Suboxone is a brand name medication commonly prescribed by clinicians to treat opioid use disorder, and it’s a combination of two medications: buprenorphine and naloxone.
Buprenorphine helps relieve symptoms of opioid withdrawal, suppresses cravings, and reduces overdose risk. Naloxone prevents the medication from being injected or misused. The FDA has also approved generic versions of Suboxone.
Buprenorphine acts like a partial opioid in the brain, which is different from methadone, oxycodone, heroin, and fentanyl. Because buprenorphine is a partial opioid, it reduces opioid cravings and withdrawal, but it does not result in the euphoric symptoms, or “high,” that people experience with full opioids. And further, because buprenorphine is a partial opioid, it has a ceiling effect—this means that after a certain dose, there is no additional opioid effect, which ultimately decreases the risk for overdose.
Naloxone (commonly known as Narcan) is an opioid antagonist, which means it blocks opioids in the brain. The combination of buprenorphine with naloxone discourages misuse of the medication.
All medications have potential side effects, and the same is true for Suboxone. Fortunately, Suboxone side effects are uncommon and tend to be mild. Common Suboxone effects include nausea, headache, dizziness, fatigue, insomnia, excessive sweating, and stomach cramps.
As with any new medication, we recommend patients refrain from driving or engaging in other potentially hazardous activities until they know how their bodies will react. Otherwise, the use of Suboxone as prescribed causes no activity limitations.
Although Suboxone typically comes in a film formulation (strips), you can find generic buprenorphine/naloxone in tablet form as well (pills). Suboxone films/strips and tablets/pills are equally effective for the treatment of opioid use disorder, including cravings, withdrawal, and overdose prevention. Films and tablets have the same strength, and one is not stronger than the other.
Insurance companies often dictate which formulation (films vs tablets) is covered, thereby determining the type of prescription. A couple pertinent points:
At the end of the day, both tablets and pills can be effective in recovery. Which one you choose will be a decision you and your doctor will make together - taking into account your past medical history and what's covered under your insurance.
How to use the sublingual Suboxone pills (AKA Suboxone tablets):
How to use the sublingual Suboxone strips (AKA Suboxone films):
You may have some chalky residue left in your mouth after the Suboxone dissolves, and this is where the Suboxone spit trick comes in. Spit out the Suboxone saliva (after the film/tab is completely dissolved), then you may want to rinse and spit again. Suboxone is absorbed beneath your tongue, so it’s perfectly fine to spit afterwards.
Medication for opioid use disorder (MOUD) includes buprenorphine, methadone, and naltrexone—all of which act to reduce opioid cravings, withdrawal symptoms, and overdose risk. Buprenorphine is one component of Suboxone.
Buprenorphine, methadone, and naltrexone are approved by the United States Food & Drug Administration (FDA) for this purpose, and MOUD is most effective when used in conjunction with counseling and psychosocial support.
Methadone is a long-acting opioid agonist, which means that it resembles other opioids like oxycodone, heroin, and fentanyl. It functions by saturating opioid receptors in the brain, ultimately blocking, or blunting, the effects of other opioids. When compared to methadone, buprenorphine has many advantages:
Naltrexone is an opioid antagonist that saturates opioid receptors in the brain, which prevents individuals from experiencing the euphoric effects of drugs like heroin or fentanyl. It is essentially a “blocker” and reduces cravings for both opioids and alcohol.
It’s important to wait until you feel mild-to-moderate withdrawal symptoms before taking your first dose of Suboxone. Otherwise, you might go into what is known as “precipitated withdrawal,” meaning you may experience intense withdrawal symptoms very suddenly, which can be uncomfortable and, in certain cases, dangerous.
The opioid withdrawal timeline varies based on your level of tolerance, typical substance, and dose. In general, patients should wait the following number of hours before Suboxone induction:
Withdrawal symptoms include the following:
You can read more about opioid withdrawal here.
Opioid withdrawal symptoms are uncomfortable, but there are opioid withdrawal treatments your medical provider can prescribe to help relieve these symptoms. Clonidine helps reduce anxiety, irritability, muscle aches, sweating, and runny nose. Loperamide (Imodium) helps relieve diarrhea. Bentyl helps relieve gastrointestinal (GI) symptoms, especially abdominal cramping. And lastly, once you start the induction and stabilization phase with Suboxone, you will experience significant reduction and relief from withdrawal symptoms.
At Bicycle Health, you’ll work with your medical provider to develop a personalized and safe home induction plan. In addition to your provider, you’ll also be supported by our Bicycle Health Clinical Support Specialists and Behavioral Health Coordinators.
Buprenorphine/naloxone (Suboxone) stays in your system for 28-42 hours after sublingual administration (under the tongue), which is the most common route for Suboxone treatment. Intramuscular, intravenous, and transdermal formulations have varying half-lives in your bloodstream.
It’s very hard to get “high” on Suboxone. The people who might experience a little bit of a “high” are those who’ve never used opioids and/or have NO opioids in their system… for these folks, when a partial opioid agonist like buprenorphine is introduced, it might produce some euphoria. However, this is not true for patients with active opioid use disorder who are accustomed to full opioid agonists (e.g., oxycodone, heroin, fentanyl) in their system.
Buprenorphine/naloxone (Suboxone) has a ceiling effect when it comes to respiratory depression. Because of this, Suboxone is considered very safe and low-risk for overdose when used alone. All overdose incidences while Suboxone was in the system involved high doses of benzodiazepines, and thus, there is some risk when used in conjunction with other substances.
Buprenorphine is not part of the standard drug screen. So, for buprenorphine/naloxone (Suboxone) to show up on a urine drug screen, it must test specifically for buprenorphine. If you’re prescribed Suboxone by a medical provider, then you have legal protections from employment discrimination.
Medication for opioid use disorder (MOUD) is critical to prevent overdose and death. Research shows that with MOUD, 75% of patients will still be in recovery one year later. Conversely, studies demonstrate that within one month of stopping buprenorphine treatment, more than 50% of patients relapse to illicit opioid use. Benefits of Suboxone include helping patients to feel normal and healthy, and when taken as prescribed by a medical provider, it treats addiction and does not cause the negative impacts of uncontrolled substance use on one’s life, goals, and daily functioning.
Thus, we do not recommend patients stop taking Suboxone. Addiction is a chronic condition, and because of that, we recommend long-term use of Suboxone. Just like patients with diabetes or high blood pressure must take daily medications to stay healthy, patients with addiction must do the same. Our program at Bicycle Health is a long-term, continuous program that supports patients over months-to-years, which is supported by evidence-based medicine. You can learn more here about why Suboxone is NOT “just trading one drug for another.”
However, if patients are adamant that they’d like to wean off Suboxone—despite knowing the risks—our providers at Bicycle Health help patients to develop the safest possible treatment plan while also assisting patients in meeting their goals for recovery.