Suboxone Detox

Suboxone is a prescription drug commonly used in medication-assisted treatment for opioid use disorder (OUD). As opioid use disorder has become more widespread – a nationwide study conducted in 2018 estimated that approximately 2 million Americans had an opioid use disorder – effective treatment methods are needed.¹  Opioid agonist medications are commonly used to both manage opioid withdrawal and as maintenance treatment for OUD. Suboxone is a brand name formulation that combines buprenorphine and naloxone, and is one of a few FDA-approved medications that may be used for induction and maintenance treatment for opioid dependence.²

What is Suboxone?

Suboxone combines buprenorphine and naloxone in a dissolvable film that goes under tongue or on the inside of the cheek for transmucosal absorption into the bloodstream.^{3, 4} Unlike methadone, another opioid agonist medication to treat opioid use disorder, which is dispensed in relatively-more restricted settings, Suboxone can be prescribed by specially certified doctors, nurse practitioners, and physician assistants in hospital, clinic, and private office settings.^{3, 5}

The opioid agonist component of Suboxone, buprenorphine, is commonly used during medical detox, a process in which medical professionals administer the medication to help manage cravings and other potential withdrawal symptoms during the early recovery period. Medical professionals may also monitor for any possible issues or complications and adjust treatment as needed during medical detox.⁶ Beyond the initial detox period, opioid agonist therapies like Suboxone are also utilized for longer-term maintenance treatment for opioid use disorders.⁵ 

Suboxone is prescribed to assist in the maintenance treatment of opioid use disorder, helping to alleviate cravings and withdrawal in individuals without eliciting the euphoric high of the previously abused opioid(s) from which the person is in recovery for.^2,5 Left unmanaged, the unpleasant symptoms of opioid withdrawal might otherwise present immediate challenges to recovery efforts and daily functioning.

Such opioid withdrawal symptoms include:⁷

• Cravings for opioids.
• Anxiety.
• Depressed mood.
• Inability to sleep.
• Restlessness.
• Feeling more sensitive to pain.
• Aching muscles and bone pain.
• Chills, fever, and sweating.
• Excessive eye tearing and runny nose.
• Nausea and vomiting.
• Diarrhea.

What is Suboxone Used For?

Suboxone can also help people experience a better quality of life by allowing them to feel and function more normally while undergoing maintenance treatment for opioid use disorder.⁶

The buprenorphine component of Suboxone is a partial opioid agonist medication. It activates them similarly to other opioids; however, as a partial opioid agonist, its pharmacologic effects are relatively less pronounced than many other full opioid agonist drugs, such has heroin and oxycodone.^{3, 4} In this manner, it is able to reduce or eliminate cravings and minimize symptoms of acute opioid withdrawal, but it doesn’t produce a strong euphoric effect like other opioids, making it less likely to be abused.^{3 , 4 , 5}

Additionally, buprenorphine has a “ceiling” to its pharmacologic effects, meaning that the drug is unable to elicit the intense highs that many other opioid drugs are capable of; attempts at misusing the drug by taking increasingly large doses will not have an effect once a certain threshold is reached, making it less likely to be abused or cause harmful side effects such as breathing difficulties.^{4, 6} With its high opioid receptor binding affinity, buprenorphine may also blocks the effects of any other full opioid agonist drugs that are taken while on the medication.⁶ Taking buprenorphine can assist people as they detox from other opioids that they are dependent on and be continued as ongoing maintenance treatment during recovery.⁴

The opioid antagonist naloxone is combined with buprenorphine to reduce the potential for misuse of Suboxone.³ When Suboxone is taken as directed as a sublingual or buccal (inside the cheek) dissolvable film, the stabilizing opioid effects of buprenorphine predominate, as naloxone has very low oral, sublingual, or buccal bioavailability.³ Naloxone is capable of blocking the effects of opioids at opioid receptors which might otherwise precipitate withdrawal in an opioid dependent individual but, as it is minimally absorbed when taken as prescribed, these effects are experienced only when Suboxone is taken in a different way than prescribed.^{4,6, 9}

For example, if Suboxone films are dissolved into solution and then injected or snorted, instead of being used through the intended oral routes, naloxone bioavailability increases—meaning that it becomes pharmacologically active in the bloodstream; this would result in a blunting of the therapeutic opioid agonist effects of buprenorphine and would instead induce immediate opioid withdrawal.^{3, 4, 9, 10}

This combination was formulated with the intention of reducing the abuse potential of Suboxone relative to pure buprenorphine formulations. Attempts to intentionally misuse Suboxone can result in markedly unpleasant withdrawal, as well as increase injection-related health risks.

