Suboxone

Fact Checked by
Dr. Adam Bisaga, MD

Suboxone (generic: buprenorphine / naloxone) is a combination medication that can help reduce opioid cravings and withdrawal symptoms while protecting against relapse and overdose.

Buprenorphine is an opioid that achieves maximum effects within an hour and lasts up to 24 hours after each dose. Naloxone is included to reduce the risk of misuse, assuring better safety.

The Details

Suboxone Medical Information

About Suboxone

Suboxone (generic: buprenorphine / naloxone) is a combination medication that can help reduce opioid cravings and withdrawal symptoms while protecting against relapse and overdose.

Buprenorphine is an opioid that achieves maximum effects within an hour and lasts up to 24 hours after each dose. Naloxone is included to reduce the risk of misuse, assuring better safety.

Short term and long term health outcomes in patients with opioid use disorder are generally better with use of Suboxone than attempts at detoxification and stopping opioid use altogether.

How does it 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, 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 is long-acting, provides stable, low-level stimulation of opioid receptors in the brain, prevents withdrawal symptoms and reduces cravings.

Naloxone reverses an opioid overdose. It works by blocking the effects of opiates on the brain and by restoring breathing.

How is it 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 optimal 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.

See Additional Prescribing Information

The FACTS

Suboxone Myths

Myth #1: You’re not really in recovery if you’re on medication.

Recovery has no single definition. Everyone has to find the path that works best for them, and the decisions made along the way are very personal. Interestingly, the idea that you have to go it alone cold turkey or you’re not really doing sobriety right is often attributed to the abstinence-only policies of 12-step programs. In the Alcoholics Anonymous book Living Sober, however, it says:

“Some drugs have legitimate value and are beneficial when administered by knowledgeable physicians if used solely as directed and discontinued when they are no longer a medical necessity.”  

This aligns perfectly with the medical model of treating opioid use disorder with medications such as Suboxone. The idea that you’re not really sober, clean or in recovery when taking medication to help stems more from a misconception about what these medications actually do. 

Myth #2: Most people are just using Suboxone to get high.

Buprenorphine is indeed an opioid. However, as a partial-opioid agonist (meaning it bonds to your opioid receptors but only stimulates them to a limited extent), the high produced from abusing buprenorphine is muted compared to other opioids. Oftentimes, people are buying Suboxone on the street in an attempt to avoid withdrawal and wean themselves off of other opioids. Importantly, as a partial-agonist, you are far less likely to overdose on buprenorphine than with other opioids because it does not cause you to stop breathing, unless it is combined with other depressants, such as benzodiazepines and/or alcohol.

Myth #3: You have to go to counseling or Narcotics Anonymous.

Medication for opioid dependence helps to relieve withdrawal, stops the incessant cravings and makes it easier for someone to feel normal in terms of focus and energy levels. It’s important for everyone, not just those in recovery from opioid dependence, to have a support system throughout their lives. Counseling and groups such as NA offer that support system. Many people find tremendous benefit in having a place that they can talk about their experience with opioids and recovery. Sometimes the first step to rebuilding your life is just to get stabilized on medication so that you can function at a level that feels manageable to you. Some people find other ways to get the support they need, beyond counseling and support groups. 

Myth #4: You shouldn’t take Suboxone for very long.

The decisions of starting and stopping Suboxone are personal, medical decisions that depend on a variety of factors. The most important thing is to ensure that you and your doctor are confident that you are stable and ready to stop taking your medication. Medically, there’s no reason that someone can’t take Suboxone as long as they feel they need to. In fact, premature discontinuation of medication for opioid use disorder is dangerous, as it puts people at risk of relapsing and overdose. 

Myth #5: You shouldn’t take Suboxone for very long.

Buprenorphine is shown to cause less severe withdrawal symptoms than full-agonist opioids, such as heroin and fentanyl. It has a longer half-life, however, meaning it stays in your system for days instead of hours. This is an advantage when it is taken properly to help stop cravings and withdrawal, but if someone stops taking it without an appropriate taper, the withdrawal will be more drawn out. 

Many people successfully taper off of Suboxone after a long period of maintenance with it. See Randy Quinn’s success story on our blog for an example. When your brain becomes habituated to a substance, it is difficult to avoid the unpleasant effects of stopping that substance altogether. Your body has to go through some kind of adjustment to its absence, which is what we know as withdrawal. The same is true for antidepressants and other common medications. The key is to work with your healthcare provider to ensure that you are tapering the medication at the right pace—and that you have the tools to deal with any unpleasant side effects that may arise. 

THE REST

Frequently Asked Questions

Q: Do I have to be in withdrawal to take Suboxone?

A: 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.

Q: Will this get me high and will I get addicted to it?

A: 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.

Q: Does Suboxone show up on a drug test and does my employer need to know that I’m taking it?

A: 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

Q: How hard is it to get off of Suboxone? 

A: 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. 

Important Safety Information

Contraindications

Buprenorphine is contraindicated in patients who are allergic to it. Patients with true allergic reactions to naloxone should not be treated with the combination buprenorphine/naloxone product. Allergy to naloxone is infrequent.
Some patients may falsely or mistakenly claim an allergy to naloxone and request buprenorphine monoproduct. Carefully assess such claims and explain the differences between an allergic reaction and symptoms of opioid withdrawal precipitated by buprenorphine or naloxone; the monoproduct has more abuse liability than buprenorphine / naloxone.

Precautions and Warnings

Respiratory depression and overdoses
are uncommon in adults, but they do happen. Most fatal overdoses involve IV buprenorphine misuse or concurrent central nervous system depressant use, including high doses of benzodiazepines, alcohol, or other sedatives. However, fatal overdoses have been reported in opioid-naïve patients treated with 2 mg buprenorphine for pain.

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