Suboxone Withdrawal TimelineAnna Ciulla
Opiate addiction is a problem that has seeped into every community, demographic, and socio-economic walk of life. Because of this many sought a “cure” which didn’t involve the nightmare of withdrawal. When Suboxone came on the scene, it appeared that cure had finally arrived. Suboxone was hailed as a miracle drug. Thanks to its properties, users could remain opiate-free, hold down a job, engage with family members, and generally feel as if they could function again as they fought this battle with addiction.
However, many soon realized the effects of Suboxone itself could be addictive. When users tried to get off Suboxone, they then had to deal with the very mental and physical withdrawal symptoms they initially sought to avoid. Now faced with a new problem, Suboxone users have questions. What is the timeline for Suboxone Withdrawal? What are the symptoms of withdrawal? What can they expect during the withdrawal process? Is there a Suboxone detox program for those that have become addicted? We answer all those questions and more here.
What is Suboxone?
Suboxone is a prescription medication, typically a sublingual strip that dissolves under the tongue. Suboxone is considered to be a useful part of a treatment program for opiate addiction. Like methadone, Suboxone can reduce opiate withdrawal symptoms and decrease the intensity and frequency of cravings.
Suboxone is a combination of Buprenorphine and Naloxone. Buprenorphine is a partial opiate agonist. Essentially, it creates a “ceiling effect,” meaning that even massive overdoses rarely cause life-threatening respiratory depression unless used in conjunction with other central nervous system depressants like alcohol. Naloxone, also known as Narcan, is a synthetic drug similar to morphine, that blocks opiate receptors in the nervous system.
Suboxone: The Gold Standard
While Buprenorphine has been used as a treatment for opiate addiction for years, in 2002 there was a significant shift in opiate addiction treatment when Subutex and Suboxone were approved and marketed in the United States. Later, in 2012, Subutex was being abused by many users during their drug detox treatment program and was discontinued. Suboxone, however, continued to be used as a treatment choice for many people struggling with opiate addiction.
Soon after its approval, Suboxone was regarded as a perfect solution for those suffering from opiate addiction. Why? First, because it doesn’t depress the respiratory system like many other opiates, it significantly decreased the chance of a fatal overdose. Secondly, users were able to function in their daily lives when they used the drug.
Controversy Surrounding Suboxone
Despite the popularity of Suboxone, there remains a passionate debate in the treatment community and Suboxone users. Why is this?
The 12-Step Abstinence Model
The 12-Step community has a hardline philosophy about what makes someone truly “sober.” Under the 12–step model, you can’t consider yourself sober unless you are substance-fee. The ideology is that it is counterproductive for true sobriety if the person dealing with addiction simply replaces one addiction for another. This “substance swapping” includes substances such as Suboxone or methadone.
Suboxone and the Black Market
Most doctors are ethical. However, some are not. Some clinics, many of whom deal only in cash, dispense Suboxone without proper monitoring and follow-through. These “pill mills” are virtually everywhere across the country. While some argue that Suboxone dependency is better than being addicted to heroin or oxycontin which can cause death, others claim Suboxone dependency is still a powerful addiction.
The pharmaceutical companies marketed Suboxone as abuse-resistant. However, instead of using Suboxone sublingually, some people inject or snort Suboxone even though the drug manufacturers claim that the naloxone in Suboxone makes this unpleasant.
Neglecting to Address the Root Cause
Some people critical of Suboxone treatment argue that the philosophy of removing just the symptoms of opiate addiction doesn’t address psychologically-based issues that contribute to the user’s dependence in the first place. These critics are concerned that rather than viewing medical assistance as merely one step in a more holistic recovery process, the Suboxone user is almost encouraged to be on some form of medication-assisted therapy indefinitely.
Keeping in mind that Suboxone contains an opiate, your body begins to depend on it in order to feel well or “normal.” Clearing the drug completely out of your system can be potentially very uncomfortable. It is important to note that Suboxone dependence is best monitored by a medical professional to ensure that the user is comfortable, experiencing only manageable physical withdrawal symptoms.
Withdrawal symptoms are similar to flu-like symptoms, but they can last potentially much longer than the average flu. It is possible that Suboxone withdrawal can continue for upwards to a month. Symptoms for withdrawal can include:
- Concentration difficulties
- Digestive problems
- Drug cravings
- Muscle aches
How to Successfully Taper Off Suboxone
Suboxone has a long half-life and a tight grasp on opiate receptors and therefore can be difficult to stop. Because withdrawal from Suboxone is challenging, the discomfort of withdrawal can potentially lead to relapse because the user so desperately wants the symptoms to cease. The “cold turkey” approach is not recommended since the user can suffer the emotional and physical pain of withdrawal, especially if the user doesn’t adhere to a reasonable tapering process.
To avoid these physical symptoms as much as possible, your doctor will give you a “taper” from the drug. Specifically, this is a buprenorphine taper.
In the most basic sense, the user will have to try tapering off Suboxone slowly. A Suboxone taper starts by coming up with a plan or “protocol” to reduce the amount of the medication the user takes each day. It is normal even during this protocol that the user will experience some withdrawal symptoms, but a well-managed taper protocol can go a long way to preventing unwanted withdrawal symptoms (more so, the ones that drive users to use again).
Each user’s tolerance for pain and general discomfort is different. Even if the user has been taking Suboxone for an extended period, he or she may experience less discomfort than someone else or vice versa. Since it is impossible to know precisely how anyone will react, it is a good idea for the user to admit himself to an inpatient drug rehab center.
What Can You Expect During A Taper?
It is common that the first 72 hours of the taper will be the time that the user experiences the greatest degree of physical symptoms. Remember, there is always a genuine potential for relapse. It’s essential that before, during, and after, the user begins to build a foundation for their taper by getting an education on their addiction, attending a 12-step program or therapy, and making changes in their lifestyle to support sobriety.
