What is buprenorphine / naloxone (Suboxone)?

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.

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.

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.

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.

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.

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.

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.

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.