Suboxone Withdrawal Symptoms and Treatment

Suboxone is one of the several medications used to treat opioid use disorder (OUD). However, abrupt discontinuation of Suboxone can lead to opioid withdrawal symptoms. 

What is Suboxone?

Suboxone is an FDA-approved medication used to treat opioid addiction. It’s available in sublingual film form.^{1, 2, 3, 4, 5} 

It contains two active ingredients: 

1. Buprenorphine: A partial opioid agonist. It attaches to opioid receptors in the brain and prevents other opioids from binding to them.^{1, 2, 3, 4}
2. Naloxone: An opioid antagonist. It blocks opioids from attaching to opioid receptors in the brain.^{3, 4, 6}

Suboxone is not used as a pain medication, although it contains buprenorphine, which is an opioid. Buprenorphine and other prescription opioids (like oxycodone and fentanyl) are commonly used to manage moderate to severe pain.

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How Is Suboxone Used in Addiction Treatment?

Suboxone contains buprenorphine and naloxone. With these two components, Suboxone can reduce cravings, prevent withdrawal symptoms, and reverse the effects of opioids. 

As an opioid, buprenorphine attaches to opioid receptors in the brain and prevents other opioids from binding. This action cuts down cravings for opioids and withdrawal symptoms.

Buprenorphine can also cause euphoria and other opioid effects. However, the impact is weaker than that of methadone and other opioids. 

In a study involving 326 heroin users, 17.8% of those on Suboxone had no trace of opioids in their urine after 4 weeks, compared to 5.8% on placebo.²

The subjects were also given questionnaires to evaluate their cravings.² 

• The scores at the start of treatment ranged from 62.4 and 65.6. 
• Those on Suboxone treatment drastically decreased their numbers to 29.8. 
• Those on placebo only reduced their scores to 55.1.

The greater score reduction among Suboxone users supports Suboxone’s effectiveness in curbing opioid cravings.

Is Suboxone Addictive?

Suboxone contains buprenorphine, an opioid, so there’s potential for opioid addiction. But the risk is lower than that of other opioids as buprenorphine is just a partial opioid agonist.. 

Moreover, buprenorphine has a ceiling effect. This means higher doses won’t produce more effects after a certain point. The addition of naloxone, which blocks opioid receptors, also contributes to the lower risk of Suboxone addiction by deterring abuse.^{1, 3, 4, 5}

In a report from Cincinnati Enquirer, people take more Suboxone not to experience euphoria but to avoid further withdrawal from opioid use.⁷

In cases of addiction, people should gradually taper their dose of Suboxone under medical supervision.⁸

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Suboxone Withdrawal Symptoms

Suboxone is often taken for long periods. If you suddenly stop your Suboxone treatment, you might experience withdrawal symptoms. This happens because your body has become used to the presence of buprenorphine.^{9, 10, 11}

Suboxone withdrawal symptoms are not as severe as pure opioid withdrawal symptoms. They vary in severity and duration and depend on the length of Suboxone use, the dosage, and the presence of other mental conditions.^{1, 8, 11} 

Symptoms of Suboxone withdrawal include:^{8, 9, 10, 11}

• Excessive sweating
• Chills or goosebumps
• Shaking or tremors
• Feeling hotter or colder than normal
• Runny nose
• Watery eyes
• Dilated pupils
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Headaches
• Muscle aches
• Tiredness
• Anxiety
• Depression
• Insomnia
• Irritability
• Trouble concentrating
• Decrease in blood pressure
• Further Suboxone cravings

Suboxone Withdrawal Symptom Timeline

Suboxone contains buprenorphine, a long-acting opioid. The onset of withdrawal symptoms with long-acting opioids is often delayed. The symptoms also last longer than with other opioids. 

Here’s a typical Suboxone withdrawal timeline:^{1, 8, 12} 

• Nausea, vomiting, headaches, and other physical symptoms commonly start within 24 to 48 hours. These are generally worse in the first 72 hours and may last up to 10 days.
• Insomnia, mood swings, and muscle aches happen in the first week.
• Psychological withdrawal symptoms like depression happen during the second week.
• Suboxone cravings and depression may persist for 1 month or longer.

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How to Cope with Suboxone Withdrawal

If you’re struggling with Suboxone withdrawal, you can:^{1, 12}

• Drink at least 2 to 3 liters of water per day. This will replace fluids you lost through sweating and diarrhea. 
• Take vitamin B and vitamin C supplements.
• Take other medications to ease withdrawal symptoms. An example is clonidine which can relieve sweating, diarrhea, vomiting, and other physical symptoms.
• Join support groups like Narcotics Anonymous (NA). Members provide guidance and support.  
• Talk to your doctor about tapering your Suboxone dose, which should lessen or stop withdrawal symptoms. 

Tapering involves slowly reducing Suboxone’s dosage over time.

 
While good results were observed with a 28-day taper schedule, one study showed success with a shorter, 7-day taper.¹³ Other studies showed better results with a 4-week taper but with naltrexone.¹⁴

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