Suboxone is a common medication used to manage opioid dependence. It contains four parts buprenorphine (a partial opioid agonist) and one part naloxone (an opioid antagonist). As an opioid combination drug, Suboxone use can lead to drug dependence.
Long-term use of Suboxone can alter brain chemistry. When the drug is not active in the bloodstream, withdrawal symptoms and cravings appear. Buprenorphine has a long half-life of between 24 hours and 42 hours, which means it can stay active in the brain for a few days.
When active, it binds to opioid receptors and elevates the brain’s dopamine levels, which, in turn, affects mood, thinking abilities, sleep functions, and movement capability. Opioids like buprenorphine also depress functions of the central nervous system. This means breathing rate and heart rate both slow and blood pressure and body temperature lower.
Even though buprenorphine has a ceiling effect, where its effects plateau after a certain amount is ingested, it is still a target for abuse. The National Survey on Drug Use and Health (NSDUH) publishes that in 2016, about 0.3 percent of the U.S. population misused a buprenorphine product.
Misuse of Suboxone can increase drug dependence and, therefore, the associated withdrawal symptoms. Since withdrawal from Suboxone can be so significant, it is not a drug that should be stopped suddenly. Instead, it should be tapered off slowly to allow a gradual adjustment for the brain and body.
The safest way to taper off Suboxone is through a medical detox program. In this program, trained medical professionals can determine the level of Suboxone dependence and work to lower levels of the drug in a safe and controlled manner to keep the body and brain stabilized.
Other medications can be used to help with drug cravings and withdrawal symptoms as well. Vital signs and emotional well-being can be closely monitored, and the environment is supportive and calm with around-the-clock supervision and care.
When tapering off Suboxone, it is vital to be honest regarding the following:
The starting dose of Suboxone during a taper will be different for everyone and is based on how dependent the brain and body are on the drug. Once this is established, the drug’s dosage can be lowered a little bit at a time over several days or weeks — again, this is related to the level of dependence. With a higher level of Suboxone dependence, the starting dosage of the taper will need to be higher, and the overall weaning process will need to be longer.
During a taper, Suboxone should generally be lowered in increments of 2 mg at a time every few days. If at any point withdrawal symptoms or drug cravings become more intense, the dosing may need to be readjusted, or the taper slowed. It may be necessary to go back to a previous dosage level to stabilize or to increase the amount of time in between when doses are reduced. Suboxone dosages can then be lowered again every two to three days until no more is needed and the drug is entirely out of the body.
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Withdrawal from an opioid drug can be physically and emotionally difficult, which is why the drug is tapered off during a specific period rather than stopped suddenly. In the case of Suboxone withdrawal, symptoms will generally start a few days after stopping the drug. The U.S. National Library of Medicine (NLM) warns that the following side effects are common during opioid withdrawal:
Since Suboxone contains an opioid drug that suppresses some of the functions of the central nervous system, if that drug suddenly leaves the body after a level of dependence has formed, then those functions can become hyperactive. Heart rate, body temperature, breathing rate, and blood pressure can increase. Depression, trouble with thinking clearly, memory issues, problems with concentration, and drug cravings are all side effects of Suboxone withdrawal.
Significant drug cravings that occur during withdrawal can make a relapse likely. Introducing other opioids, or altering and injecting Suboxone, can activate the dormant naloxone component, which can then precipitate withdrawal symptoms, and they can be even more intense when brought on this way.
Naloxone essentially kicks opioids off the receptors in the brain, and intense withdrawal can start immediately.
A return to opioid use after a period of withdrawal can be especially risky, as the brain and body had some time to regulate without the drugs. Going back to using drugs at the same rate as before can be toxic and trigger a life-threatening overdose. The U.S. Department of Health and Human Services (HHS) publishes that every single day more than 130 people die from an opioid overdose in the United States.
There are several things you can do to make detox more manageable.
Again, the optimal method for tapering off Suboxone is through a medical detox program. These programs offer support and encouragement 24/7 as well as medical and mental health care, including medications to address withdrawal symptoms. A medical detox program can manage any complications as they arise and can even help with cravings, often through the use of other medications and/or supplements.
Keep these things in mind to ease the withdrawal process:
A Suboxone taper should be controlled, slow, and closely monitored by a trained professional. Pay attention to your body and mental state, and be honest about how you are feeling. This can help to ensure that dosage levels remain safe and the chemical balance in the brain is maintained at a stable level.
(March 2016). A Brief Review of Buprenorphine Products. Pharmacy Times. Retrieved September 2018 from https://www.pharmacytimes.com/contributor/jeffrey-fudin/2016/03/a-brief-review-of-buprenorphine-products
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
Dosing Guide for Optimal Management of Opioid Dependence. National Alliance of Advocates for Buprenorphine Treatment (NAABT). Retrieved September 2018 from http://www.naabt.org/documents/Suboxone_Dosing_guide.pdf
(August 2018). Opioid and Opiate Withdrawal. U.S. National Library of Medicine. Retrieved September 2018 from https://medlineplus.gov/ency/article/000949.htm
(July 2018). Treatment and Recovery. National Institute on Drug Abuse. Retrieved September 2018 from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
(September 2018). What is the U.S. Opioid Epidemic? U.S. Department of Health and Human Services. Retrieved September 2018 from https://www.hhs.gov/opioids/about-the-epidemic/index.html