Suboxone (a common brand of buprenorphine/naloxone), is a partial opioid used in medication-assisted treatment (MAT) for opioid use disorder (OUD) to help relieve cravings (1) and withdrawal symptoms (2) without producing any euphoric effects once the stable dose is reached. This way, you can feel mentally and physically well and remain clear-headed all day. It also lowers the chances of relapse (3) and reduces the chances of overdose death by 70-80% as long as you keep taking it. (4)
It’s important to note that you DO have to be careful when taking the first dose, and it’s best to do it as directed by the prescribing provider in order to avoid a bad reaction (called precipitated withdrawal). That’s where your dedicated Ophelia care team comes in. Comprised of a prescribing clinician, nurse, and care coordinator, your team will help you get on Suboxone comfortably and safely. We’ll discuss:
- How long to wait after the last dose of an opioid you are using regularly (oxycodone, oxycontin, hydrocodone, etc)
- What medications to take during this time
- What symptoms to look out for
You do have to be in mild withdrawal in order to take Suboxone, which means waiting between 12-24 hours after last using opioids — although for short-acting opioids like heroin, you may only need to wait about 12-16 hours since they’re eliminated from your bloodstream faster than long-acting opioids like methadone (where you have to wait 17-48 hours). (5) However, if you’ve been using drugs containing fentanyl, you may need to wait longer than expected and take additional medications in the meantime.
Common symptoms of withdrawal may include diarrhea, nausea, abdominal cramps, fever/sweating, anxiety, insomnia, and muscle aches/pain/spasms, but when you progress through induction with the support and expertise of a doctor at Ophelia, you’ll be better positioned to manage these symptoms with additional medications and frequent check-ins with an experienced induction specialist.
Because of this withdrawal requirement, one of the most frequently asked questions we get is the amount of time it takes for a dose of Suboxone to kick in on that first day. Here’s what you need to know:
- It starts to work quickly — about 20-60 minutes after the first dose — and achieves its maximum effects at around 100 minutes (1 hour 40 minutes). This can be sustained for many hours. (6)
- There are two main versions of Suboxone (buprenorphine/naloxone): sublingual tablets or sublingual films. Both need to be dissolved under the tongue, but because some tablets take longer to dissolve than the strips, it can also influence how long it takes the medication to kick in.
- Buprenorphine has a longer elimination half-life than heroin and fentanyl, meaning it stays in your system for days instead of hours — an advantage when it is taken properly to help stop cravings and opioid withdrawal symptoms. Because buprenorphine stays in the system long after the dose, medications like Suboxone may be taken as a once daily dose, twice a day, or, for some people, every other day.
- Buprenorphine is a “partial” opioid agonist, which means that it activates opioid receptors but much less so than heroin or fentanyl does. Because of that, buprenorphine eliminates withdrawal and cravings without producing an opioid “high” or slowing the respiration and causing overdose.
- Buprenorphine does not show up as an opioid on a typical urine or saliva drug test that an employer might have you do, but there is a special test used during treatment to specifically detect buprenorphine.
- Most research shows that Suboxone works best when taken as a maintenance treatment for a minimum of 1-2 years. Over time, patients tend to maintain these benefits even with lower doses. That said, everyone is different and, once stabilized, should discuss the length of their Suboxone treatment plan with healthcare professionals.
- As with any treatment program, Suboxone should be prescribed as part of a comprehensive approach that also offers the opportunity for therapy, peer support, and community support groups if one finds it beneficial to talk about their experience with opioid drug use, recovery, and treatment. Prefer something more private than an inpatient treatment option? Ophelia’s got you covered.