Suboxone is a brand name medication commonly prescribed by clinicians to treat opioid use disorder (OUD).
Suboxone is a combination of two medications: Buprenorphine and Naloxone. Buprenorphine is a partial opioid agonist, and helps relieve symptoms of opioid withdrawal, suppress cravings, and reduce overdose risk. Naloxone prevents the medication from being injected or misused.
Buprenorphine acts like a partial opioid in the brain, which is different from methadone, oxycodone, heroin, and fentanyl which are considered “full” opioids. 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. 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 brand name Narcan) is an opioid antagonist, which means it blocks opioids in the brain. The combination of buprenorphine with naloxone discourages misuse of the medication.
What are the side effects of Suboxone?
All medications have potential side effects, and the same is true for Suboxone. Common Suboxone effects are similar to those of full opioid agonists, although might even be less so for individuals who are used to the effects of opioids. Common side effects include nausea, headache, dizziness, fatigue, insomnia, sweating, and stomach cramps.
As with any new medication, we recommend patients refrain from driving or engaging in other potentially hazardous activities until they have been stable on a proper dose of the medication. Once a patient feels well on a proper dose, the use of Suboxone as prescribed should cause no activity limitations.
Should I take Suboxone strips (AKA Suboxone films) or Suboxone pills (AKA Suboxone tablets)?
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. Both the pills/tablets or the films/strips are designed to be dissolved under the tongue.
Insurance companies often dictate which formulation (films vs tablets) is covered, thereby determining the type of prescription.
At the end of the day, both tablets and pills are equally 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 do I take Suboxone?
How to use the sublingual Suboxone pills (AKA Suboxone tablets):
- Drink water before taking the tablet(s) to help moisten your mouth.
- Do not cut, crush, chew, or swallow the tablet(s).
- Place the tablet(s) beneath the tongue and keep there until completely dissolved. This generally takes less than 5 minutes.
- If you take 2 or more tablets at a time, place all tablets in different locations beneath the tongue.
- Do not eat or drink anything until the tablets are completely dissolved.
How to use the sublingual Suboxone strips (AKA Suboxone films):
- Drink water before taking the strip(s) to help moisten your mouth.
- Do not cut, chew, or swallow the strip(s).
- Place the strip(s) beneath the tongue and keep there until completely dissolved. This generally takes less than 5 minutes.
- If you take 2 or more strips at a time, place the films in different locations beneath the tongue.
What is the Suboxone spit trick?
You may have some chalky residue left in your mouth after the Suboxone dissolves. You can either swallow this residue or, if it bothers your stomach you can also spit it out (the “spit trick”).
What are the alternatives to Suboxone?
FDA approved Medication for opioid use disorder (MOUD) includes three options: 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 OUD, medication for OUD 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 as a substitute for the other opioids the person is using. In this way, it prevents unpleasant withdrawal symptoms and the urge to continue to use other opioids.
What are the differences Between Methadone and Suboxone?
There are some advantages to Buprenorphine/naloxone (Suboxone) as compared to Methadone. First, Suboxone has a lower risk for sedation and overdose when taken as prescribed, as compared to Methadone which can cause an overdose. Suboxone can also be prescribed by any licensed physician whereas Methadone can only be dispensed at a special clinic (outpatient treatment program).
What is Naltrexone for OUD?
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” that prevents a person from getting high or potentially overdosing if they use opioids after taking this medication. In contrast to Methadone and Suboxone, it is NOT an opioid agonist and therefore doesn’t reduce actual cravings or withdrawal symptoms. For these reasons, it does not always work as effectively as Suboxone or Methadone for OUD, but can be considered as an alternative to Methadone or Suboxone in patients who cannot tolerate Suboxone or Methadone.
When should I start taking Suboxone?
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”. Precipitated withdrawal occurs when other full opioids are in the body and then a dose of Suboxone is taken too soon. When this happens, the buprenorphine in Suboxone kicks the full opioids off of their receptors and all of a sudden a person goes from a state of full opioid agonism to partial opioid agonism quickly, and they can experience uncomfortable symptoms of withdrawal such as nausea, GI distress, dizziness, shakiness, dysphoria, etc.
