While it doesn’t get produce a high, Suboxone is still an opioid, which means that you will experience withdrawal symptoms if you try to quit it cold turkey. This article discusses the symptoms of Suboxone withdrawal and what you can do to avoid them and find relief.
What Is Suboxone?
The way Suboxone works is a little complicated, so let’s break it down. Think of the opioid receptors in your brain like a light switch. First, you touch the light switch, then you flick it on. Heroin, morphine, and prescription opioids are what’s known as full opioid agonists. They bind to the opioid receptors in your brain and turn the lights on. Buprenorphine is what’s known as a partial opioid agonist. Think of this as your opioid dimmer switch. It binds to your opioid receptors and dials up the brightness without turning the lights on completely. Naloxone is an opioid antagonist, which means that it binds to the opioid receptors but doesn’t turn them on. Naloxone acts like a hand over the switch, preventing other opioids from flicking the switch on and producing a high. If your light switch is already turned on, naloxone will shut it off. Naloxone was added to Suboxone to prevent diversion and misuse. This means that if someone injects Suboxone when they have opioids in their system, it can cause them to enter withdrawal immediately. When used as directed sublingually, the naloxone is not absorbed. You should not begin taking Suboxone until all other opioids are out of your system. Suboxone is most effective when taken after you begin experiencing opioid withdrawal symptoms. The buprenorphine in Suboxone will dial up the lights enough to stop your withdrawal, but not enough to get you high. If you stop Suboxone suddenly, you may experience sweating, anxiety, agitation, muscle aches, and an upset stomach. Rather than quitting cold turkey, clinicians typically advise slowly tapering down your dose. By slowly dimming the lights, your withdrawal experience should be relatively smooth. The most common complication of opioid withdrawal is relapse. Relapse is more common when withdrawal symptoms and cravings are severe. A combination of tapering, medication management, and counseling can help improve your odds.
Suboxone Side Effects
You may experience some side effects when taking Suboxone. Some of the most common side effects include:
Anxiety DepressionFatigueHeadache InsomniaNauseaSweating
While uncommon, some serious side effects may occur while taking Suboxone. These may include breathing problems, liver damage, hormone issues, severe allergic reactions, or severe withdrawal symptoms. You should seek medical help immediately if you experience any severe symptoms.
Symptoms of Suboxone Withdrawal
If you are using Suboxone as directed for the treatment of opioid addiction or to treat pain, you can expect to experience withdrawal symptoms if you miss a dose or try to quit abruptly. Opioid dependence occurs with any long-term opioid use, regardless of whether you are following a doctor’s orders. Once you become physically dependent on a drug, you experience withdrawal symptoms when it leaves your system. Suboxone causes most of the physical symptoms typical of opioid withdrawal. These include:
AnxietyChillsGooseflesh Muscles aches and painsNausea or vomiting Restlessness Runny noseStomach cramps or diarrheaSweatingTremors or twitchingTeary eyes
If you take Suboxone to treat opioid addiction, then your withdrawal symptoms should be less severe than what you have experienced in the past.
Psychological Symptoms
The psychological challenges associated with withdrawal are not always caused by withdrawal itself. Withdrawal can trigger the return of mental health problems that were muted by drug use, such as anxiety and depression. After withdrawal, people are also forced to take a good look at the damage that their drug addiction has wrought. It is not unusual to struggle with issues of guilt and regret. Figuring out how to get your life back on track can feel overwhelming and emotionally exhausting. That’s why it’s so important to reach out for help.
Suboxone Withdrawal Timing
The timeline of Suboxone withdrawal is also be a bit different from withdrawal from other opioids. Buprenorphine is a long-acting opioid, which means withdrawal symptoms can take several days to appear. Suboxone withdrawal typically begins within two to four days after taking the last last dose, peaks around days three to five, and resolves within seven days. Sometimes, however, psychological symptoms can linger for several weeks. This may include depression and an inability to experience pleasure.
Coping With Suboxone Withdrawal
The most effective way to treat Suboxone withdrawal is to avoid it in the first place. You can avoid the symptoms of withdrawal by working with your doctor to taper down your dose. Tapering means gradually reducing your dose over time. If you have not been getting your Suboxone from a doctor, you will want to find a doctor to help your taper. Some studies have shown that overall success (measured by a period of prolonged abstinence) tends to be better with a shorter, seven-day taper. Other studies have found that withdrawal symptoms are managed best by a slow, flexible tapering schedule. With a flexible taper schedule, your doctor can slow the dose reduction if you experience any uncomfortable symptoms. If you are still struggling with withdrawal despite the Suboxone taper, your doctor may recommend one or more support medications.
