Detoxing From Suboxone
Suboxone is a prescription medication used to treat opioid addiction or dependence. This article will discuss the use of Suboxone in the process of opioid withdrawal, as well as the tapering and withdrawal process associated with the abuse of Suboxone itself.
Suboxone Detox Symptoms and Timeline
Suboxone was designed to address the withdrawal process that occurs with physical dependence and/or addiction to opioid drugs, including heroin, morphine and oxycodone.
Suboxone combines the effects of two drugs (buprenorphine and naloxone) into one medication, giving it an advantage over other similar drugs. It is designed to treat physical dependence, which can be useful in avoiding relapse.
However, simply taking Suboxone as part of a medically assisted detox does not treat the underlying addiction. Additionally, people may become physically dependent on Suboxone or abuse it.
If someone were to immediately discontinue using Suboxone, the withdrawal symptoms would most likely not occur immediately. The withdrawal timeline below is based on the time following the last dosage of Suboxone taken. Withdrawal from Suboxone or other opioid drugs is not life-threatening, even though it may feel that way to the person experiencing it.
- 24 to 72 hours: Withdrawal will be most intense within the first 3 days or 72 hours following the last dosage. The symptoms will likely peak between 48 hours and 72 hours for most individuals. Common symptoms in this phase include:
- Chills and/or fever.
- Dilated pupils.
- Watery eyes.
- Restlessness and malaise.
- First week: Users may continue to feel restless after the first week and experience muscle and joint pains, cramps, insomnia and mood swings.
- Second week: Physical aches and pains may subside. However, if the person had been taking opioid medications for pain control, they may continue to feel some pain. Some people may also continue to feel mildly restless, have issues with their moods such as experiencing depression, and may still be irritable.
- Third week and beyond: Most of the physical withdrawal symptoms should have subsided. However, some people may continue to experience cravings and psychological or emotional symptoms.
For most people, the acute effects of opioid withdrawal range anywhere from 3 to 5 days and can last as long as 10 days.
Protracted Withdrawal Syndrome or Post-Acute Withdrawal Syndrome (PAWS)
The acute withdrawal effects described above usually peak within a few days and then subside rather quickly. But some people may experience prolonged emotional and/or psychological symptoms, including:
- Irritability and agitation.
- Mood swings.
- Bouts of depression.
- Drug cravings.
Factors Affecting Withdrawal
Several factors affect the withdrawal symptoms that people experience as a result of using any opioid drug: 1
- The method of discontinuation: People who use Suboxone under the supervision of a physician typically taper down the dosage slowly until they can stop using the medication altogether. Quitting drug use in this manner results in mild or no symptoms of withdrawal. Stopping the medication or drug abruptly will produce more intense withdrawal symptoms and a potentially protracted term of unpleasant withdrawal.
- The dosage of the drug typically used: The higher the dosage typically used, the more severe and longer-lasting the withdrawal symptoms will be.
- The length of time the drug was used: The longer a person uses the drug, the more complicated the withdrawal process will typically be.
- How the drug was used: Certain methods of drug use, such as injecting or snorting, may cause people to develop higher tolerances to the drug compared to taking it in pill form. Having developed a higher tolerance to a drug often results in exaggerated drug dosing to overcome the effect. This, in turn, will result in longer and more intense withdrawal symptoms.
- Individual variations between people: Individual differences can also dictate the severity and length of withdrawal symptoms. No two people experience the same process when withdrawing from any drug.
Risks of Suboxone
Only use Suboxone under the supervision of a physician.
Use of opioid drugs over the long term will result in changes in pathways of the brain. 2 Long-term users have a higher probability of developing a substance abuse disorder to similar drugs. For example, a heroin addict using Suboxone for heroin detox will more quickly develop a physical dependence on Suboxone than someone who was addicted to another, non-opioid class of drugs and who then started using Suboxone.
Contrary to what many sources on the Internet claim, Suboxone was not designed to replace one addiction with another. But people who use replacement medications such as Suboxone to deal with addiction to opioids should only do so under the supervision of a physician.
Suboxone Detoxification Treatment
Suboxone detox can take place in a standalone detox center, or as part of an inpatient/residential recovery program or an outpatient recovery program.
The detox procedure is typically done under the supervision of a physician. The physician will:
- Initiate a medical detox procedure and taper the dose slowly so the person can adjust.
- Taper the dosage over a long period of time, such as 2 milligrams every two to three days over a period of weeks.
- Withdraw the drug when the person has a very low dosage of daily intake, typically less than 2 milligrams per day.
- Recommend psychotherapy or attendance at groups for substance abuse disorders during the detox/tapering portion of the program until the person is off Suboxone completely.
If opioids are being abused in conjunction with other drugs such as alcohol, the physician may also help the person discontinue those drugs as well.
Tapering down any opioid medication without the assistance of a physician is not recommended. People who attempt this procedure on their own are prone to relapse due to cravings, issues with pain and emotional problems. Tolerance levels in some people may quickly diminish during the detox process, and attempting to administer potentially dangerous opioid drugs under these conditions (e.g., a relapse with strong opioid drugs) can result in overdose or death.
