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How Is Suboxone Used in Opioid Detox?

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Suboxone is used  both in opioid detox during the first days after quitting opioid use, and during maintenance treatment, when prescribed as a component of an addiction treatment program. This is because it both reduces withdrawal symptoms, short-term and reduces craving and prevents relapse, long-term.

During detoxification, Suboxone alleviates uncomfortable withdrawal symptoms and reduces sweats, nausea, chills, pain, and diarrhea. In addition it physically and emotionally stabilizes a person who is trying to recover from an opioid use disorder and helps them stay away from opioids over months to years.

Suboxone is relatively safe and, despite some potential side effects, can be continued for months or years, usually without major adverse consequences. However, tapering off Suboxone is possible, too, with a doctor’s oversight.

Suboxone as Part of Opioid Detox

The term “detox” refers to detoxification, and is the part of treatment that happens during the early stages of recovery from addiction. During the initial days after quitting most substances of abuse, people who have developed a physical dependence will go through withdrawal. Withdrawal from opioids is not life-threatening but it can be very uncomfortable, both physically and emotionally.

Suboxone is well established as an efficacious treatment for opioid withdrawal. Suboxone is a combination of buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist.[1] Buprenorphine is the most important component of Suboxone from the standpoint of withdrawal treatment. Naloxone is added to the buprenorphine in Suboxone to reduce the ability to tamper with the medication, or to abuse it and get high.

By reducing or eliminating opioid withdrawal symptoms, Suboxone helps people get through the physical and emotional discomfort of withdrawal, and bridges them to maintenance treatment, which may involve medications for addiction treatment (MAT) and/or involvement in psychosocial support programs like rehabilitation and other forms of counseling.

Beginning Suboxone Treatment & Maintenance

When used during MAT, Suboxone saves lives by preventing relapse to opioid use and reducing the risk of overdose. Suboxone induction starts either during detox, or later, after detoxification has already occurred. It is continued long-term to prevent craving and relapse, when prescribed in the context of maintenance treatment.

Suboxone should only be initiated or started in collaboration with your provider. This is because if you take suboxone when opioids are still in your system, a withdrawal syndrome can result. Your first dose of Suboxone should only be taken when you are in active withdrawal, or an extended period of time after you have last taken an opioid. If taken too soon, you can experience precipitated withdrawal, which is a long uncomfortable withdrawal syndrome. Depending on the type of opioid you struggled with, your induction process will be a little different.

  • Short-acting opioids like heroin: Opioids that have a short half-life metabolize out of the body quickly. You are likely to begin feeling withdrawal symptoms within a few hours after your final dose.

  • Long-acting opioids like methadone: Opioids that have a longer half-life take more time to fully metabolize out of your body, so you may begin taking Suboxone before the opioid has completely metabolized out. 

Your provider will likely start with a very small test dose to make sure the Suboxone will not accidentally trigger withdrawal. Then they will increase the dose to an appropriate level, which usually varies from person to person.  The dose that you and your provider settle on is often called a “maintenance dose”.

Many people remain on their maintenance dose of Suboxone for months, years, or even indefinitely. This helps people focus on attending counseling and getting back to living their lives, because it reverses the craving and reduces other compulsive behaviors around drugs. Longer time in recovery allows people to be able to learn signs of relapse and identify their own triggers, and increases their ability to make more and more intentional and healthy choices for themselves.

How Does Tapering With Suboxone Work?

Suboxone is a relatively safe, and effective medication for people who are overcoming opioid use disorder. Tapering off this prescription medicine is an option, although many people choose to stay on Suboxone indefinitely.

Tapering is an individual process. In early recovery, longer tapers are clearly more effective than short ones.[2] The study found that participants who tapered over four weeks were more likely to remain abstinent from opioids compared to those who tapered over two weeks or just one week.

The study also found that people who tapered over four weeks were more likely to remain in treatment and take naltrexone, if prescribed, compared to those who went through two-week and one-week tapers. Avoiding withdrawal symptoms during the detox and tapering process helps to maintain retention in opioid use disorder treatment programs.

A study from 2018 also found that a single high dose of buprenorphine (without naloxone) at the beginning of opioid detox could help reduce cravings for those who were outpatients, for up to five days after administration.[3] This could help bridge the gap between initial opioid detox and addiction treatment, which might occur in a hospital or emergency setting in the former case, and treatment at a rehabilitation program that includes Suboxone in the latter.

In later stages of recovery, as when someone has been on maintenance treatment with Suboxone for months or years, the ideal method of tapering is not well-known. However, recent studies show that those that tapering off even after 6-9 months of maintenance treatment increases risk of relapse and opioid use disorder recurrence compared to those that stay on the Suboxone for longer.

Do I Have to Taper Off Suboxone?

No, you don’t have to taper off the medication if it continues to help you.

It is possible to taper off Suboxone as part of opioid detox if your goal is to fully end your physical dependence on opioids. However, more and more opioid use disorder treatment programs encourage continuing Suboxone or other medications that reduce relapse risk for months, since they definitively reduce relapse risk and prevent overdose. Also, after months and years of maintenance treatment, many people successfully taper off of Suboxone, but others choose to continue on the medication indefinitely. Either approach is fine.

SOURCES

  1. Highlights of Prescribing Information. Suboxone.com. https://www.suboxone.com/pdfs/prescribing-information.pdf. March 2021. Accessed February 2022. 
  2. A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers. JAMA Psychiatry. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1761270. December 2013. Accessed February 2022.
  3. Single High-Dose Buprenorphine for Opioid Craving During Withdrawal. Trials BMC. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3055-z. December 2018. Accessed February 2022. 

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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