The raging opioid addiction crisis is a disease with few remedies. A substance that is seen as one is Suboxone, a buprenorphine medication used to treat the effects of opioid withdrawal. Like the old-guard methadone, Suboxone works by treating the symptoms that accompany opioid withdrawal — often referred to as “dope sickness.”
Suboxone is a staple of medication-assisted treatment (MAT), where addicted persons are administered drugs in combination with counseling and behavioral therapy to treat their substance abuse disorders. Studies have affirmed Suboxone as a substance that can help people sustain recovery. Its adoption and use, however, have been decried by those who advocate abstinence-based treatment, people such as Tom Price, the former U.S. Secretary of Health and Human Services.
“If we’re just substituting one opioid for another, we’re not moving the dial much,” Price once said of MAT.
No matter your stance on the use of this treatment medication, this much is clear: Suboxone is a substance of abuse in its own right, capable of ensnaring users into a cycle of dependence.
Nowhere is this more clear than rural areas like the southwestern Appalachian town of Lebanon, Virginia, where dealers are slinging Suboxone as a “black market” drug, according to a 2016 New York Times report.
“…Suboxone is supposed to give addicts a chance to get their lives together before they taper off [opioids]. But Suboxone can get you high if you inject it or snort it or take it in combination with benzodiazepines, a sometimes fatal blend,” the report said.
There is ample evidence that Suboxone misuse is widespread.
A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) reported a tenfold increase in emergency room visits involving buprenorphine medications like Suboxone between 2005 and 2010, from 3,161 to 30,135. More than half of those hospitalizations were due to the non-medical or recreational use of buprenorphine.
Just as concerning are the withdrawal symptoms Suboxone produces, which are dangerous in their own right.
Suboxone is a combination substance comprised of the opioid buprenorphine and the anti-overdose medication naloxone. Buprenorphine, the drug’s active substance, is a partial opioid agonist, meaning it partially functions as an opioid and produces far weaker effects than heroin or methadone, which are full agonists.
Buprenorphine was first synthesized in the mid-1960s and was introduced in the U.S. as an opioid analgesic in 1985. However, in October 2002, the U.S. Food and Drug Administration (FDA) approved Suboxone and Subutex (buprenorphine hydrochloride) tablets for opioid treatment. Both tablet products were eventually discontinued, but generic versions and Suboxone film were brought to market later.
What makes Suboxone different from methadone — another widely employed opioid treatment medication — was that it could be administered in physician offices rather than at approved clinics.
While the buprenorphine component does produce opioid sensations, there is a ceiling effect that occurs with use. This means the opioid effects level off even after someone attempts to increase their dose. As an opioid antagonist, the naloxone component blocks the effects of opioids. Naloxone is administered by itself in opioid overdose situations.
Suboxone has utility as a treatment medication, but it is still a narcotic. When abused, it can produce dangerous effects of its own, though not as acute as full-on opioids.
Suboxone can be habit-forming, leading users to become dependent where they need to use the drug to feel normal. When Suboxone cycles out of someone’s system, that person can begin to experience withdrawal symptoms, which manifest as physical and psychological effects.
Unlike other opioids, the effects of Suboxone take longer to manifest. Therefore, the withdrawal symptoms that come from it begin slowly and last longer than usual. Suboxone’s slow onset can complicate treatment. While opioid withdrawal timelines vary and depend on the health and history of the individual, there is a general timetable for symptoms to occur during a Suboxone detox.
It’s worth noting that each case is different, and it is entirely possible that a person does not exhibit some or any of the symptoms on certain days. Also, it is not wise to go through Suboxone detox at home. Intolerance for the drug’s effects will go up as the tolerance level goes down. This creates a dangerous situation for someone going through withdrawal, and the possibility of overdosing is present.
The following is a general Suboxone withdrawal timeline:
Days 1-3: The first three days of Suboxone detox are seen as the most physically strenuous and unpleasant. Within six to 12 hours of complete detox, users can experience distressing withdrawal symptoms such as cramps, nausea, and diarrhea. Thankfully, there are many medications that treatment centers commonly use to treat these withdrawal symptoms.
Days 4-7: Typically, by day four, a user will experience insomnia where they will have trouble falling and/or staying asleep. Along with insomnia, psychological symptoms, such as anxiety and agitation, will generally manifest on day five, six, or seven.
Weeks 2-4: Depression symptoms can set in after a person has spent a week in Suboxone detox. Also, cravings may also be at their most intense, compelling some users to relapse. In a medically supervised detox setting, doctors and therapists will provide resources or medication (such as antidepressants) so that you can endure these uncomfortable psychological symptoms and avoid relapse.
Month 2 and beyond: Because Suboxone can cause cravings years after detox, relapse prevention becomes critical by month two and beyond. With the Suboxone fully out of your system, drug cravings will likely persist. It is worth noting that the greatest opportunity for relapse during Suboxone detox occurs after the first month.
Attempting to detox without medical supervision can leave you vulnerable to the lingering effects of withdrawal, which can compel you to relapse. This is why professional treatment is crucial.
A professional recovery program will begin with medical detoxification, which is referred to as acute treatment. At this stage, you will be weaned off the Suboxone and given medications to treat those painful and uncomfortable withdrawal symptoms.
Opioids may not produce life-threatening symptoms like alcohol, benzodiazepines, or barbiturates, but they are enough to cause someone to reuse and increase their chances of succumbing to overdose, which can be fatal.
Therapy and counseling services offered in clinical stabilization include:
Depending on the severity of your addiction, you can also receive outpatient care where you receive ongoing treatment and counseling on a part-time basis. An outpatient program can occur after acute treatment or after clinical stabilization has taken place.
When your treatment is completed, you can get connected to a recovery community that provides long-term support and counseling, which provides a hedge against relapse.
You do not have to struggle with Suboxone withdrawal on your own. Let us help you find a treatment community that can help you realize sustained recovery.
Call 844-326-4514 anytime, day or evening, for a free consultation with one of our knowledgeable addiction recovery specialists. We can help you find the right treatment option. You can also contact us online for more information.
Center for Behavioral Health Statistics. (n.d.). Emergency Department Visits Involving Buprenorphine. Retrieved from https://www.samhsa.gov/data/sites/default/files/DAWN106/DAWN106/sr106-buprenorphine.htm
Buprenorphine (implant) Uses, Side Effects & Warnings. (n.d.). Retrieved from https://www.drugs.com/mtm/buprenorphine-implant.html
Delphi Behavioral Health Group. (2019, March 05). Suboxone Detox. Retrieved from from https://delphihealthgroup.com/suboxone/detox-withdrawal/
How Effective is Suboxone? (2017, February 28). Retrieved from https://www.thefix.com/how-effective-medication-assisted-treatment-suboxone
Jacobs, H. (2017, May 10). Trump's health secretary isn't a fan of the 'gold standard' substance-use treatment – bad news for the opioid crisis. Retrieved from https://www.businessinsider.com/hhs-secretary-tom-price-medication-assisted-treatment-suboxone-news-opioid-crisis-2017-5
Macy, B. (2016, May 28). Addicted to a Treatment for Addiction. Retrieved from https://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html
National Institute on Drug Abuse. (n.d.). How effective are medications to treat opioid use disorder? Retrieved from https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder
Saleh, N. (n.d.). Using Buprenorphine for Chronic Pain Management. Retrieved from https://www.verywellhealth.com/buprenorphine-for-chronic-pain-management-4156472
Suboxone Uses, Dosage, Side Effects & Warnings. (n.d.). Retrieved from https://www.drugs.com/suboxone.html