Suboxone is a medication comprised of buprenorphine and naloxone. The National Institute on Drug Abuse (NIDA) states that buprenorphine is a partial opioid agonist that helps people with addiction manage cravings and stay off the opioids they have been addicted to, such as heroin, prescription opioids, or opium. People who are addicted to opioids face a challenging recovery process because opioid addiction comes with intense cravings and painful withdrawal symptoms once dependency has set in. Most addiction providers agree that medication-assisted therapy (MAT) that uses either methadone or buprenorphine is the best way to help people with opioid addictions recover and maintain sobriety.
After someone has been in recovery for a while, they may wish to stop taking their maintenance medication. Is rapid detox the best way for them to get off Suboxone, or are the risks too high?
Rapid detox from Suboxone involves putting a person under general anesthesia for the duration of the detoxification period, allowing them to sleep through the worst of the withdrawal symptoms. They are then injected with naloxone, which forces the body into rapid withdrawal from all opioids.
Rapid Suboxone treatment usually lasts from four to six hours, during which time the Suboxone is processed out of the body. When the person is awakened from the general anesthesia, the Suboxone has already metabolized out of their system.
The goal of this rapid detox process is to ensure that the patient is comfortable and safe during withdrawal and to reduce the risk of relapse during the initial detox phase. Patients are monitored closely for safety, and they can then transition to a lower level of care.
Rapid detox does come with many risks, and generally, it’s not recommended over traditional detox methods. Some of the risks include:
. As a result, it is not recommended in most cases.
Buprenorphine attaches to the opioid receptors in the brain to reduce pain during withdrawal and manage cravings. Naloxone blocks some signals to the nervous system and prevents people from obtaining the euphoric effects of opioids. Suboxone combines these drugs to help people manage their cravings while also preventing them from getting high.
Because Suboxone blocks the euphoric effects of opioids, a person on the medication would not get the same effects from opioids if they relapse, which can be a powerful motivator for people with addictions to remain sober and stay away from opioids. Research shows that Suboxone is as effective as methadone at keeping patients engaged in treatment and reducing misuse of opiate drugs.
Suboxone is a partial opiate that does interact with the opioid receptors in the brain, and people can become addicted to it. Some people remain on Suboxone for a long period as they recover from opioid addiction. However, there may come a time when a person wants or needs to come off the medication.
Research has shown that although Suboxone has abuse potential, the risks are lower than for buprenorphine alone. Detoxing from Suboxone can cause uncomfortable withdrawal symptoms just as with other opioid medications. Thus, Suboxone detox needs to be medically monitored to prevent intense and dangerous side effects or relapse.
Some people may try to taper their medication themselves and gradually lower their dosages, but this can be dangerous and cause unnecessary suffering.
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Developing a treatment plan for opiate addiction can be complex because there are so many individual factors that impact each person’s health and recovery journey.
In some cases, detoxing from Suboxone may not be recommended if the person is using it as an ongoing maintenance medication to treat opioid addiction. If the person has been abusing Suboxone, detox is likely recommended, but it requires careful supervision from a medical professional. Since Suboxone is an opioid addiction treatment medication, addressing the underlying Suboxone abuse issue is important.
Many people are concerned that if they use MAT for opioid addiction recovery, they are merely trading one addiction for another. However, opioid addiction is a long-term, chronic disorder. Addiction changes the brain and makes addiction recovery very challenging. Addressing opioid addiction without MAT results in higher relapse rates and increases the chance of a deadly overdose.
If you think the time is right to detox from Suboxone and transition to a recovery plan that does not use MAT, you should discuss this with the prescribing physician. You and your doctor can discuss what form of detox is best for you to withdraw from Suboxone safely.
Usually, doctors recommend a tapered approach where the dose of the medication is slowly lowered over weeks or months. Rapid Suboxone detox is usually not recommended because of the associated risks. You should not try to detox from Suboxone on your own. Trying to manage your withdrawal process can cause serious withdrawal symptoms that could lead to relapse.
Relapse can put you in danger of having an overdose, particularly if you have not used other opioids in a while. You have lost any previous tolerance you had, so taking your prior average dose could quickly lead to overdose.
There are currently no studies that support the use of rapid Suboxone detoxification as a safe or effective way to withdraw from the drug. Rapid detox is available in some private treatment facilities, but no available research backs up the long-term efficacy of this method.
If you do decide to detox from Suboxone, rapid detoxification is not the most effective option for your long-term recovery goals. A study from American Journal of Drug and Alcohol Abuse found that people who completed an extended (30-day) detox from Suboxone were more likely to successfully engage in and complete treatment than those who completed a brief five-day detoxification course.
This evidence suggests that a slower course of detoxification from Suboxone may set people up for a more successful long-term recovery.
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(December 2011). Can the Chronic administration of the combination of buprenorphine and naloxone block dopaminergic activity causing anti-reward and relapse potential? Molecular Neurobiology. Retrieved January 2019 from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682495/
(November 2015). Long-Term Follow-up of Medication-Assisted Treatment for Addiction to Pain Relievers Yields “Cause for Optimism”. National Institute on Drug Abuse. Retrieved January 2019 from from https://www.drugabuse.gov/news-events/nida-notes/2015/11/long-term-follow-up-medication-assisted-treatment-addiction-to-pain-relievers-yields-cause-optimism
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