Suboxone Detox – Withdrawal Symptoms and Timeline

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In 2016, approximately 2.1 million people had an opiate use disorder (OUD) involving opiates, drugs such as painkillers like hydrocodone, oxycodone and fentanyl, or the street drug heroin. Overcoming chronic opiate dependence and addiction requires professional treatment to be safe and effective. Suboxone is one of the medications used in opiate use disorder (OUD) treatment. A partial opioid agonist/opioid antagonist, Suboxone is used in medication-assisted treatment (MAT) for opiate dependence and to help treat withdrawal symptoms for opiate drugs.

The medication, which combines buprenorphine and naloxone, is classified as a Schedule III narcotic under the Controlled Substances Act. As such, Suboxone also has the potential for misuse, diversion and abuse and has its own set of withdrawal symptoms once the drug is discontinued. Indeed, there is growing street diversion of Suboxone that the Drug Enforcement Agency (DEA) is closely monitoring. The FDA approved Suboxone in 2002 for use in opiate addiction therapy. Prior to that date, Suboxone was classified as a Schedule V narcotic.

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Derived from thebaine, an opium extract, buprenorphine stimulates the same areas of the brain as heroin and morphine, producing some of the same euphoric, sedative and pain-relieving effects. However, buprenorphine produces a lesser degree of sedation and respiratory depression and causes no significant cognitive or motor skill impairment.

Since Suboxone also reduces cravings for heroin and other opiate drugs and combats withdrawal from those drugs, it can be useful for opiate addicts undergoing professional treatment who want to get clean. Like methadone, Suboxone blocks heroin’s effects, so Suboxone users are not able to get high from heroin. But Suboxone also has a ceiling effect, meaning higher doses do not result in increased effects of euphoria, analgesia and sedation after a certain point. Taking high doses of Suboxone can precipitate withdrawal symptoms, however. The naloxone that’s in Suboxone causes withdrawal symptoms in abusers who inject or snort the drug, although snorting Suboxone is one way abusers have used successfully to get high.

SUBOXONE WITHDRAWAL SYMPTOMS

Withdrawal from suboxone has been described as similar to heroin withdrawal, with somewhat milder symptoms, which may involve a number of the following:

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• Anxiety
• Body aches
• Cramping
• Diarrhea
• Dilated pupils
• Gooseflesh skin
• Headaches
• Increased heart rate

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• Insomnia
• Intense opioid cravings
• Irritability
• Mood swings
• Nausea
• Sweating
• Vomiting
• Yawning

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A study published in Drug and Alcohol Dependence that examined correlations and factor structure of the Clinical Opiate Withdrawal Scale (COWS) in opiate-dependent men and women against clinical trials comparing buprenorphine/naloxone tapering strategies found that there is no single underlying construct in the scale that applies to withdrawal. For example, resting pulse rate in men is not related to withdrawal, while yawning and gooseflesh skin is not withdrawal- related in women undergoing buprenorphine/naloxone tapering.

Long-term use of opiates has been linked with adrenal insufficiency, a potentially life-threatening condition. Any patient on Suboxone experiencing a grouping of adrenal insufficiency symptoms, such as anorexia, dizziness, fatigue, low blood pressure, nausea, vomiting, and weakness should seek medical attention immediately.

Suboxone should not be used if you have severe liver impairment, and may not be appropriate treatment for those with even moderate liver impairment.

According to the official prescribing information for Suboxone, there is a risk of potentially fatal additive effects when Suboxone is used concomitantly with benzodiazepines and other Central Nervous System (CNS) depressants, including alcohol.

Concomitant use of Suboxone with serotonergic drugs (such as selective serotonin reuptake inhibitors, or SSRIs) may cause a potential life-threatening condition called serotonin syndrome.

Since taking Suboxone may impair mental and physical abilities for challenging tasks, such as driving, care should be taken during dose adjustment to ensure that treatment with Suboxone does not adversely affect ability to perform such functions.

Opiate-dependent women on Suboxone maintenance therapy may require additional analgesia during labor. Furthermore, infants whose mothers are receiving treatment with Suboxone or who repeatedly used opiates during pregnancy may experience neonatal opioid withdrawal syndrome (NOWS), an expected and treatable condition.

Acute overdose symptoms of Suboxone include drowsiness, cold and clammy skin, fainting, slow heart rate, weak pulse, pinpoint pupils, hypotension, slow or shallow breathing, complete respiratory depression, sedation, and death. If Suboxone overdose is suspected, immediate medical attention is required, with doctors closely monitoring heart and respiratory functions, administering naloxone to counteract buprenorphine overdose, oxygen, IV fluids, possibly even putting the patient on a mechanical respirator to restore and maintain normal breathing. The Centers for Disease Control and Prevention (CDC) estimates there were about 50,000 overdose deaths from opiates in the U.S. in 2017, a significant increase from 2016.

