms peak, they’ll start to subside until most symptoms are gone. By the end of your first week, the most physical symptoms will have disappeared, and your acute withdrawal phase may be behind you. However, post-acute withdrawal symptoms may last longer. Anxiety, insomnia, and other psychological symptoms are common.
Some symptoms may continue indefinitely until they are addressed in treatment. It might be especially likely if you had preexisting mental health problems like an anxiety disorder. Drug cravings may also last for a long time and need to be addressed in treatment.
Medical detox is the highest level of care in addiction treatment and involves 24-hour medically managed treatment. Detox is intended for people who are likely to experience severe withdrawal symptoms that pose a health risk. Opioids aren’t known to cause deadly withdrawal symptoms, and not everyone who goes through opioid withdrawal needs medical detox. However, opioid withdrawal is notoriously unpleasant and hard to get through on your own without the possibility of relapse.
Plus, detox can help address other medical needs alongside treatment. Opioid withdrawal can cause serious complications in some people. Because it causes vomiting, diarrhea, and sweating, you can become dehydrated quickly. A lack of access to fluids can lead to severe medical problems.
If you complete medical detox, or if you don’t need it, you may advance to another level of care in addiction treatment. If you still have high-level medical or psychological needs, you may enter an inpatient program that involves around-the-clock care. If you can live independently, you may be able to enter an intensive outpatient program or an outpatient program. Addiction treatment should be tailored to your individual needs. It addresses matters that are unique to you, such as your medical health, psychological problems, and social needs.
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Opioid use disorders are progressive and can get worse if they aren’t addressed. Even if you’re using a mild opioid like Suboxone, opioid abuse can constitute a chronic disorder. Addiction can get out of control quickly without treatment. It may lead to severe consequences like long-term health problems or financial instability. Addiction treatment can help you avoid some of the worst consequences of addiction, but it can also help to address and treat some of the consequences if they’ve already occurred. Learn more about addiction treatment to take your first steps toward recovery today.
National Institute on Drug Abuse. (2016, February). 8: Medical detoxification. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
Pietrangelo, A. (2016, November 7). Anxiolytics: Everything You Need to Know – Healthline. Retrieved from https://www.healthline.com/health/anxiolytics
SAMHSA. (2019, September 9). Medication-Assisted Treatment (MAT). Retrieved from https://www.samhsa.gov/medication-assisted-treatment
SAMHSA. (2019, September 27). Naloxone. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone
Welsh, C., & Valadez-Meltzer, A. (2005, December). Buprenorphine: a (relatively) new treatment for opioid dependence. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2994593/