What is Suboxone?

Our guide to this life-changing medication, the good, the bad and its alternatives.

What is Suboxone? What is it used for?
Suboxone is the most well known brand name medication used to treat opioid dependence. It typically comes in the form of strips that should be placed under the tongue (sublingual). Suboxone is a combination of two medications: Buprenorphine and Naloxone. Buprenorphine helps relieve symptoms of opiate withdrawal and suppresses cravings. Naloxone prevents the medication from being injected or misused. The FDA has also approved generic versions of Suboxone.

Suboxone (Buprenorphine) is FDA-approved for the treatment of opioid addiction

How Does Suboxone Work? What does Suboxone Do?
Suboxone is a combination of two medications: Buprenorphine and Naloxone. Buprenorphine is a partial opioid agonist. A fancy way of saying that it works just like other stronger opioids (prescription pain pills, heroin etc.), but produces a milder effect. It also has a ceiling effect - taking more of it doesn't get you a bigger high! Hence, Buprenorphine helps keep with withdrawal symptoms away without producing strong feelings of euphoria. It also stays in the brain for a few days and, while it's there, blocks any other opioids (like prescription pain pills, heroin, etc.) from doing their job. Naloxone prevents the medication from being injected or misused.

Together, Buprenorphine and Naloxone make the ideal medication to treat opioid dependence (or opioid addiction). They trick the brain into thinking you are using opioids while actually allowing you to function just like any other individual.

What are the side effects of Suboxone?
The most common side effects of Suboxone include headache, constipation, dry mouth, nausea, vomiting, sweating, trouble sleeping, excessive sleepiness, blurred vision, dizziness and more. Many of these symptoms can be effectively managed through medication and/or simple lifestyle changes. Learn more on Healthline.

Suboxone tablets or Suboxone strips? Which is the best formulation.
Although Suboxone typically only comes in a film formulation (strips), you can find generic Buprenorphine/Naloxone in tablet form as well (pills). Research says that Suboxone film may be more effective than tablets because it takes less time to dissolve into your system. The tablets also taste much worse than the strips. Some people however, claim the tablets work better and that the Suboxone strips cause nausea. 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.

What are the alternatives to Suboxone?
The FDA has approved many Buprenorphine based medications to treat opioid dependence, including Suboxone. Here are a few of the most common ones:

  • Bunavail (buprenorphine and naloxone) buccal film: Bunavail uses BDSI's proprietary BioErodible MucoAdhesive (BEMA) delivery technology, also called a buccal film, which adheres to the inside of the cheek. Bunavail has double the bioavailability of Suboxone Film (and generics) and as a result only half the buprenorphine is required per dose. The lower dose may reduce side effects, such as constipation.
  • Zubsolv (buprenorphine and naloxone) sublingual tablets: Zubsolv comes in tablet form that is supposed to be consumed by placing it under the toungue. It has a higher bioavailability than Suboxone and as a result comes in different doses than Subxone or generics. Hence, it comes in sizes of 5.7-mg/1.4-mg (buprenorphine/naloxone), and 1.4-mg/0.36-mg (buprenorphine/naloxone) both have equal bioavailability to 8mg/2mg and 4mg/1mg of competing buprenorphine/naloxone products, respectively.
  • Generic Buprenorphine/Naloxone sublingual tablets: A generic version of Suboxone that is typically the cheapest Buprenorphine/Naloxone medication on the market. It comes in a tablet form that is supposed to be consumed by placing it under the toungue.

Using Suboxone

What's the safest way to take Suboxone?
Suboxone is a powerful medication. It is important to take it exactly as prescribed by your doctor. Here are some general guidelines on how one should take suboxone.

You must wait until you are withdrawing (kicking) from opioids (heroin, pain pills, etc.) to start taking Suboxone. If you start Suboxone before you are in withdrawal from opioids, it will precipitate withdrawal. It should take at least 12 hours since you used heroin or opioid pain pills (oxycontin, vicodin, etc.) and at least 24-48 hours since you used methadone.

Wait it out as long as possible. The worse you feel when you begin the medication the better it will make you feel and the more satisfied you will be with the whole experience. You should have at least 3 of the following signs and/or symptoms:

  1. Anxiety/Restlessness
  2. Joint and bone aches
  3. Chills or “goose-bumps”
  4. Heart going fast, or pounding
  5. Nausea/Vomiting/Diarrhea
  6. Runny nose/teary eyes
  7. Yawing

When you think it is time to start Suboxone, here is what you should do:
  1. Take everything out of your mouth (gum, etc.)
  2. Sit or stand, but don’t lie down
  3. Take a sip of water to wet your mouth and tongue, then swallow the water or spit it out
  4. Put one tablet or film of Suboxone under your tongue. Do not swallow it or suck on it. Even if it does not taste good, it is important that you let it sit under your tongue until it is completely dissolved. Do not talk while the tablet/film is dissolving, just sit still and wait.
Remember - this is just a rough guide. Always follow your doctor's instructions while taking Suboxone.