SUBOXONE WITHDRAWAL TIMELINE

Suboxone has a long half-life, ranging from 36 to 72 hours. In practical terms, that means half the Suboxone could still be in your body in three days. Blood, urine, saliva or hair tests can detect Suboxone or buprenorphine in a person’s system.

• Urine — Buprenorphine is detectable in urine within 40 minutes of taking the drug and can remain detectable for two weeks or longer in those taking high doses. Most of a dose of buprenorphine is excreted via feces, while 10-30 percent is excreted in urine.
• Saliva — Tests of Suboxone users can detect the presence from 3-10 days after use.
• Hair — Metabolites of Suboxone (principally norbuprenorphine) can be found in hair 1-3 months after discontinuing the drug.
• Blood – Suboxone stays in the blood for 2-10 hours after the last dose. A blood test can detect same-day usage of Suboxone.

While undergoing Suboxone withdrawal, the worst phase typically occurs during the first 72 hours after discontinuation of the drug. That’s when the most physical symptoms are experienced. Withdrawal symptoms generally begin to subside over the course of a week, gradually diminishing in frequency and intensity.

Other factors affecting the timeline for Suboxone withdrawal include the client’s age, weight, body fat content, urine concentration of buprenorphine and norbuprenorphine, psychiatric history, and history of Suboxone use (quantity and duration of use).

Lingering withdrawal symptoms from Suboxone can include overall body aches and pains, insomnia and mood swings, which may last a month or two, but rarely past three months. Some patients, particularly long-term Suboxone users, experience longer-term depression or anxiety that may have been precipitated by withdrawal symptoms. Such depression or anxiety can persist for months.

INPATIENT TREATMENT FOR SUBOXONE

For anyone who wants to overcome Suboxone dependence or addiction, one of the treatment options is inpatient or residential treatment. The mandatory first stage of the process is Suboxone detox, during which medical professionals constantly monitor your progress all through the detox period and help minimize or reduce withdrawal symptoms.

For chronic Suboxone users, the use of anti-anxiety or anti-depressants may be indicated to help reduce feelings of anxiety or depression during the withdrawal process. Combating fatigue, loss of energy, other troubling or uncomfortable withdrawal symptoms may call for the use of supplements, adding meditation, spiritual guidance, introduction to and participation in 12-step or self-help groups.

Some who have undertaken Suboxone detox and subsequent treatment have said that it was easier to overcome their original opiate dependence or addiction than the one they had with Suboxone. It takes commitment and determination to follow through with the complete Suboxone detox and then treatment, including individual and group therapy as appropriate. As the most intensive level of care, inpatient treatment provides as many supports as possible for sustaining that commitment and determination.

Learn more about Inpatient Suboxone Rehab >

OUTPATIENT TREATMENT FOR SUBOXONE

Another treatment option for getting off Suboxone dependence is outpatient treatment. This may be a more cost-effective and convenient treatment choice for some, although it does involve going back and forth from treatment facility following detox (which must occur before formal treatment can begin). While you live at home and go to the treatment facility for appointments, you’re not 100 percent-immersed in the rehab experience, like you would be in residential detox.

Some residential treatment centers also offer intensive outpatient treatment following medical detox from Suboxone. You may be able to return to the same treatment facility where you were a client for opiate detox and treatment originally. Again, committing to going to the outpatient treatment facility is important for effective Suboxone detox in the long run.

Learn more about Outpatient Suboxone Rehab >

CAN SUBOXONE DETOX BE DONE AT HOME?

Since withdrawal symptoms for Suboxone include intense opiate cravings, Suboxone detox should always be conducted in a medically supervised detox facility. Deciding to go it alone is not a wise course of action, as once the drug begins to leave the system, the potential to relapse to illicit substances is high. It’s too easy just to go back to using, or revert to previous opiate use.

You’ll also not know the appropriate taper dose to use, or what to do in the case of side effects, which may be severe, or adverse reactions, which could be life-threatening. Why should you even consider taking the risk? Go for professional Suboxone detox and rest easy.

TAPERED VS. COLD TURKEY

Suboxone withdrawal presents moderate symptoms upon abrupt discontinuation of the drug. For this reason, those wishing to stop using Suboxone as a treatment for opiate addiction, or to get off dependence on the drug as an opiate substitute, are strongly advised to enter a medical drug detox center where they can receive tapered dose reduction and treatment to overcome dependence.

