A short taper of buprenorphine/naloxone (Suboxone) is essentially a way of helping treat acute withdrawal from opioids when a person is attempting to detox. In contrast, long-term Medication for Addiction Treatment (MAT) is used over weeks, months, years, or even life long to help prevent people from relapsing to opioid use. Ideally, Suboxone medication is paired with behavioral care, such as therapy.
Which is right for you? This is a question best answered by you and your treatment team. Here's what you should know about both models.
Patients who have opioid use disorders (addictions to pills like Percocet or Vicodin or to intravenous drugs like heroin or fentanyl) can use Suboxone for the first few days of withdrawal. Suboxone is a “partial opioid agonist”: It turns on opioid receptors enough to substitute for the opioids that the patient was misusing, preventing the symptoms of withdrawal. After a couple days or weeks, the patient then has the option of discontinuing Suboxone, particularly once their withdrawal symptoms have resolved.
After detoxing acutely, people will not experience the severe unpleasant symptoms of acute withdrawal. However, they may still struggle with the desire to use, either to treat pain, or because they have cravings for the drug. For these people, longer term use of Suboxone can be extremely helpful to prevent cravings for other opioids.
When Suboxone is taken regularly, and in conjunction with behavioral health treatments, patients have an optimal chance of engaging in long-term recovery and meeting their treatment goals.
Some individuals may only require short term therapy, particularly those with mild use disorders who do not have strong cravings when they discontinue use. Other situations in which people might only need or prefer short term therapy include persons who cannot tolerate Suboxone long term due to side effects. Lastly, patients may prefer not to be on long term medication for any number of reasons. For these people, short term use may be helpful/appropriate for acute withdrawal symptoms and may not be necessary more long term, particularly if they have good social support and other strategies for preventing relapse.
However, there is very strong evidence that continued use of Suboxone long term helps prevent relapse, particularly for people who have severe OUDs. [3] People who stop Suboxone after detox are at high risk of relapse, and most people go back to drug misuse within six months.[1] Research shows that continuous, long-term use of MAT with Suboxone is safe and effective long term (even life-long for some individuals) at preventing relapse to opioid misuse. [2] For those who are open to long term therapy, MAT has the strongest evidence of any treatment for preventing relapse.
Every person is different, has a different degree of dependence on opioids, has different support structures, and different goals for their treatment. There is no “right” duration of treatment.
Our advice at Bicycle health is to enter Suboxone treatment with an open mind and a firm commitment to keep yourself healthy. As you progress through your experience with Suboxone, you and your treatment team can have ongoing discussions about what duration of treatment is best for you as an individual.
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