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How to Get Off Suboxone

Can I Get Addicted to Suboxone?

Suboxone is a combination medication of buprenorphine and naloxone that is prescribed to help patients recover from opioid addiction.1-3 Buprenorphine is a partial opioid agonist that binds to the same receptors in the brain as many opioid drugs of abuse. Although it may elicit similar effects as other opioids (e.g., positive mood, sedation, respiratory depression, etc.) buprenorphine has a plateau effect that limits the feeling of euphoria that comes with a full opioid agonist, such as heroin, hydrocodone, and oxycodone. This characteristic helps decrease both the likelihood of Suboxone abuse as well as overdose.4

By activating opioid receptors throughout the body, Suboxone helps to limit withdrawal symptoms that would otherwise occur when the once-abused opioid is stopped.

The addition of naloxone, an opioid antagonist that blocks the effects of opioid drugs, helps further deter abuse of Suboxone because naloxone blocks buprenorphine’s effects when injected.2,3 In addition to “shutting off” the effects of buprenorphine, naloxone and its opioid receptor blockade actions may elicit immediate withdrawal symptoms during attempts at misuse.

By activating opioid receptors throughout the body, Suboxone helps to limit withdrawal symptoms that would otherwise occur when the once-abused opioid is stopped, which serves to stabilize patients in detox and help maintain them in longer-term recovery.1,2,3,5

Only doctors who have acquired the necessary certification requirements can prescribe Suboxone.Illicit use and misuse of Suboxone can occur both with those who are self-treating their opioid addiction and with those seeking an opioid high.

Suboxone, Opioid Dependence, and Addiction

Since Suboxone has an opioid component (buprenorphine), it has some inherent potential for misuse. Even when used as prescribed, buprenorphine may lead to the development of physical dependence and an associated withdrawal syndrome of its own.1-3 

If  Suboxone is abused or if a person decides to stop using the medication after a period of consistent use,  it’s important to taper off Suboxone slowly.3,5

Physical Dependence vs. Addiction

Although drug dependence and drug addiction may coexist in the same individual, these two conditions do have some differences. Physical dependence occurs when the body adapts to the drug so that more of it is is required to achieve the same effect; quitting the drug abruptly can lead to withdrawal symptoms. Addiction, or compulsive use of the drug despite harmful effects, is distinguished by the inability to stop using the drug and failure to meet personal obligations; sometimes the addict experiences physical tolerance and withdrawal.8

Although drug dependence and drug addiction may coexist in the same individual simultaneously, these two conditions do have some differences.

Whether you’re dependent on the drug or actively addicted, stopping Suboxone suddenly may result in the onset of withdrawal symptoms and trigger cravings that may contribute to relapse or even a possible overdose.

Tapering Off Suboxone

A treatment plan to help you taper off Suboxone safely can be developed and supported either by your own doctor or by a healthcare professional at a detox facility.

Dose Reduction Amount

Although treatment plans may vary from one individual patient to another, the recommended daily dose reduction is usually no more than 25%, with no more than a 4 mg reduction per day.4

Length of Tapering Schedule

Tapering plans may vary in length. So, while one plan may reduce each Suboxone dose on a daily basis, another plan may reduce each Suboxone dose every 2 or 3 days. These differing dose reduction schedules mean that the Suboxone tapering plan for one person may end up being 28 days or longer, while for another person the tapering plan may be as short as 7 days.4

Which Suboxone Tapering Plan Is Best?

A 2009 study published in the journal Addiction set out to evaluate if the length of the buprenorphine tapering plan made any difference in the plan’s effectiveness in keeping patients clean.Researchers concluded there was no significant difference in effectiveness between the 7-day and the 28-day tapering plans. However, the study found that patient satisfaction at the 3-month post-taper follow up visit was greater for patients who underwent the longer tapering plan of 28 days.

Another study—published in JAMA Psychiatry in 2013—compared the relative efficacy of 1-, 2-, and 4-week buprenorphine tapering regimens. This study found that the 4-week taper was superior to the shorter tapers, with 50% of patients in that group remaining in treatment, abstinent, and receiving naltrexone after 12 weeks, versus 21% for the other groups. Naltrexone is another treatment medication that binds and blocks the body’s opioid receptors, which is thought to decrease reactivity to drug-conditioned cues and even ease opioid cravings to help people in recovery better maintain abstinence.7

Suboxone Withdrawal Symptoms

If an individual uses Suboxone regularly and suddenly stop taking it without any period of tapering off the medication, some of the following typical opioid withdrawal symptoms may occur:8,9,10

  • SweatingIf you have been regularly taking Suboxone and suddenly stop taking it without any period of tapering off the medication, you may experience opioid withdrawal symptoms including anxiety.
  • Runny nose
  • Anxiety
  • Muscle aches
  • Insomnia
  • Abdominal cramping
  • Diarrhea
  • Nausea
  • Vomiting
  • Chronic constipation
  • Blurred vision
  • Dizziness

While these withdrawal symptoms may be uncomfortable, they are rarely lethal.10 For a more comfortable experience withdrawing from Suboxone, consider professional opioid detoxification programs. They can help gradually reduce the level of Suboxone in the system. These programs also provide helpful resources for preventing drug relapse.

Quitting Suboxone without any medical supervision is not recommended; an individual is more likely to recover from Suboxone dependency if they get help with the detox and rehabilitation process.9

Support for Stopping Use

Getting off of Suboxone involves more than just quitting and detoxification. Whether the individual is dependent on a street drug like heroin or a prescription maintenance medication like Suboxone, counseling and support will them you stay on track with your recovery goals.

Treatment Facilities for Suboxone Dependency

Treatment facility typesWhen you’re ready to start looking at your treatment options for Suboxone, you’ll find there are a few different facility types available to you:

  • Luxury treatment facilities provide residential addiction treatment alongside an array of high-end, resort-like amenities.
  • Executive treatment facilities offer very similar services and features as luxury facilities only with extra accommodations for business professionals who need to remain engaged in their workplace throughout treatment.
  • Standard treatment facilities offer both residential (inpatient) and non-residential (outpatient) addiction treatment, depending on your particular needs and circumstances. These programs may not have the full range of plush amenities that luxury or executive programs have, but they do come at more affordable prices for those whose budgets are more limited.

Sources

  1. U.S. National Library of Medicine. (2018). MedlinePlus: Buprenorphine Sublingual and Buccal (opioid dependence).
  2. Substance Abuse and Mental Health Services Administration. (2019). Buprenorphine.
  3. Welsh, C., Valadez-Meltzer, A. (2005). Buprenorphine: A (Relatively) New Treatment for Opioid Dependence. Psychiatry (Edgmont), 2(12), 29-39.
  4. Walsh, S.L., Preston, K.L., Stitzer, M.L., Cone, E.J., Bigelow, G.E. (1994). Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther, 55(5), 569-580.
  5. Ling, W., Hillhouse, M., Domier, C., Doraimani, G., Hunter, J., Thomas, C…Bilangi, R. (2009). Buprenorphine tapering schedule and illicit opioid use. Addiction, 104(2), 256-265.
  6. Sigmon, S.C., Dunn, K.E., Saulsgiver, K. (2013). A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers. JAMA, 70(12, 1347-1354.
  7. Substance Abuse and Mental Health Services Administration. (2019). Naltrexone.
  8. Substance Abuse and Mental Health Services Administration. (2015). Certification of Opioid Treatment Programs (OTPs).
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Is there a difference between physical dependence and addiction?
  10. Indivior. (n.d.). Suboxone.
  11. U.S. National Library of Medicine. (2019). MedlinePlus: Opiate and opioid withdrawal.

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