What Happens When You Go Through Suboxone Withdrawal?

Stopping or substantially reducing Suboxone can cause opioid withdrawal, because its buprenorphine component can produce physical dependence. This can happen during appropriate treatment and does not mean the medication has failed.

There is no required date by which everyone should stop. If treatment is helping, continuing it may be appropriate for years. CDC: Treating Opioid Use Disorder

Like any other medical treatment, there are certain risks that should be weighed against the potential benefit. Keep reading to learn more about Suboxone withdrawal.

Understanding Suboxone

Suboxone is the brand name for a drug that consists of buprenorphine and naloxone. It is one of the most commonly prescribed drugs for opioid use disorder.

It is often prescribed alongside counseling or other support.

Basic Pharmacology

Suboxone is a film that dissolves in the mouth. It is four parts buprenorphine and one part naloxone. Buprenorphine binds to the mu-opioid receptors located in the central nervous system.

Here, it partially agonizes (activates) the receptor. Since it is only a partial agonist, the effect is milder than that of a full agonist. Those partial-agonist properties reduce some risks compared with full agonists, but they do not remove the risk of overdose.

Naloxone is a pure opioid receptor antagonist, meaning it competes with opioids that would activate the receptor. Naloxone by itself (without buprenorphine) is sold commercially as Narcan and is used to reverse an acute opioid overdose. The naloxone in Suboxone is not a substitute for rescue naloxone. FDA Suboxone prescribing information

The Science of Withdrawal

Abrupt cessation of many types of substances can lead to some form of withdrawal symptoms. Some everyday substances can lead to significant withdrawal symptoms.

For example, imagine a person that drinks multiple cups of coffee every day for several years. Now imagine what happens to that person if, all of a sudden, they can no longer drink coffee.

They would almost certainly have a severe headache, and irritability and difficulty concentrating could linger for a few days, or until they manage to get their caffeine.

Opioid Withdrawal

Unfortunately, the headaches of not getting your coffee or your cigarettes are not as dangerous per se as experiencing withdrawal from opioids or alcohol.

Opioid withdrawal can make you seriously sick. The onset of the symptoms depends on the type of opioid used. Heroin withdrawal symptoms typically occur only a few hours after the last use.

Most people experience extreme anxiety, diarrhea, tearing of the eyes, muscle pains, insomnia, and powerful cravings. In fact, this often leads people to use again or to take risks to get drugs.

The Facts on Suboxone Withdrawal

Although Suboxone is a lifesaving medication, it is not without side effects. Like other opioid agonists, there is a significant risk of experiencing withdrawal once you stop taking the medication.

This doesn't mean that you shouldn't take it if your doctor recommends it to you. Nor is this guide meant to substitute professional medical advice in any way.

However, we feel being aware of what to expect can help you get through the process and live a healthier, happier life.

Suboxone Withdrawal Symptoms

Buprenorphine is an opioid, so the withdrawal that follows stopping Suboxone is opioid withdrawal. SAMHSA TIP 63: Medications for opioid use disorder

It is characterized by nausea, difficulty concentrating, irritability, restlessness and a general sense of unease. However, this can lead to vomiting, diarrhea, cravings, myalgia (muscle pain), headache, fever, chills, sweating and trouble sleeping. Low mood may also become more noticeable.

Other conditions can produce overlapping symptoms. Depression that does not lift, severe pain, or other concerning changes deserve an assessment rather than an automatic withdrawal label.

Complications

People are really only given Suboxone to treat opioid use disorder. Anyone who has experienced opioid withdrawal knows it is no laughing matter.

One of the most dangerous complications is a relapse that could end in an overdose. However, opioid withdrawal can lead to other health complications.

Opioid withdrawal is usually not life-threatening by itself, but dehydration, pregnancy, medical illness, or withdrawal from other substances can change the risk. For this reason, it is highly recommended to seek medical advice if you are experiencing even 'mild' withdrawal symptoms.

Relapse

One of the most concerning things about going through withdrawal is the risk of relapse.

The reasons for relapse are multifaceted. However, the 'sickness' of opioid withdrawal can lead one to believe that using again will make them feel better. Plus, people in withdrawal almost always report strong cravings.

Reduced tolerance can increase overdose risk if someone returns to opioids after stopping. Detoxification alone is not recommended treatment for opioid use disorder. CDC: Treating Opioid Use Disorder

There are steps you can take to help with the craving. We'll discuss that later.

GI Disturbances

It is one thing to feel nausea and experience loose bowels. But prolonged vomiting and/or diarrhea can lead to dehydration and/or electrolyte imbalance.