A general guide for what to expect is as follows:
- General aches and pains
- Inability to sleep
- Mood swings
Weeks Three – Four
- Some patients still experience cravings for Suboxone
What Does A Taper Look Like?
The following is a sample “taper” over a three-month period. That said, anyone considering discontinuing Suboxone should consult their doctor to decide what type of taper protocol would be best suited for them.
The following is a three-month taper:
- Days 1-14: 2 mg
- Days 15-28: 1.5 mg
- Days 29-42: 1.0 mg
- Days 43-66: 0.5 mg
- Day 67: 0.0 mg
- Day 68: 0.5 mg
- Day 69: 0.0 mg
- Day 70: 0.5 mg
- Day 71: 0.0 mg
- Day 72: 0.5 mg
- Day 73: 0.0 mg
- Day 74: 0.5 mg
- The next process is to dose every third day:
- Days 75-76: 0.0 mg
- Day 77: 0.5 mg
- Day 78-79: 0.0 mg
- Day 80: 0.25 mg
- Days 81-82: 0.0 mg
- Day 83: 0.25 mg
- Days 84-85: 0.0 mg
- Day 86: 0.25 mg
- To taper off Suboxone completely, abstain for three days and then take one last dose:
- Days 87-89: 0.0 mg
- Day 90: 0.25 mg = Last Dose
Is It Possible to Take a Break in the Taper?
The answer is yes. Because everyone is different, even when someone tapers off Suboxone with a medical professional, it is possible they may experience uncomfortable withdrawal symptoms. If this happens, the user can go back to the previous dose and maintain this dose for a few days until the symptoms have passed.
Another course of action may be to continue on the higher dose for a more extended period than initially laid out in the tapering protocol. When your body adjusts, the user can then return to the recommended dosing schedule.
Generally speaking, if the user finds this “break” necessary, he/she shouldn’t experience any serious adverse outcomes. However, keep in mind that the longer someone stays on the taper, the harder it may be to give it up completely. Regardless, pausing the protocol is better than relapsing. It is recommended to limit taking higher doses only once or twice during the protocol. Making these minor adjustments to the protocol shouldn’t ruin the progress of the person trying to quit Suboxone.
Are All Tapers 90 Days?
No. Originally, an average Suboxone taper was 28 days. Some people even adhere to a 4-day Suboxone taper, and there is a 5, 7, 21-day taper as well.
Will a Taper Lead to a Long-Term Recovery?
A successful taper does not necessarily equal long-term recovery. Addiction of any kind involves a myriad of issues that led to the addiction in the first place. It is essential that anyone who wants to stop using Suboxone not only invest in a medically supervised taper protocol but also take the time and effort to improve and understand other areas in their life that may have contributed to their initial opiate addiction.
On the most basic level, addiction of any kind often masks negative feelings the user wants to avoid. Instead of turning to substances to numb these feelings, it is recommended that the user acts and thinks in new, more healthy ways.
Alternatives to Substance Use
The following are just a few alternatives to using substances:
- Exercise – Regular exercise builds endorphins often lacking in Suboxone users. Vigorous exercise five days a week can go a long way to counter withdrawal symptoms.
- Good nutrition – For Suboxone users, nutrients have been lost which are important to proper brain functioning. Proper nutrition ensures more energy, better sleep, and mood improvement.
- Mindfulness programs – Being aware of how to manage your emotions can be an essential aid while the user tapers off Suboxone. The ability to be present and appreciate the moment while also recognizing a full range of emotions without turning to drugs will help the user to quiet the frantic mind.
- Taking nonaddictive endorphin – deficiency supplements – Amino acids found in protein-rich foods like beef, tofu, chicken and fish is a natural way to raise dopamine levels in Suboxone users and can significantly aid in the depression many Suboxone users experiences.
- Volunteering or “giving back” – Suboxone users often become isolated and have a difficult time seeing beyond themselves and their own problems. Giving back allows them to shift their focus onto others, thus taking a weight of self-analysis.
New Ways of Thinking and Being
When someone decides to stop using Suboxone, it is often advisable to find support through therapy or a drug rehabilitation center. While the user is going through their withdrawal, therapy or a rehabilitation center can support the user by helping to develop new ways of thinking which can lead to new ways of behaving. The brain is entirely capable of creating new synaptic pathways and thinking differently can be a part of this.
Instead of leaning on drugs to solve problems, it is possible to train the brain to respond differently to former “triggers” that prompted drug use. During the taper protocol, if the user has proper support, he can use these new ways of thinking about stress and other problems to help ensure the potential for long-term recovery.
Seeking Addiction Treatment
We have seen that Suboxone, while still considered an effective addiction treatment for Opiate recovery, can be a powerfully addictive. If a user wants to stop taking this drug, he or she will likely experience Suboxone withdrawal symptoms which may lead them back to opiates, other substances, or may tie him to a lifetime of Suboxone use. However, there are alternatives to living a life tied to Suboxone.
If the user seeks out a proper taper protocol and professional medical support for their Suboxone detox, they can expect to experience only minimal Suboxone withdrawal symptoms. Additionally, we discussed the importance of addressing the underlying issues that initially drove the Suboxone user to opiates. Once the Suboxone user addresses both the emotional and medical aspects of their opiate dependence, there is still hope that someone who is addicted to Suboxone can eventually live a drug-free life.
For more information on substance abuse and addiction treatment, please contact our Florida rehab recovery center today.
Substance Abuse Services and Mental Health Association. August 2018
US National Library of Medicine National Institutes of Health. August, 2009
Suboxone Overview – https://www.drugs.com/pro/suboxone.html