5-Day vs. 3-Day Suboxone Detox
Some Internet sources discuss a shorter duration for Suboxone detoxification. Some of these sources typically recommend giving Suboxone only when the withdrawal symptoms appear and only in doses that suppress them. The dose can then be tapered down and detox can occur within a 5-day or 3-day period. Others sources use the standard practice of administering Suboxone first thing in the morning.
- Day 1 – 4 milligrams
- Day 2 – 2 milligrams
- Day 3 – 1 milligram
- Day 4 – 0.5 milligram
- Day 5 – 0.5 milligram
- Day 6 – no dosage
- Day 1 – 4 milligrams
- Day 2 – 2 milligrams
- Day 3 – 1 milligram
- Day 4 – No dosage
As with any medically assisted addiction treatment, seek the care of an addiction treatment professional, and then closely follow closely the prescribed tapering guidelines. The inherent dangers of the involved substances, and the potential risks encountered throughout withdrawal, warrant close supervision and close adherence to a detox regimen.
Past research has supported the observation that higher doses of and longer periods on medications such as buprenorphine are associated with lower rates of relapse in recovering addicts.3 By this token, the 5-day taper would have advantages over the 3-day taper due to a longer detoxification period. The person also receives more of the drug in this time interval. Some people may need a longer tapering period than 5 days.
A person’s drug history may also play a role in the effectiveness of the use of maintenance medications, tapering periods and dosages in treatment outcomes. People with more chronic histories of drug abuse appear to respond better to higher doses and longer tapering periods than people who recently developed substance abuse disorders. 4
Detoxing at Home
Using Suboxone to detox from an opioid drug or detoxing from Suboxone itself should only be done under the supervision of a physician.
Engaging in your own unsupervised “detox” instead of attending a supervised inpatient or outpatient detox program has several disadvantages:
- People who attempt to “go it alone” often find it easier to give in to temptation and relapse.
- You do not receive assessment or treatment for other emotional or psychological issues that may have contributed to the substance abuse disorder, nor ones that may arise in conjunction with the withdrawal process itself.
- A medical professional cannot treat unforeseen issues that can occur during the detox process.
- There is no formalized treatment program in place that can help you to develop strategies to deal with relapse triggers.
- You are not exposed to a network of professionals and peers who encourage recovery.
- You do not develop coping strategies for stress, boredom and other factors that often cause relapse.
- You do not receive a long-term aftercare program to help you maintain sobriety.
Tips for Detoxing
Several other factors may assist in the detoxification and addiction recovery process:
- Eat a balanced diet and avoid fatty foods, sugar, starch and alcohol.
- Become educated on the process of withdrawal and detoxification.
- Find things to do to keep busy – boredom can be a trigger for relapse.
- Stay close to family and drug-free friends and build a social support network to help maintain new goals.
- Keep a regular schedule and get plenty of sleep.
- Try to get regular exercise.
- Do not be afraid to ask for help.
- Stay focused and be patient. Recovery takes time.
What Happens After Detox?
Detox helps you get clean so you can begin to work on your addiction and the issues that may have led you to use. Working through the causes of your addiction is an essential step – whether you were using Suboxone to withdraw from another drug such as heroin or had become dependent on or were abusing Suboxone itself.
If you choose to detox in an inpatient or outpatient rehab facility, you may be able to transition into the recovery program there. If you complete detox in a detox center, the staff can make recommendations for or directly transfer or refer you to a nearby treatment center. Common recovery options for opioid addiction include:
- Inpatient or residential rehab. Inpatient drug recovery programs usually last anywhere from 30 days to 60 days to 90 days. Many offer detox as the first stage of treatment. After you complete detox, you participate in a recovery program that includes individual and group therapy, medical care and relapse prevention planning.
- Outpatient treatment. Outpatient programs may also offer detox as well as individual and group therapy. However, you travel to the treatment center on certain days of the week instead of living there.
- 12-step programs. These programs are based on the 12-step approach of Alcoholics Anonymous. Narcotics Anonymous is a popular 12-step program that helps people recovering from opioid addictions.
Find a Suboxone Detox Program
Treatment can save your life. If you’re looking for Suboxone detox treatment, give us a call at 1-888-319-2606Who Answers?. We can help you find a program that works for your needs and will verify your insurance.
. Taylor, D. R. (2015). Managing patients with chronic pain and opioid addiction. New York: Springer International Publishing.
. Hatfield, R. C. (2013). The everything guide to the human brain. Avon, MA: Adams.
. Fareed, A., Vayalapalli, S., Casarella, J., & Drexler, K. (2012). Effect of buprenorphine dose on treatment outcome. Journal of addictive diseases, 31(1), 8-18.
. Woodcock, E. A., Lundahl, L. H., & Greenwald, M. K. (2015). Predictors of buprenorphine initial outpatient maintenance and dose taper response among non-treatment-seeking heroin dependent volunteers. Drug and alcohol dependence, 146, 89-96.