Suboxone Detox Timeline

For someone on a medication-assisted treatment regimen for opioid use disorder, Suboxone may be used for detox and maintenance for several months or longer, as needed.^{3, 6} It’s important to note that individual Suboxone regimens are likely to vary based on several factors including practitioner preference and patient progress, however in general, Suboxone treatment commonly involves 3 stages:

• Induction is when a person starts taking Suboxone. It should occur only when early symptoms of opioid withdrawal have appeared, between 6 and 24 hours after the last dose of opioids have been taken, depending on whether short-acting or long-acting opioids were used.^{3 , 6, 9} If Suboxone is started while a person is under the influence of opioids, it can bring on symptoms of withdrawal.^{3 , 4}  
• Stabilization is when a person has stopped or significantly cut back on their opioid use and is no longer experiencing cravings for opioids.³ If any side effects or withdrawal symptoms continue to arise, the prescriber can adjust the dose as needed.³ The dose of Suboxone may be titrated or adjusted upwards until a stabilizing dose and dosing schedule is achieved.^{6, 9} In some instances, due to the long-acting nature of buprenorphine, some people may be adequately stabilized on an every-other-day dosing schedule, rather than needing daily dosing.³ Regular follow-up visits are recommended at this stage to monitor response to the medication and progress. Urine tests to check for compliance with dosing and abstinence from other drugs are also recommended during this phase.⁹
• Maintenance is when a person continues to thrive in their recovery plan on their regular dose and schedule of Suboxone, and doesn’t require any more dosing adjustments.³ The period of time spent in the maintenance stage is different for each person and can be tailored to meet their relapse prevention needs.^{3, 9} The maintenance stage can last as long as a person is benefiting from Suboxone. There is no maximum recommended time to stay on this medication.⁹

Suboxone may be most effective when it is paired with behavioral counseling and participation in self-help groups such as Alcoholics Anonymous or Narcotics Anonymous.³ When the person is ready to come off Suboxone, the dose may be gradually decreased until the person can stop taking it.^{6, 9}

Is Suboxone Addictive?

Suboxone is classified as a Schedule III controlled substance, meaning that it has a medically accepted use, the potential for abuse, and either high risk for psychological dependence or low to moderate risk for physical dependence.¹¹ Suboxone is generally safe to take when used as prescribed under the supervision of a doctor to reduce the risk of side effects, abuse, and addiction.¹⁰

Buprenorphine, the opioid agonist component of Suboxone, can lead to physical dependence when taken for an extended time.^{4, 9} After a person has been taking Suboxone for a period of time, stopping this medication suddenly or drastically decreasing the dose can bring about symptoms of opioid withdrawal.^{4, 9 , 10} As a partial opioid agonist, the buprenorphine withdrawal syndrome may be relatively milder than that associated with full opioid agonist drugs.^{4, 6, 9}

The decision to end Suboxone use should be made between you and the medical professional who prescribes it.^{4, 10} You and the prescriber should work together to develop a treatment plan that involves gradually tapering doses of Suboxone until you are off the medication completely.^{4, 9, 10}

While Suboxone can lead to physical dependence when used therapeutically, it is important to keep in mind that physical dependence is not the same thing as having an addiction to a substance.¹⁰ Diversion and nonmedical use of Suboxone does still occur, however. Compulsive, problematic misuse of Suboxone may be part of several characteristic signs, symptoms, and behavioral changes associated with opioid use disorders. These characteristics can include changes to an individual’s physical and mental health, as well as recurring troubles with an individual’s social, legal, or occupational abilities.  Difficulty stopping opioid use even after experiencing serious consequences related to Suboxone misuse could signify an ongoing opioid use disorder, despite it involving the very drug intended to treat these disorders to begin with.^{7, 12}

When used as prescribed, Suboxone does not result in a reinforcing euphoria or high and shouldn’t impair a person’s ability to function in their daily life.⁵ People in recovery consider themselves to be clean and sober when they are abstinent from drugs and alcohol. As such, some may have concerns that they are not abstinent while taking Suboxone. However, when Suboxone is used properly, it can be a highly effective support for people in recovery by assisting the individual in staying abstinent from opioids.^{5, 13} Rather than a substitute for the drug that a person was using, Suboxone is a tool that is used to help them stabilize, regain control over their health and life, and function more effectively at home, school, and/or work.^{12 , 13}

Finding the Best Detox Rehab Center

There are many detox rehabilitation facilities located around the country, and it can be difficult to choose among them to find the best facility for you or a loved one. As the leading provider of addiction treatment services in the United States,American Addiction Centers (AAC) make the choice a little easier. AAC operates 8 inpatient treatment centers across the country that offer access to evidence-based substance use and mental health care.

Rather than simply addressing the symptoms of addiction, AAC works to identify the root causes of addiction, treat any underlying mental health disorders, and improve physical health, socialization skills, and any other areas of concern that have arisen throughout the course of addiction. Substance use disorders and mental health disorders commonly occur together, so AAC specifically starts all treatment with a mental health evaluation to screen for this dual diagnosis. This allows staff to identify any potential disorders and treat them accordingly.

Groups are an important part of the treatment process because they allow participants to start building a support system of peers who are going through the early stages of recovery at the same time. Group and individual sessions also provide support and education for developing healthy coping skills to deal with stressors and avoid relapse. A full spectrum of care, starting with medical detox and continuing through aftercare options like sober living and counseling, is available at AAC.

Still Have Questions?

Learning about addiction and treatment options can feel overwhelming, especially if it’s your first time seeking treatment. Fortunately, the following guides are available to help you learn more about this process.

• This Sobriety Guide can explain more about how treatment works.
• This Substance Abuse Helpline Guide can make it easier to ask for help by providing information on how helplines work.
• Learning about how to get treatment can make it less intimidating to seek treatment. This Admissions Guide can explain more about the admissions process.

Recovery is possible and the information above can help make it more accessible. The proper medication, support, and resources can make recovery easier than ever before. All you have to do is ask for help and be willing to try.