Any signs of severe dehydration, such as headache, confusion, muscle weakness, and dizziness should be considered a potential medical emergency. Dehydration can be treated with medical care.

Contact a clinician for persistent vomiting or diarrhea, inability to keep fluids down, fainting, or severe weakness. Seizures, severe confusion, breathing problems, or loss of consciousness require emergency assessment.

Heart Problems

People with heart conditions or other medical illness should tell their clinician before stopping Suboxone, because medical illness can change the risk during withdrawal.

Identifying Withdrawal

However, it isn't easy to recognize if someone is experiencing withdrawal. They may even take steps to hide it.

You might notice they are acting or look unusual. Are they unusually agitated or anxious? People going through withdrawal may appear profusely sweaty, with teary red eyes, and a runny nose.

In short, a person with withdrawal may look like they have a cold or some type of fever. Be aware that, in this moment, they can be feeling severe stress and may take risks to get drugs.

What To Do In Case of Emergency

If you have any reason to believe you or somebody else is in danger due to withdrawal or overdose, you should contact emergency services immediately.

Naloxone (sold commercially as Narcan) is a life-saving treatment for people experiencing an opioid overdose. It is available as a nasal spray to facilitate its use among non-medical professionals who encounter someone experiencing an overdose.

Keep naloxone accessible and tell supportive people how to use it. Call 911 and give naloxone if someone cannot be awakened or is breathing abnormally. CDC: Responding to an Overdose

Narcan is not used to treat opioid withdrawal. In fact, it can cause immediate opioid withdrawal symptoms in some people due to its pharmacology.

Treating Withdrawal Syndrome

Opioid withdrawal is usually not life-threatening by itself. However, it is extremely distressing to those who experience it.

Plus the potential risk of relapse should not be underestimated. That's one of the reasons that medication-assisted treatment (MAT) is so important.

So, what helps with Suboxone withdrawal?

The main tool is a supervised taper. A taper is a gradual dose reduction planned with your prescriber. It should consider your goals, stability, previous attempts, symptoms, and support.

The plan may need to slow down, pause, or be reconsidered. There is no single reduction schedule that fits everyone. Do not cut Suboxone films or alter doses without specific instructions from your clinician. Before tapering, discuss how you will respond if cravings return and how to stay connected to care.

Other support may include medication for symptoms, cognitive therapy, and inpatient treatment at a rehab center. Do not use alcohol, borrowed sedatives, or unproven supplements to manage symptoms.

Most people do well with a combination of treatments. A physician or other medical professional can help you come up with a plan that suits you.

If you ran out unexpectedly, contact your prescriber and pharmacy promptly and explain when you took your last dose and any opioid use since. If stopping was not your goal, withdrawal does not mean you have to finish coming off. Your clinician can help you resume appropriate treatment.

How Long Does Withdrawal Last?

There is no exact timeline. Buprenorphine acts for a long time. The film label reports a mean elimination half-life of 24 to 42 hours, so withdrawal may be delayed after a missed or stopped dose. FDA Suboxone prescribing information

Dose, length of treatment, the pace of a taper, your health, and other substances all influence the course. The stages below might help you get an idea of what to expect. However, no two people are alike and you can't expect everyone to respond the same way.

First 12 Hours

Because buprenorphine is long acting, you may notice little at first.

When symptoms begin, one might expect the onset of cravings. The early withdrawal symptoms are relatively mild but may include runny nose, teariness, anxiety, and muscle pain.

First Three Days

Unfortunately, the withdrawal symptoms may worsen before you're out of the woods. Over the following days, the original symptoms can become more severe.

It is during this stage that there is an increased risk of experiencing vomiting, diarrhea, dilated pupils, tachycardia (fast heart rate), and high blood pressure.

This is often the hardest stage. Medical help can get you through it and reduce the risk of relapse.

Weeks Following

As time passes, the more severe symptoms usually ease. The chance of needing urgent medical help is lower.

However, that doesn't mean that you will feel 100%. You might feel a little 'off'. It is common to experience a wide range of emotions during this period.

It is essential that you are honest with yourself about how you are feeling. You may be at risk for depression and/or relapse. What's important is that you continue to find the help you need.

What If I Feel Like Using Again?

No one except you knows how you are feeling. Even if someone has experienced withdrawal before, their reaction is likely to be different from yours.

It is only natural to experience these things and there is no reason to feel ashamed. Cravings are a natural reaction to Suboxone withdrawal.

Know that you aren't alone. Ask for the help you deserve, and tell your clinician if cravings return. Going back on treatment is a reasonable choice, not a failure.

Start Suboxone treatment online. Our online Suboxone doctors see patients by video visit. The first visit is $89. Follow-up visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and medication is priced separately.