How Long Does Suboxone Work?Anna Ciulla
In the previous two decades, opiate addiction has mushroomed into a deadly, worldwide epidemic that knows no cultural or socioeconomic boundaries. According to the Centers for Disease Control and Prevention (CDC), over 400,000 people have died from opiate overdoses in the United States. Furthermore, over 650,000 opiate prescriptions are dispensed and approximately 4,000 people engage in illicit opiate abuse daily—primarily as a result of diversion.
The first wave of the opiate epidemic was dominated by irresponsible prescription practices that occurred after the pharmaceutical industry deceptively assured doctors and the American public that the opiates they were routinely prescribed for pain management were “safe.” As the epidemic progressed, synthetic opiates such as fentanyl emerged on the black market as potent killers, and synthetic medications used to treat opiate addiction—such as Suboxone—emerged as promising solutions. Although methadone (also a synthetic opiate) has been used controversially and with moderate success since the 1970’s to treat opiate addiction, Suboxone is widely considered the safer and more effective of the two treatment options.
WHAT IS SUBOXONE?
Suboxone is the popular brand name for a combination of buprenorphine and naloxone—two medications commonly used in treating opiate dependence. Buprenorphine, considered a partial opiate agonist, chemically resembles other opiates but the effects are weaker than full-blown agonists such as heroin or methadone. The drug is clinically valued for its “ceiling effect,” an industry term that describes the leveling off of opiate effects that occurs even with increased dosage. This ceiling effect dramatically reduces the risk of developing chemical dependence, abuse, and unwanted side effects. Buprenorphine also reduces the severity of opiate withdrawal symptoms and significantly curbs cravings.
Naloxone, Suboxone’s other chemical component, is considered an opiate antagonist, or blocker. Antagonists prevent opiate receptors from being activated by the brain and central nervous system (CNS) and are only effective when intravenously injected or used as a nasal spray. Taking the medications orally and exactly as prescribed fails to produce the desired effect. In opiate-dependent individuals who are reliant on intravenous (IV) injections, injecting Naloxone directly into the bloodstream triggers various withdrawal symptoms. This, in turn, discourages further opiate abuse.
Suboxone was originally approved by the Food and Drug Administration (FDA) in 2002 and is only appropriate when used as part of a comprehensive treatment plan. Suboxone is available as a pill or sublingual film and can be prescribed by ordinary doctors in contrast to methadone, which is available only at designated methadone clinics or special treatment facilities. Although the opiate treatment industry is highly supportive of Suboxone treatment, numerous research studies report that it also exhibits the potential for abuse, and may even become a primary drug of choice for certain users.
LONGEVITY OF EFFECTS
One of the overwhelming concerns regarding Suboxone involves how long the drug will stay in a user’s system. This is not an easy question to answer. Like other potentially addictive substances, Suboxone’s lingering effects depend upon a complex variety of factors—most importantly its half-life—the time it takes for half of a single dose to be eliminated from the system. Suboxone’s primary ingredient, buprenorphine, features an exceptionally long half-life of approximately 37 hours. However, considering that buprenorphine is then metabolized by the body into norbuprenorphine—a metabolite with no scientifically established half-life—Suboxone may remain in the system for up to two weeks following dosage.
On average, Suboxone takes nine days to exit the system. Naloxone, on the other hand, features an extremely short half-life of approximately 30 to 60 minutes and is commonly used to treat opiate overdoses. A certain variable must be carefully considered when determining the half-life and subsequent effects of any drug—especially one as chemically complex as Suboxone.
The following factors all combine to influence the extended effects of the drug beyond the initial 37-hour half-life:
- Body mass
- Genetic predisposition
- Level of hydration
- Metabolic rate
- Liver function
- Exact dosage
- Frequency of use
- Duration of use
- Overall physical health
Despite Suboxone’s intended use an opiate addiction medication, it is still abused and considered addictive due to the intense high it is capable of producing—particularly in those who have never used opiates. Suboxone’s pleasurable effects have been described by users as euphoric, calming, pain-relieving, and craving-reducing.
