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Detoxification & Withdrawal Guide for Suboxone.

Written By Jeff Mahre BA MFA MLIS - January 12th, 2017

Suboxone is truly an oxymoron of a drug. It contains both an opioid as well as an opioid antagonist and was designed to treat opioid addiction and withdrawal (Velander, 2018). However, it has the potential to be misused. Continue reading to find out more about the potential dangers of this drug as well as the misconceptions surrounding it.

In order to fully grasp the use and implications of suboxone, please read our article on opioid detoxification. You can also read our article on heroin, a type of opiate.

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suboxone abuse facts

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Suboxone is a mixture of two pharmaceutical drugs; buprenorphine and naloxone (Velander, 2018). Buprenorphine is an opioid whereas naloxone is an opioid antagonist. According to the Center for Substance Abuse Treatment (2004), buprenorphine has been regarded as safer than other opioids due to its weaker effects at opioid receptors; even at high doses. It was approved for use in the United States for the treatment of opioid dependence in 2002 (Substance Abuse and Mental Health Services Administration, 2013). It is thus occasionally used in opioid detoxification programs to help manage withdrawal symptoms. Think of it as a way of “weaning” someone off opioids.

Although it is prescribed in order to manage opioid addiction and withdrawal, it has been reported to be abused or taken incorrectly. A summary from Substance Abuse and Mental Health Services Administration showed that (2013):

  • Emergency department visits secondary to buprenorphine usage increased substantially from the years 2005 to 2010
  • 52% of these emergency department visits were due to misuse of buprenorphine, 24% were due to patients seeking detoxification and 13% were due to adverse reactions
  • Other substances were involved in 59% of buprenorphine-related emergency department visits

Schuman-Oliver et al. (2010) found that misuse of buprenorphine is primarily carried out by individuals already dependent on opioids, and that their primary desire is to self-treat opioid dependence and withdrawal.

Furthermore, Velander (2018) outlines misconceptions about suboxone, which are as follows:

  1. One misconception is that suboxone acts merely as a substitute drug of abuse. Suboxone is a medication, not a substance and is prescribed with a clear medical indication. Its maximum effects are less than that of other opioids and, when prescribed by a doctor in treatment facility, the dose is safe and highly unlikely to cause intoxication.
  2. Another is that use of suboxone indicates that a patient has “given up.” Suboxone is a medical treatment for withdrawal. Addiction is a disease on its own, involving changes in the brain’s neurochemistry. It has nothing to do with a lack of willpower. Suboxone simply attempts to stabilise this neurochemistry.
  3. A misconception is that suboxone cannot be used in 12-step programs. However, certain programs have pioneered the use of the drug with promising results. For example, a study by Mitchell et al. (2013) has shown that buprenorphine can be used in community-based programs to combat opioid withdrawal.
  4. A final misconception worth mentioning is the belief that users can easily get “high” from suboxone. This is not the case if a patient is already dependent on opioids. Intoxication only occurs if patients combine suboxone with other substances or do not take it as directed. Because of its ceiling effect, even at very high doses, suboxone on its own has a much lower potential for overdose.

Please peruse our article on opioids to learn more about the symptoms of opioid intoxication and long-term effects of opioid use.

symptoms of suboxone withdrawal

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As already stated, withdrawal is unlikely in this drug if taken purely as medical therapy. However, in known drug-users misusing this drug, it may cause withdrawal (albeit usually mild).

Buprenorphine is a long-acting opioid. Withdrawal may reach a peak between 5-6 days. Symptoms also may linger for longer in long-acting opioids (Fareed et al., 2011).

Withdrawal symptoms, if they occur, can entail (Fareed et al., 2011):

  • Vomiting and nausea
  • Diarrhoea
  • Abdominal pain
  • Muscle aches and cramps
  • Anxiety
  • Irritability
  • Insomnia
  • Sweating
  • Elevated pulse and blood pressure

suboxone withdrawal timeline

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As delineated by Fareed et al. (2011), the timeline depends on whether a short-acting or long-acting opioid was used. For a long-acting opioid such as buprenorphine:

  • Withdrawal symptoms may start within 12-48 hours after the last dose
  • Withdrawal peaks at 5-6 days
  • Symptoms do not subside for 14-21 days
  • Cravings and depression may linger even if other symptoms resolve

Within the first 72 hours, physical symptoms are at their worst (for example, pain and vomiting). After the first week, insomnia and psychological complaints is prominent. Depression and mood changes are also common and can last for up to two weeks by (Fareed et al., 2011).

symptoms of suboxone detox

Abuse facts  |  Withdrawal symptoms  |  Withdrawal timeline  |  Back to top

Schuman-Olivier et al. (2010) sum it up best with evidence that illicit use of suboxone decreases when opioid-dependent treatment-seekers are given legal prescriptions of suboxone. This is because, as the study proves, misuse is often times associated with self-medication to decrease other opioid withdrawal symptoms. They also stated that “the use of illicit buprenorphine rarely represents an attempt to attain euphoria” (Schuman-Olivier et al., 2010, p50)

 

To prevent suboxone intoxication and withdrawal in known opioid users, it is best to always seek out help in a treatment facility. As stated in our opioid detox guide, using medication to assist with opioid withdrawal symptoms should only be carried out by a professional in a facility. The entire process should be monitored by health care providers that have specific knowledge and expertise in the field of drug addiction treatment (Kleber, 2007).

 

References

Center for Substance Abuse Treatment. (2004). Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction (Treatment Improvement Protocol [TIP] Series 40; DHHS Publication No. SMA 04-3939). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Fareed, A., Stout, S., Casarella, J., Vayalapalli, S., Cox, J., & Drexler, K. (2011). Illicit opioid intoxication: diagnosis and treatment. Substance Abuse5, 17-25

Kleber H. D. (2007). Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues in Clinical Neuroscience9(4), 455-70.

Mitchell, S. G., Gryczynski, J., Schwartz, R. P., O’Grady, K. E., Olsen, Y. K., & Jaffe, J. H. (2012). A randomized trial of intensive outpatient (IOP) vs. standard outpatient (OP) buprenorphine treatment for African Americans. Drug and Alcohol Dependence128(3), 222-9.

Velander, J.R. (2018). Suboxone: rationale, science, misconceptions. Spring, 18(1): 23–29.

Schuman-Olivier, Z., Albanese, M., Nelson, S.E., Roland, L., Puopolo, F., Klinker, L., & Shaffer, H.J. (2010). Self-treatment: Illicit buprenorphine use by opioid-dependent treatment seekers. J Subst Abuse Treat, 39(1):41–50.

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). The DAWN Report: Emergency Department Visits Involving Buprenorphine. Rockville, MD.

 

MEDICALLY VERIFIED ON 2/1/2019

Chief Editor

Dr. Ashley Murray

About

Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practises in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.

Author

Contributor

Jeff Mahre BA MFA MLIS

About

Jeff holds an MFA in Creative Writing from the University of California-Irvine, and has eleven years of experience teaching Composition on the college level.