It’s important to keep in mind that the desire to taper off Suboxone treatment, while a positive goal, should only be considered as part of an overall comprehensive treatment plan. Your treatment team will determine when the time is right to slowing taper off Suboxone and help manage withdrawal symptoms, while simultaneously creating a treatment plan to help your recovery.

Trying to taper on your own, like going cold turkey, could have disastrous consequences. As the body becomes used to a lowered dosage, or no dosage, in the case of abrupt discontinuation of Suboxone, relapse and overdose become very real concerns. This is particularly dangerous for chronic Suboxone users and those who were chronic opiate addicts prior to treatment, as well as those who transitioned from methadone to Suboxone during opiate detox. Taking the same or higher doses of Suboxone or resorting to an illicit opiate like heroin, possibly in combination with benzodiazepines or alcohol, could result in overdose and death.

By the same token, going through Suboxone detox without going on to receive professional treatment is very dangerous. Some individuals get clean from Suboxone with the intent to go right back to using either Suboxone or other opiates to achieve greater effects of the drug. Because their tolerance is lower, they’re more susceptible to relapse, overdose and death after taking more of the drug than their body can handle.

CONSIDERATIONS/HOW TO DECIDE WHAT IS RIGHT FOR YOU

There is never a single consideration in helping you decide on the choice of a treatment program. Instead, there are several factors to carefully weigh. Chief among them may be cost considerations, although ability to pay should never be the deciding factor, as there often is financial help available through federal, state and local agencies. Treatment facilities may also offer sliding scale, payment plans and/or financing to help ease the financial burden of treatment.

The most important factor is where you’ll receive the best care for your Suboxone detox and treatment. Evaluating all your options, including assistance you may be able to get through the Veterans Administration and elsewhere, will help you decide what is right for you.

RECOVERY SUCCESS AND AFTERCARE SERVICES FOR SUBOXONE

Research has found that long-term therapy with buprenorphine/naloxone combination (Suboxone), while it provides acute benefits for short-term heroin addiction, is unable to prevent relapse and may even increase the likelihood for relapse. With such a high relapse potential, it is important that you receive ongoing support following Suboxone detox and treatment. Aftercare, offered by the best drug and alcohol treatment facilities, provides clients with individual therapy, group and family therapy, 12-step and non-12-step groups, alumni programs and more.

Remember that Suboxone recovery is a process, just as recovery from the original opiate addiction was a process. The encouragement and support you’ll get with aftercare services will facilitate your journey to a clear-headed, symptom-free recovery.

Learn more about Suboxone Aftercare >

For more about Suboxone detox and recovery, check out these related articles:

• Dangers of Long-Term Suboxone Treatment
• Choosing Between Inpatient and Outpatient Rehab
• Why Medication-Assisted Treatment is Important for Opiate Addicts in Early Treatment
• Medication-Assisted Treatment
• Are All Drug Detox Programs the Same?
• Dangers of Drug Detox at Home and Quitting Cold Turkey
• What to Consider Before Deciding to Detox at Home
• How to Know if You Need Rehab Treatment

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Addiction. “The pharmacodynamic and pharmacokinetic profile of intranasal crushed buprenorphine and buprenorphine/naloxone tablets in opioid abusers.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21395892

Clinical Pharmacokinetics. “Buprenorphine: clinical pharmacokinetics in the treatment of opioid dependence.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15966752

Drug and Alcohol Dependence. “Examining the factor structure of the Clinical Opiate Withdrawal Scale (COWS): A secondary data analysis from the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25908321

European Journal of Gastroenterology and Hepatology. “Acute hepatitis due to buprenorphine administration.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15371928

Journal of Addiction Research and Therapy. “Buprenorphine Response as a Function of Polymorphic Antecedents: Can Dopamine Genes Affect Clinical Outcomes in Reward Deficiency Syndrome (RDS)?” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318568/

Journal of Addictive Diseases. “Efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet for the treatment of adults with opioid dependence: A randomized trial.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27267785#

Molecular Neurobiology. “Can the chronic administration of the combination of buprenorphine and naloxone block dopaminergic activity causing anti-reward and relapse potential?” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682495/ 

National Drug Intelligence Center. “Intelligence Bulletin.” “Buprenorphine: Potential for Abuse.” Retrieved from https://www.justice.gov/archive/ndic/pubs10/10123/index.htm

National Institute on Drug Abuse. “Overdose Death Rates.” “National Overdose Deaths: Number of Deaths Involving Opioids.” Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Suboxone.com. “Prescribing Information.” Retrieved from https://www.suboxone.com/content/pdfs/prescribing-information.pdf

Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health.” “Opioid Use Disorder.” Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm#tx2

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