What is buprenorphine / naloxone (Suboxone)?

Suboxone is a medication that is one of the most effective forms of treatment for opioid addiction. It helps patients manage withdrawal, prevent opioid cravings, and protect against relapse and overdose.

Diagram of buprenorphine and naloxone (Suboxone)

It works

Millions of Americans have achieved long-term recovery from opioids by using Suboxone. This medication is associated with a 70-80% reduction in death.

It’s trusted

Suboxone is on the World Health Organization’s List of Essential Medicines for its life-saving effects. The US Department of Health and Human Services promotes it as the first-line of treatment for opioid addiction.

It’s safe

There are hundreds of medical research papers that validate Suboxone’s effectiveness. It was approved by the FDA in 2002, and it came to market in Spring 2003. 

It’s accessible

Suboxone can be prescribed by licensed medical providers in any treatment setting, and you can get it from your local pharmacy. 

Suboxone is a combination medication. Here’s why that matters.

Buprenorphine activates opioid receptors, reducing withdrawal symptoms and cravings. Naloxone blocks the action of opioids at opioid receptors. Suboxone prevents cravings, lowers risk of overdose, and enables people to transition from addiction to recovery

We call bullsh*t

Let’s clear up the common misconceptions people have about medication-assisted treatment.

Myth #

1

You’re not sober or in recovery

Opioid use disorder is a chronic medical condition that changes your brain chemistry. And just like any other medical conditions, you can treat it with medication and lifestyle changes.

The idea that you cannot be truly sober if you’re taking medications is an outdated misconception and a dangerous view of treating opioid addiction.

Myth #

2

You're just trading one addiction for another

It's tempting to say that someone is addicted to something if they take it every day and need it to feel “normal.” But this isn’t correct or helpful.

Addiction is when someone can't control the behavior they wish to change, despite it having serious, negative consequences on their lives. 

People who take blood pressure or anti-seizure medications are physically dependent on their medications and need it to feel “normal.” But no one is pointing fingers and calling them addicts. Most of them would not do dangerous things to obtain the medications. 

Hear us loud and clear: Taking Suboxone, as prescribed by your doctor, is not drug abuse.

Myth #

3

You’re just using Suboxone to get high

Buprenorphine is an opioid. However, when taken as directed, it produces no euphoric effects and, even if it’s misused, the high produced from abusing it is muted compared to other opioids. 

At a consistent dose, you know it's working not because you feel high, but because you stop experiencing withdrawal symptoms, you don't feel cravings to use other opioids, your mind is clear, your mood is stable, you can sleep normally, and you have the motivation and energy to live your life.

Myth #

4

You have to go to counseling, group therapy and/or be in-person

Medication, and medication alone, works. Nobody should be mandated to participate in therapies that they don't find helpful, though people with coexisting mental health problems may find it useful. However, we do believe that a strong support system and other treatments can always be additional options with medication. 

Treatment should be on the patient’s terms. Not an outdated view of one-size-fits-all recovery.

Myth #

5

You’re on it forever and can’t taper off

The decisions of starting and stopping Suboxone are personal and vary. The most important thing is to ensure that you and your doctor are confident that you’re ready to stop taking your medication and have tools to manage life’s challenges without the support medication provides. 

Buprenorphine is shown to cause less severe withdrawal symptoms than other opioids. It stays in your system for days instead of hours. If someone stops taking it without an appropriate taper or medications to help with residual symptoms, the withdrawal will be more drawn out. 

Many people taper off of Suboxone after a long period of maintenance with it.

Myth #

6

Rehab and complete abstinence works

No. Without medication, rehab fails 90% of the time. Medication works.

Suboxone 101

How does Suboxone work?

Like other opioid drugs, buprenorphine attaches to a specific site on the nerve cell (μ-opioid receptors). However, buprenorphine activates these receptors only partially, with about half the strength of other opioids (a "partial agonist"), As such, it does not produce a high, even at higher and higher doses (a “ceiling effect”). It is, therefore, safer than medications like oxycontin or methadone. At the same time, it’s long-acting, provides stable, low-level stimulation of opioid receptors in the brain, prevents withdrawal symptoms and reduces cravings.

How is Suboxone used?

Depending on the plan that is developed by your doctor, buprenorphine/naloxone may be taken daily, twice a day, or every other day, with doses adjusted to relieve all of the symptoms of the disorder. The optimal duration of buprenorphine/naloxone treatment is still unclear, however, most experts believe that best outcomes happen with a minimum of 1 to 2 years if not indefinite treatment.

What are the possible side effects?

The most common side effects (in order of most common to least common) of daily tablets include: headaches, opioid withdrawal syndrome, pain, increased sweating, low blood pressure, and vomiting. The most common side effects seen in film formulations are tongue pain, decreased sensation and redness in the mouth, headache, nausea, vomiting, excessive sweating, constipation, signs and symptoms of opioid withdrawal, sleeping difficulties, pain, and swelling of the extremities.

How long does Suboxone stay in your system?

The half-life of buprenorphine (the active ingredient in Suboxone) is around 40 hours for most people and it takes about 6 days to remove more than 90% of the drug from the body. There is, however, some individual variability here.

Do I have to be in withdrawal to take Suboxone?

Yes, but taking the medication will make you feel better within an hour. How long you have to wait between using opioids and beginning treatment depends on several factors and can range from as short as 12 hours to up to four days. When you first start taking Suboxone, it’s important that other opioids have cleared your system to avoid precipitated withdrawal, which is worse than the withdrawal you will experience otherwise.

Will Suboxone get me high and will I get addicted to it?

If taken as prescribed, Suboxone will help you feel normal and functional. Buprenorphine, the partial-opioid agonist ingredient in Suboxone, can be abused to produce a high, though it has a much lower abuse potential than other opioids. Like anything that can change the way you feel, there is the potential to fall into a pattern of abuse. Your clinician will work closely with you to ensure that you feel stable and able to take your medication correctly.

Does Suboxone show up on a drug test, will my employer know I’m taking it?

Generally, buprenorphine does not show up as an opioid on a typical drug panel that an employer might have you do. It does depend on the test, however. If you are specifically being tested for buprenorphine, which is usually done to ensure you are taking your medication, then it will show up. 

Your employer does not have to know that you are on medication-assisted treatment unless you are asking your employer for reasonable accommodations in order to continue treatment (for example, a later start to your workday so that you can stop by the methadone clinic in the morning). Federal law prohibits discrimination against employees on medication-assisted treatment. You can learn more about your legal rights while on MAT here.

How hard is it to get off Suboxone?

The difficulty of stopping Suboxone depends on several factors. It’s important to have a solid support system and taper off of it slowly. The exact timeline will depend on what you and your medical provider decide is best for you. Many people have successfully tapered off of Suboxone without relapsing.

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