How much Suboxone should I take?
How many mg of Suboxone you take depends on how much opioids you had been using in the past, and the length of time you had been using it for. Here's a rough guide:

  1. Make sure you are in withdrawal before starting Suboxone. Start with a small dose - say 2mg. You could break a film or tablet in half if you need to.
  2. Put the Suboxone film or tablet under your tongue and let it dissolve completely. You should start to feel some effect in about 20 - 45 minutes.
  3. Usually, you will feel a little better, or at least, no worse. If you feel worse, it means you started taking it too soon. Stop taking Suboxone for a couple of hours, and then try again; or contact your doctor for advise.
  4. If you felt better or the same after the first dose, you can take another dose (the same amount as the last one) in about 1 - 3 hours after the first dose. Dissolving it the same way that you did before under the tongue.
  5. You can repeat this one more time in another 3-6 hours after your second dose if you continue to feel lousy.
  6. Don't take more than 6mg on your first day. Most people feel better after 2-6mg on the first day. If you still feel lousy after 6mg, contact your doctor for advise.
Your dose on Day 2 depends on how much you took on Day 1.
  1. If you felt fine after waking up on Day 2, then take the total Day 1 dose on Day 2.
  2. If you took a total of 2mg on Day 1 and felt some withdrawal after waking up on Day 2, then try starting with 4mg on Day 2. Later in the day on Day 2, see how you feel. If you feel fine, there is no need to take more. If you still feel withdrawal, consult your doctor.
  3. If you took a total of 4mg on Day 1 and felt some withdrawal after waking up on Day 2, then try starting with 6mg on Day 2. Later in the day on Day 2, if you still feel withdrawal - consult your doctor.
  4. If you took a total of 6mg on Day 1 and felt some withdrawal after waking up on Day 2, ask your doctor for advise.
As you can see, we recommend working with a doctor when you start Suboxone. Taking the wrong dose and/or at the wrong time can cause severe withdrawal and other side effects. An experienced physician to help you find the right dose to start with. And help you titarate it to get to a dose that works for you.

The right dose of Suboxone every day will help you keep withdrawal away without the high - hence allow you to spend time on other activities on the journey to getting opioid free.

How long does Suboxone stay in the system?
This varies person to person. Typically, half of the dose of Suboxone is excreted out within 48 hours. But it might take up to 10 days to full get Suboxone out of your system.

Can you get high on Suboxone?
Short answer - yes. Since Suboxone contains opioids, you can use it to get high. However, Suboxone will provide a very dissapointing high.

Firstly, it produces very mild euphoria (compared to heroin or opioid pain medications). Secondly, Suboxone has a ceiling effect - taking more will not produce a greater effect. Hence, Suboxone is a safe medication to help people control their opioid dependence. After a succesful Suboxone Taper (described below), one can stop using opioids altogether with minimal physical withdrawal/pain in the process.

Can you overdose on Suboxone?
Short answer - yes. But only if it is used improperly, or in combination with other sedatives. If Suboxone is used exactly as prescribed while following your doctor's instructions, there is a very very low chance of overdose.

Does Suboxone show up on drug tests?
Usually not. Unless the conductor of the test (your provider or employer) is specifically looking for Suboxone.

Stopping Suboxone

Since Suboxone contains Buprenorphine, which is an opioid, stopping Suboxone abruptly can cause withdrawal symptoms. Many people ten to be afraid of withdrawal symptoms, having experienced them in the past. And hence are hesitant of going cold turkey. Fortunately, there is another way.

A Suboxone taper is essentially decreasing the dosage of your Suboxone medication by a very small amount over a period of time. The plan is to sliver off a piece small enough that it's not noticeable and there is no pain from withdrawal.

The taper might be slow initially - starting with a small decrease for the first month or two. Then a little bit more for the next couple of months. And so on. A taper gives the mind and body time to adjust to the new normal while avoiding any added stress and pain.

During the medication taper, your doctor needs to be mindful of any changes in your lifestly or symptoms that might arise - decrease in sleep or energy, increased in pain or stress, changes in mood or emotions, etc. Taking these into account, your doctor can advice you on whether you should stay at the current dose or go down by a little bit more.

A succesful taper can take many months and is different for every individual. However, the reward of not using any opioids is worth the journey! Doing a taper or not is an individual choice and we work with you to find a treatment plan that suits you the best.

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