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:
- 12-24 hours for short-acting opioids (heroin, oxycodone, Percocet, Vicodin, Dilaudid);
- 36 hours for intermediate-acting opioids (fentanyl, Oxycontin, MS Contin); and
- 48-72 hours for long-acting opioids (methadone).
Bear in mind that these are estimates and can vary greatly from person to person.
What are common opioid withdrawal symptoms?
Withdrawal symptoms include the following:
- Muscle aches
- Runny nose
- Excessive sweating
- Inability to sleep
- Abdominal cramping
- Goosebumps on skin
- Nausea & vomiting
- Blurry vision
- Rapid heartbeat
- High blood pressure
You can read more about opioid withdrawal here.
Opioid withdrawal symptoms are uncomfortable. In addition to methadone or suboxone, there are opioid withdrawal treatments your medical provider can prescribe to help relieve the symptoms of withdrawal.
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.
While these “adjunctive” medications can be helpful, Methadone and Suboxone are still considered to be the preferred and most effective medications to treat opioid withdrawal.
At Bicycle Health, you’ll work with your medical provider to develop a personalized and safe home initiation plan. In addition to your provider, you’ll also be supported by our Bicycle Health Clinical Support Specialists and Behavioral Health Coordinators.
Wondering if Suboxone treatment might be able to help you reclaim your life from opioid misuse? Call us or schedule an appointment here. We’d love to walk with you as you re-shape your life’s path.
How long does Suboxone stay in the system?
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 are less common but are available for certain individuals and have varying half-lives in your bloodstream.
Can you get high on Suboxone?
It’s very hard to get “high” on Suboxone as compared to full opioid agonists, although it is possible. The people who might experience a little bit of a “high” are most commonly those who’ve never used opioids (“opioid naive”). For these folks, when a partial opioid agonist like buprenorphine is introduced, it might produce some euphoria. The more your body is accustomed to opioids, the less likely you are to experience feelings of euphoria.
Can you overdose on Suboxone?
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. In the majority of cases where overdose death occurs when Suboxone has been taken, it has been taken in combination with other respiratory depressants such as Benzodiazepines. Thus, there is some risk of overdose when used in conjunction with other substances, however rare.
Does Suboxone show up on drug tests?
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 for having a drug test that is positive for Buprenorphine.
Is it safe to taper/stop Suboxone?
Medication for opioid use disorder (MOUD) is critical to recovery. Research shows that 75% of patients who start on medications for OUD 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.
Thus, we do not recommend patients stop taking Suboxone until they have been in sustained, long term remission. Addiction is a chronic condition, and many individuals may require 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, and should be permitted to do so.
However, if patients are adamant that they’d like to wean off Suboxone for whatever reason, our providers at Bicycle Health can help to do so as safely as possible to prevent relapse and continue to promote recovery.
How Often Is Suboxone Used in Treatment Programs?
Very commonly! Suboxone can ease your drug cravings, allowing you to focus on therapy and other psychosocial aspects of recovery.
Don't let myths and misconceptions keep you from the treatments that could help you leave your addiction behind. If you need help, you deserve to get it.
How Effective Is Suboxone for the Treatment of Opioid Use Disorder?
Suboxone is remarkably effective at keeping people in drug treatment programs. In a study comparing buprenorphine to placebo, 100% of people taking placebo dropped out, whereas 75% of those on Suboxone stayed with therapy. The longer you stay in treatment, the more you can develop the skills to resist relapse.
Suboxone alone can't treat your opioid use disorder fully; you must learn how to deal with temptation, build a community of supporters, and otherwise change your life. A medication can't do all that for you, but it can help stabilize you enough to begin the work of recovery.
Since Suboxone helps you to focus on your recovery, you can make real progress without worrying about opioid withdrawal symptoms or cravings. This can make a big difference in your recovery.
Learn more about how Suboxone treatment can work for you—without ever stepping into a clinic.