Choosing a medication can be challenging for people dependent on opioids. Buprenorphine/naloxone (Suboxone) is one of several options available for opioid use disorder (OUD).
Addressing your OUD with medications is always a smart idea.
In general, people benefit from Suboxone if they have an OUD and are serious about staying away from opioids.
Why Choose Suboxone?
Suboxone is an FDA approved treatment for opioid use disorder that has helped many people bring their addiction under control and return to the life they want to lead.
Physical stabilization with medications like Suboxone helps to create the space to address underlying issues that contribute to opioid misuse in the first place, including mood disorders (anxiety/depression), chronic pain, or PTSD.
Who Is a Candidate for Suboxone Treatment?
Suboxone is a powerful therapy that can help you get your life back on track. People who benefit from this treatment have the following traits and characteristics.
Opioid Use Disorder
Suboxone helps people struggling with opioids, such as these:
- Pain pills (oxycodone, hydrocodone, tramadol, and other prescription painkillers)
If you’ve tried to quit opioid misuse before without medications and have gone back to using, MAT and Suboxone might be a great choice for you.
A Willingness to Achieve Sobriety
You should follow your doctor’s recommendations carefully and take your medication as directed. This form of therapy is a commitment, which means showing up to your scheduled appointments and taking your medication on a daily basis as prescribed, as well as participating in other forms of help including therapy, support groups, etc. as discussed with you and your treatment team.
Tolerance for Side Effects
Like any medication, Suboxone has the potential for side effects. The most common issues people experience are headaches, nausea, dizziness or stomach upset. Most of these effects are temporary and go away after your body becomes accustomed to the medication after a few days. Some people don’t have difficulty at all, but others have an uncomfortable adjustment period to the drug. If you’re intolerant of these issues long term, the drug may not be right for you. However, if the symptoms are mild and tolerable, stick it out! The long term benefit will be worth it.
Who Shouldn’t Use Suboxone?
While Suboxone treatment is effective for many people with opioid use disorder, not everyone is an ideal candidate for this kind of treatment. MAT might not be right for people with certain health issues  Your doctor can review your health history and order any appropriate testing before determining if Suboxone is right for you.
People With a Complicated Recovery Path
If you’ve tried Suboxone before and you had good support and follow-up care, but you relapsed anyway, Suboxone may not be the right medical choice for you. In those cases, methadone (a long-acting substitute opioid) or Vivitrol (an injectable opioid blocker) are two other FDA approved medications that are also options for you.
People Allergic to Suboxone
Allergies to Suboxone are extremely rare. However, it is possible to be allergic to any medication, including Suboxone. A true Suboxone allergy might produce hives, anaphylaxis, and swelling in the throat, lips, or eyes. Anyone who has experienced this with Suboxone should avoid taking it again unless they are under close medical supervision.
Special Circumstances That Impact Your Care
Suboxone therapy typically lasts for months, if not indefinitely. You’ll need time to recover from your addiction, and your medication will be a constant as you learn to live without opioid misuse. Some people enter treatment programs under special circumstances that demand a tailored approach, including:
Opioid Dependence During Pregnancy
Pregnant women must have access to care for opioid use disorder due to high relapse rates during pregnancy and opioids’ potential harm to the baby. Historically, a medication called subutex was used instead of Suboxone during pregnancy because the teratogenicity of the Naloxone component of Suboxone was not well understood. However, nowadays Naloxone (and correspondingly, Suboxone) is thought to be very safe during pregnancy, and most doctors support continuing Suboxone therapy during pregnancy for women with a history of OUD.
Severe Chronic Pain
The main ingredient in Suboxone (buprenorphine) is actually a pain medicine, and many patients with chronic pain benefit from Suboxone treatment. In fact, there is a form of Buprenorphine that comes in a patch form called Butrans that is FDA approved to treat chronic refractory pain.
Many patients become dependent on opioids after an illness or injury for which they received opioids. Many people with chronic pain find that their symptoms improve with buprenorphine. Therefore if you have a chronic pain condition and are also looking for treatment for OUD, Suboxone may be particularly beneficial for you to treat both OUD and pain.
Should You Get Treatment with Bicycle Health?
Doctors at Bicycle Health use telemedicine to deliver MAT.
Previous participation in Suboxone programs does not exclude an individual from treatment with Bicycle Health, especially if the treatment was working but interrupted by incarceration, a provider leaving, or COVID-19. Restarting Suboxone with a telemedicine provider can help overcome barriers and increase the chance of success.
Bicycle Health uses standard criteria to determine if a person has a dependence versus similar issues that can confuse a diagnosis, such as poorly controlled chronic pain. If you are unsure if you meet the criteria for addiction, please contact Bicycle Health to discuss with our staff.
Untreated Severe Mental Illness
Every patient deserves the best care for overlapping addiction and mental health issues. Patients with mood disorders (anxiety/depression), trauma or post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), and similar psychiatric issues may do very well with Bicycle Health’s services.
Because Bicycle Health does not offer complex psychiatric services, individuals with more severe or untreated psychiatric disorders (such as hallucinations or mania) may benefit more from an intensive program that can provide diagnosis and medications for more complex psychiatric issues. Please contact Bicycle Health to speak with our staff if you are unsure where you fall on this spectrum.
Length of Care
Some people reach out to us and ask about using Suboxone to get sober in the first few days to weeks and then discontinue medications. While this is an option and ultimately a valid option for some individuals, we recommend longer term therapy for most individuals. Short Suboxone tapers used to detox from opioids are comparatively less effective for long term recovery than sustained treatment.  Most people who attempt rapid tapers return to opioid misuse quickly. The optimal length of treatment varies from person to person, but short tapers benefit very few. If you are unsure about the optimal treatment length, please talk to our staff about this process.
Medically Reviewed By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
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