Similar to other drugs, people frequently obtain Suboxone through diversion and defy medical recommendations by taking dangerously high doses. Such irresponsible practices are almost always habit-forming and eventually lead to addiction. The following warning signs are indicators of Suboxone addiction:
- Doctor shopping—seeking multiple scripts from various doctors
- Skipping doses and stockpiling them for future use
- Quitting previously rewarding hobbies or activities in order to acquire and abuse Suboxone
- Neglecting major commitments, responsibilities, and relationships such as work, school, family and friends
- Resorting to pathological behaviors such as lying, stealing, and evasiveness in order to sustain a growing habit
Even when taken exactly as prescribed for legitimate medical purposes, Suboxone can produce serious side effects. This potential is exponentially increased when the drug is abused or co-ingested with other substances. Side effects of Suboxone may include:
- Respiratory depression
- Blurred vision
- Difficult sleeping
SUBOXONE WITHDRAWAL TIMELINE
Buprenorphine’s extended half-life directly impacts the Suboxone withdrawal process—which doesn’t begin for approximately one to three days following dosage in most cases. According to scientific studies found in multiple journals, tapering is an effective way to minimize Suboxone withdrawal symptoms. Tapering involves a physician administering diminishing doses of the medication in a controlled manner over a predetermined period of time. This method of treatment helps prevent “precipitated withdrawal”—the rapid acceleration and intensification of symptoms that occurs whenever a user quits any opiate or related treatment medication cold turkey.
Under a standard taper protocol, Suboxone is reduced by a certain percentage daily until a user successfully weans off. Opiate tapers featuring Suboxone are typically performed over a seven-day period, with the dosage being reduced by 4 milligrams daily. Ultimately, only an experienced physician and team of licensed medical professionals can establish an appropriate tapering schedule, and many factors including individual biology, intensity, and duration of opiate dependence, level of family and community support, genetic predisposition, and co-occurring physical and/or mental health disorders must be carefully considered. Although the effects of Suboxone withdrawal usually subside within two weeks, a protracted withdrawal process may follow based upon the aforementioned factors—a phenomenon known as post-acute withdrawal symptom (PAWS).
SUBOXONE DETOX AND ADDICTION TREATMENT
Suboxone addiction and withdrawal both require medical detox in order to help safely stabilize clients physically and psychologically. The majority of inpatient detox programs last approximately one week and feature 24/7 client monitoring in a safe and highly supportive environment. For those clients who have successfully completed an inpatient detox program, the following treatment options provide excellent continuing care designed to help clients gradually re-adjust to life without opiate or Suboxone dependence:
- Inpatient treatment—provides round-the-clock client monitoring and increased security at a designated residential facility. Inpatient treatment includes ongoing assessment and evaluation by a team of licensed medical professionals and qualified clinicians—with many reputable facilities providing additional holistic services and ancillary benefits in addition to the primary treatment routine. This comprehensive, client-focused quality of care is why inpatient treatment is generally considered the industry “gold standard” for treating opiate and/or Suboxone addiction.
- Outpatient treatment—offers many of the same services and benefits as inpatient treatment, but without the intensive level of clinical care, 24/7 monitoring and additional security. Typically cheaper than inpatient treatment and less effective, outpatient treatment offers the singular advantage of greater flexibility for certain clients based upon their personal and/or professional schedules. It is also useful for those clients successfully transitioning from more intensive levels of care or desiring longer-term maintenance therapy.
If you or someone you love are suffering from addiction to opiates and in need of treatment, or have already undergone treatment and are addicted to Suboxone, call a substance abuse professional today. Addiction cannot afford the luxury of delayed treatment, and favorable long-term recovery outcomes are dependent upon early intervention.
And remember, an opiate overdose is considered a medical emergency that requires immediate treatment by calling an ambulance or driving to your nearest hospital emergency room (ER). Never resort to self-guided treatment or take a casual, non-professional approach when it comes to your own life or the life of someone you love.
For more about opiate addiction and recovery, check out these related articles:
- “How Long Does it Take for Opiates to Leave Your System”
- “Preventing an Opiate Overdose with Naloxone”
- “Synthetic Drugs Addiction and Treatment”
- “Opiate Addiction by the Numbers: Date You Can’t Ignore”
- Journal of Addiction Medicine. Two-year Experience with Buprenorphine-naloxone (Suboxone) for Maintenance Treatment of Opioid Dependence Within a Private Practice Setting. June, 2007.
- International Journal of Neuropsychopharmacology. Rewarding or aversive effects of buprenorphine/naloxone combination (Suboxone) depend on conditioning trial duration. Sept, 2014.
- Anesthesiology. Buprenorphine-Naloxone Therapy in Pain Management. May, 2014.
- PLOS ONE. Long Term Suboxone Emotional Reactivity As Measured by Automatic Speech Reaction. July, 2013.