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Suboxone Withdrawal: Symptoms & Timeline

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June 9, 2022

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Suboxone is an important Medication for Addiction Treatment (MAT) that helps people overcome problems with compulsive use of  illicit opioids, otherwise known as “opioid use disorder”, by easing cravings and withdrawal symptoms. Tapering off of Suboxone with your physician’s oversight is the safest way to stop taking Suboxone, but you can safely take this medication for months or years.

Buprenorphine, the main ingredient in Suboxone, is a partial opioid agonist. Since it binds to opioid receptors in the brain, suddenly quitting this medication can cause withdrawal.

Buprenorphine withdrawal can last for a long time since it is a long-acting medication.

timeline for suboxone withdrawal

Suboxone: A Safe Medicine for Addiction Treatment

Suboxone combines buprenorphine and naloxone to help people overcoming opioid use disorder (OUD) ease withdrawal symptoms and cravings so they can reach both physical and emotional stability.[1,2] In addition, this medication reduces the desire to use opioids over the long haul. This helps people remain in rehabilitation, with a counselor, or with another treatment program, and restore functioning in their daily lives.

The buprenorphine in Suboxone binds to the opioid receptors lasting most of the day. It doesn’t cause intoxication by virtue of its partial agonist effect. A partial agonist binds more weakly to the opioid receptor than full opioid agonists, like heroin or methadone. Buprenorphine also has a ceiling effect which means that at higher doses its effect doesn’t increase if someone takes more and more. This renders it safer than other opioid from the overdose risk perspective. Naloxone, added to the buprenorphine in the Suboxone, stops the medication from working if Suboxone is tampered with or taken inappropriately. If someone uses the Suboxone in a way other than as it is prescribed (to be administered under the tongue) naloxone will render the opioid agonist effect inert, and can even trigger withdrawal symptoms.

Although it is possible to develop a physical dependence on buprenorphine, meaning that when someone stops it suddenly they experience withdrawal, it is important to note that physical dependence is not the same as addiction. Many people who take buprenorphine or other opioid-based medications need help withdrawing from it, and it is important to work with your provider to find the best way for you to safely and comfortably taper off.

Suboxone Withdrawal Symptoms

Abruptly stopping Suboxone will cause withdrawal symptoms, like trying to quit illicit opioids “cold turkey.”[3] This is because buprenorphine is in the opioid family. It binds to opioid receptors in the brain as do other opioid drugs.
On the other hand, is it an excellent and effective choice for helping someone stop and stay abstinent from opioids, and it prevents relapse and saves lives. Therefore it is an important Medication for Addiction Treatment (MAT). When combined with counseling or psychotherapy, it is the best choice for many people struggling to recover from an opioid use disorder.

You can take Suboxone for months or years without adjusting your dose or discussing a taper. However, if you feel like you are not benefitting from Suboxone treatment anymore and would like to try tapering off of it, discuss this with your prescribing provider so you can develop a safe and comfortable tapering plan.

If you stop taking Suboxone without consulting your doctor, you will experience withdrawal symptoms including these:[4] 

  • Nausea, stomach upset, or vomiting
  • Headaches
  • Anxiety or restlessness
  • Irritability or low mood
  • Insomnia
  • Muscle aches and cramps
  • Sweating
  • Diarrhea
  • Cravings for opioids
  • Potential relapse into opioid abuse

Timeline for Suboxone Withdrawal

Buprenorphine was approved by the U.S. Food and Drug Administration (FDA) for use in opioid use disorder treatment in 2002, so the withdrawal symptoms associated with cessation of this medication have been well characterized for over20 years. 

Here is an approximate timeline of what you can expect if you abruptly cease Suboxone:

  • 1–3 days: The beginning of withdrawal is often the most physically and psychologically painful period. With buprenorphine, the first full day triggers discomfort, pain, nausea, exhaustion, anxiety, cravings, and other symptoms.

  • 4–7 days: By the end of the first week, symptom intensity will peak. This will be very physically uncomfortable, and you may feel like you have a serious flu. You are also likely to crave buprenorphine or other opioids.

  • 2–4 weeks: After 14 days to a month, the worst physical symptoms like sweating, nausea, and muscle or joint pain have likely dissipated, although you may still feel twinges from time to time. Anxiety, depression, fatigue, insomnia, and similar psychological symptoms are likely still present. This may trigger such intense cravings that you are at risk of a relapse.

  • After a month: Even after four or five weeks, you could still struggle with poor mental health, exhaustion, bad sleep quality, and other psychological problems. Cravings may still be present as well. 

How to Manage Suboxone Withdrawal Symptoms

The most commonly suggested approach to reduce the experience of Suboxone withdrawal symptoms is to slowly taper off this medicine with your doctor’s oversight.[5] A taper of between 4 and 12 weeks is recommended, but you may taper longer to keep yourself physically stabilized.

If you experience withdrawal symptoms, inform your physician. They may adjust your dose, hold you at the current dose, or offer recommendations to manage symptoms.

Mild withdrawal symptoms like minor pain or a headache can be managed with over-the-counter painkillers like acetaminophen, a hot shower, yoga, or other relaxation techniques. More serious withdrawal symptoms may involve readjusting to a slightly higher Suboxone dose, or your doctor may prescribe medications targeting specific symptoms like body aches, sweats, or insomnia, as needed.

Suboxone is a safe medicine to take as long as you can benefit from it and many people choose to stay on their maintenance dose for years after their last use of illicit opioids, without negative consequences.

Medically Reviewed By Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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Citations

  1. Important Safety Information. Suboxone.com. https://www.suboxone.com/#. Accessed February 2022. 
  2. Buprenorphine/Naloxone (Suboxone). National Alliance on Mental Illness (NAMI). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone). January 2021. Accessed February 2022. 
  3. Highlights of Prescribing Information: Suboxone. Access Data FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed February 2022. 
  4. Understanding Buprenorphine. Alcohol and Drug Support (ADIS) Health, Queensland. https://adis.health.qld.gov.au/sites/default/files/resource/file/Understanding%20Buprenorphine_Fact_Sheet_v1.6_lc_3.pdf. Accessed February 2022. 
  5. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction: A Treatment Improvement Protocol (TIP). US Department of Health and Human Services (HHS). https://www.naabt.org/documents/TIP40.pdf. 2004. Accessed February 2022.

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