Suboxone is a medication used to treat opioid dependence, addiction, and withdrawal. It’s proven to be useful as a prescription medication for people who have experienced several relapses back into opioid addiction after a period of sobriety.
It’s also shown to help reduce rates of dangerous overdoses and lower the potential for misuse. However, Suboxone use in addiction treatment will mean continuing to be dependent on an opioid drug. If you stop using Suboxone abruptly, you’ll go through opioid withdrawal, which can be extremely unpleasant.
But what are the symptoms of Suboxone withdrawal, and is withdrawal dangerous? How can withdrawal be treated? Learn more about Suboxone withdrawal, symptoms, and treatment options.
Suboxone is a prescription medication that’s specifically used to treat opioid dependence and addiction. It’s a brand name for a formulation that contains two active ingredients: buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, which means that it works in a way that’s similar to other opioids but doesn’t have as powerful an effect on opioid receptors.
Buprenorphine has some other unique features when it comes to opioids. It’s able to stave off withdrawal symptoms and can alleviate cravings, but an effective dose doesn’t cause powerful feelings of intoxication. As an opioid dependence medication, this can allow people to spend less time seeking opioids, taking them, and recovering from an opioid high.
Buprenorphine is also less likely to cause a life-threatening overdose. It’s said to have an effects ceiling, which means the effects of the drug start to diminish at a certain dose, while other drugs cause more intense effects with higher and higher doses. Buprenorphine can be misused to achieve a euphoric high, even if it’s not as potent as other opioids like heroin. However, naloxone can help avoid Suboxone misuse. If you’re in a medication-assisted treatment (MAT) program that uses Suboxone, you may only be given the drug once per day.
The drug is taken sublingually, which means it’s placed under the tongue where it dissolves. The buprenorphine makes it into the bloodstream in amounts that aren’t enough to cause a significant high. The naloxone doesn’t make it into the bloodstream in high enough amounts to be effective at all, but this is normal if you take the drug as intended.
If you try to increase the potency of Suboxone by taking it intravenously, the naloxone will become active. Naloxone is an opioid antagonist that binds to opioid receptors, kicks off any opioids, and blocks them from being activated. This will send an opioid-dependent person into immediate withdrawal.
If you’re prescribed Suboxone, you’re likely in an addiction treatment program that involves medication-assisted treatment. MAT is usually reserved for people who have gone through many rounds of treatment and relapse in the past.
Drugs like Suboxone can allow you to avoid uncomfortable opioid withdrawal and intoxication from an opioid high. This can decrease your risk of medical, psychological, social, and legal issues that are often associated with active addiction. While you’re on Suboxone, you can attend to responsibilities and goals in your life that addiction would have prevented.
However, Suboxone treatment does mean you’ll continue to be dependent on the drug. When you decide to stop taking it, you’ll experience withdrawal symptoms. Withdrawal is a consequence of your brain’s adaptation to an active chemical like an opioid. This is called dependence. Your brain and nervous system adapt to rely on the drug as part of your balanced brain chemistry.
To adapt, your brain will adjust your natural chemical balance to account for the effects of Suboxone. If you’re taking Suboxone, you’ve probably already become dependent on another opioid. When you stop taking the drug suddenly, your brain chemistry will be thrown out of balance, causing uncomfortable withdrawal symptoms.
Tolerance is a common sign you’ve become dependent on a drug. Tolerance is the feeling that your typical dose is less effective than it used to be, and you may feel like you need to take higher doses to achieve the same effect. This is because your brain is adapting to the drug and counteracting some of its effects. Other signs that you might experience withdrawal include:
- Feeling the need to increase your dose
- Taking the drug more often
- Feeling uncomfortable when you skip a dose
- Trying and failing to cut back or quit
Suboxone withdrawal may cause symptoms that are similar to other opioid withdrawal symptoms. Opioid withdrawal is often compared to a bad case of the flu because it causes some of the same symptoms. Symptoms can include:
- Runny nose
- Watery eyes
- Body aches
- Sleep issues
Your symptoms may be worse if you quit cold turkey. The length of time you’ve been opioid-dependent can also influence the intensity of your withdrawal symptoms.
When Do Symptoms Start?
Your withdrawal timeline and symptoms will depend on whether you taper off the drug gradually or quit cold turkey. Quitting abruptly is usually avoided and causes more severe withdrawal symptoms. It also increases your risk of relapse. Buprenorphine is a long-acting medication that leaves opioid receptors very slowly. It can remain effective in your system for as long as 24 to 36 hours.
You may not experience your first withdrawal symptoms until two days have passed after your last dose. Your first symptoms may show up within three days of your last dose. Symptoms may start fairly mild, and they’ll gradually intensify. You may also start to experience powerful cravings to use again.
How Long Does Withdrawal Last?
Withdrawal symptoms will intensify once they begin. Once you reach peak symptoms, you’ll start to feel better gradually. Peak symptoms are when your withdrawal period is at its most intense. You may experience nausea, vomiting, and diarrhea. After your peak withdrawal period passes, you’ll start to feel better until most of your symptoms are gone. Psychological symptoms like depression tend to last the longest and may need to be addressed in treatment. Your acute withdrawal phase will most likely end within seven to 10 days.
Opioid withdrawal can be extremely unpleasant, and it’s very difficult to get through without help. But a relapse is more likely to happen than life-threatening complications, unlike alcohol and other depressants. Opioids aren’t commonly associated with fatal withdrawal symptoms like seizures or heart failure. However, some circumstances can make opioid withdrawal more dangerous. Because opioid withdrawal symptoms are similar to symptoms of the flu, you may experience dehydration.
If you experience severe vomiting, sweating, or diarrhea, you can dehydrate fairly quickly. In most cases, this is remedied by making sure you drink plenty of fluids, just like when you’re sick. However, if you don’t have free access to water or if you can’t get clean water, you could experience life-threatening complications.
Many fatal opioid withdrawals have occurred in jail situations when inmates going through withdrawal didn’t have access to enough water. You may also experience dangerous dehydration if your nausea is so severe that you can’t keep water down. If you’re not able to hydrate through opioid withdrawal, you may need medical help as soon as possible.
If you’ve come to the end of an MAT program, then addiction treatment professionals or your doctor will likely guide you through a tapering process. Tapering can take longer than a typical withdrawal period, but you may not experience withdrawal symptoms as severely. If you do quit cold turkey, you may experience fairly severe withdrawal since MAT treatment with Suboxone often involves several months of chemical dependence.
Suboxone withdrawal is usually addressed through tapering. Tapering involves a gradual reduction of your dose of Suboxone until you stop taking the drug completely. This is done to avoid sending your body into chemical imbalance abruptly. Instead, the lower and lower doses allow your body to adapt to life without the drug. Tapering schedules can be anywhere between seven days to a month.
Longer tapering schedules are thought to provide even more stability than shorter ones. However, a 2011 study found that shorter tapering periods seem to be just as effective in avoiding relapse after one and three-month follow-ups.
If you’ve used a drug like buprenorphine as a recreational drug, or if you’ve used Suboxone and relapsed into active addiction, you may need to revisit addiction treatment. Relapse is a part of the recovery process for many people. You may need to reassess your relapse prevention strategies in treatment. You may go through or continue cognitive-behavioral therapy (CBT), which involves identifying triggers and developing effective coping strategies.
You may also need to build up your self-efficacy, which is your belief in your ability to overcome challenges like cravings. People who experience a relapse often go through a period of very low self-efficacy. You may feel powerless to avoid a relapse in the future. However, treatment options like CBT, group therapy, and one-on-one counseling can remind you that you’re capable of achieving and safeguarding sobriety.