Lucemyra (Lofexidine Hydrochloride)
Lucemyra is a medication approved by the FDA in May 2018. It is the first non-opioid medication approved to treat the symptoms of withdrawal. Lucemyra works by reducing the release of norepinephrine, a neurotransmitter believed to play a role in withdrawal symptoms. Because it does not contain an opioid agonist, Lucemyra treatment can begin immediately after your last dose of Suboxone. It is currently approved to treat healthy adults for a maximum of 14 days following opioid cessation.
Lifestyle Changes
If you are struggling with Suboxone withdrawal it may help to drink more fluids than usual to prevent dehydration. It’s also important to eat a well-balanced diet to keep vitamin and electrolyte levels up. Work closely with a doctor, counselor, or physical therapist to develop new ways of coping with pain during and after withdrawal. Practice relaxation techniques (meditation, listening to music) to help you deal with anxiety and agitation. Try mild to moderate exercise to help you deal with restlessness. Find something else to focus on during withdrawal, such as a television show, book, or hobby. Get support and encouragement from a local community group or Narcotics Anonymous (NA) meeting.
Warnings
Opioid withdrawal is often unpleasant, but it is very rarely dangerous. When it comes to Suboxone, complications are even more unlikely. Still, it is important to work closely with a medical professional during your Suboxone taper. Relapse is common among people with opioid use disorders and is generally considered a normal part of the recovery process. But people who have been taking Suboxone are typically further along on the path to recovery. A relapse at this point can be both discouraging and dangerous, because your tolerance will have dropped substantially. Relapsing after your tolerance has decreased can lead to a dangerous or potentially fatal opioid overdose. If you have been acquiring your Suboxone illicitly or do not have a close relationship with your doctor, it can be tempting to try tapering down on your own. This is inadvisable for several reasons. Tapering on your own increases the likelihood of failure. Unsuccessful attempts to quit are discouraging and psychologically distressing. If you are quitting Suboxone because you’re pregnant or breastfeeding, you should definitely talk to a doctor. Suboxone is not recommended during pregnancy, but buprenorphine without naltrexone is. Depending on your situation, your doctor may recommend an accelerated taper or a switch to buprenorphine or methadone, which have been proven safe to use during pregnancy.
Long-Term Treatment for Opioid Use Disorder
Opioid use disorders are notoriously difficult to beat. It is not uncommon for someone to make it through detox successfully only to relapse a few weeks later. But if you have been using Suboxone to treat your addiction, you are already ahead of the game. Suboxone allows you to develop a long-term treatment strategy without being distracted by the discomfort of withdrawal. After Suboxone, a long-term treatment plan should focus on preventing future relapse. Talk therapy plays a very important role in relapse prevention. Once you come off Suboxone, you will have beaten your physical dependence on opioids, but not the psychological aspects of addiction. Talk therapy can help you figure out why you began using drugs in the first place. You can learn to identify specific situations and feelings that have led you to use in the past. Identifying these triggers helps you recognize and eliminate the negative thought patterns that cause you to make poor decisions. There are many ways to explore talk therapy. You might consider working one-on-one with a psychologist or mental health counselor in private practice. You can meet with a mental health or addiction counselor at a local community clinic. Or you can explore group therapy programs, which are offered at many hospitals, clinics, and addiction treatment facilities.
Resources
To find more information about Narcotics Anonymous (NA) meetings in your area, check out its website. You can find a meeting near you with their searchable directory. If you are the loved one of someone with an opioid use disorder, you may want to consider attending a support group for people like you. Nar-Anon is a 12-step program for family and friends of people with substance abuse problems. At these meetings, you can talk with people who have experienced the same fears and frustrations as you.
A Word From Verywell
If you are on Suboxone and making plans to quit, chances are you are already on the path to recovery. Don’t try to quit cold turkey on your own—work with a doctor. Remember that a relapse at this stage can be very dangerous, so don’t become over-confident in your ability to abstain. Finding some sort of support, whether through meetings or therapy sessions, can help you stay sober in the long term. For more mental health resources, see our National Helpline Database.
