Tips for Tapering Off Suboxone

People who are in treatment for opioid addiction may be prescribed specific medications like Suboxone or methadone to help them limit withdrawal symptoms that would otherwise occur when the once-abused opioid is stopped. These medications serve to stabilize patients in detox and help maintain them in longer-term recovery. Some people who start out taking methadone may switch to Suboxone because it is seen as a safer drug with a lower potential for abuse and addiction.¹

Quitting Suboxone can cause withdrawal symptoms. People looking to end their Suboxone use should not stop using abruptly but rather gradually taper their dosage.²

What Is Suboxone?

 Suboxone is a medication taken either in sublingual (under the tongue) or buccal form that contains a combination of buprenorphine and naloxone. Suboxone is often used as a part of medication-assisted treatment (MAT).³

MAT is one of the most effective methods to treat opioid use disorders, as it is a comprehensive form of treatment that is tailored to a person’s specific needs. It combines medication with behavioral therapies and counseling to treat addiction.^3,4

Buprenorphine

Buprenorphine is referred to as a partial opioid agonist because, although it binds to the same receptors as opioid drugs of abuse—many of which are full opioid agonists—it doesn’t activate the body’s opioid receptors to the same extent as a full agonist (e.g., heroin or methadone). As a partial agonist, it has a less robust opioid effect that plateaus at a certain point, even if additional doses are administered; as such, buprenorphine is not associated with the same magnitude of euphoria or pain relief that a full agonist is. This plateau, or ceiling effect, minimizes buprenorphine’s abuse potential and makes it safer in the case of overdose.^5.6

Despite its relatively increased safety profile, intentional misuse of the drug—such as dissolving buprenorphine to be used intravenously or combining it with other substances like benzodiazepines or alcohol—may still place you at risk of overdose and death.²

Naloxone

Naloxone is a medication that is often used to reverse an opioid overdose. An opioid antagonist, naloxone blocks the receptor sites that an opioid activates, effectively stopping any opioid effects.⁷

Naloxone is included in Suboxone to help prevent drug misuse.⁷ Although the naloxone has no effect when Suboxone is administered as prescribed (e.g., sublingually), a person who is opioid-dependent who attempts to inject Suboxone to administer it intravenously will likely suffer from immediate withdrawal symptoms.⁶

How Bad Is Suboxone Withdrawal?

Like other opioid-containing medications, Suboxone is associated with physical dependence. Keep in mind, however, that physical dependence is not the same as addiction/substance use disorder. Physical dependence means that your body requires the drug in order to function and feel normal.^8,9 Therefore, if you are physically dependent on Suboxone and you stop using the drug cold turkey, you will likely experience withdrawal symptoms.¹⁰

Symptoms may be less intense than withdrawal from full opioid agonists and likely will not start as quickly (it may take up to 48 hours for symptoms to arise).^11,12

Suboxone withdrawal symptoms may include:^11,12,13

• Anxiety.
• Restlessness.
• Insomnia.
• Dilated pupils.
• Watery eyes.
• Yawning.
• Runny nose.
• Goosebumps.
• Nausea.
• Vomiting.
• Muscle aches and pains.

Withdrawal symptoms from Suboxone can be very uncomfortable and unpleasant, but they are usually not life-threatening.¹³

What Is The Best Way To Wean Off Suboxone?

Tapering off from Suboxone should be performed under medical supervision to prevent severe withdrawal symptoms and keep you comfortable. Your physician can provide a tapering schedule that is most appropriate to your needs.¹⁴

There is no set timeline or dosage because Suboxone tapering needs to be individualized. If you force a specific taper, you make risk a worsened outcome.⁶

If you are interested in quitting opioids and want professional help, you have options. At Desert Hope, we offer a medical detox with 24/7 monitoring to ensure patient safety and comfort. In general, the Substance Abuse and Mental Health Services Administration recommends hospitalization “or some form of 24-hour care” for people who are withdrawing from opioids, due to humanitarian and safety concerns.¹⁵ However, if you have not been misusing your Suboxone, you may not need inpatient medical detox. If you speak with your doctor and he or she suggests that you do not need an inpatient detox program, you may also taper off Suboxone with periodic visits to an outpatient program or your physician’s office.

Remember that detox is just the first step on the road to recovery. If you are abusing Suboxone or any other medications, you’ll need further substance abuse treatment to learn the skills you’ll need to avoid relapse. Desert Hope offers a variety of treatments, such as individual counseling, group therapy, recreational and expressive therapies, and drug education to cement your newfound sobriety and help you remain abstinent.

References:

1. Chen, K. Y., Chen, L., & Mao, J. (2014). Buprenorphine-naloxone therapy in pain management. Anesthesiology, 120(5), 1262–1274.
2. U.S. Food & Drug Administration. (2016). SUBOXONE® (buprenorphine and naloxone) sublingual film, for sublingual use.
3. Substance Abuse and Mental Health Services Administration. (2019). Medication and Counseling Treatment.
4. Mattick  RP, Breen  C, Kimber  J, Davoli  M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD002207.
5. Substance Abuse and Mental Health Services Administration. (2019). Buprenorphine.
6. Velander J. R. (2018). Suboxone: Rationale, Science, Misconceptions. The Ochsner Journal, 18(1), 23–29.
7. Substance Abuse and Mental Health Services Administration. (2019). Naloxone.
8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
9. National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction (8: Definition of dependence).
10. National Alliance of Advocates for Buprenorphine Treatment. (2008). What is withdrawal?
11. U.S. Food & Drug Administration. (2014). NDA 22?410 SUBOXONE® (buprenorphine and naloxone) sublingual film CIII Buprenorphine (opioid partial agonist?antagonist) Naloxone (opioid antagonist).
12. B.M.Tripathi, P. .Hemraj, N.K. Dhar. (1995). Buprenorphine Withdrawal Syndrome. Indian J. Psychiatry 1995,37(1), 23-25.
13. U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal.
14. Ling, W., Hillhouse, M., Domier, C., Doraimani, G., Hunter, J., Thomas, C., … Bilangi, R. (2009). Buprenorphine tapering schedule and illicit opioid use. Addiction (Abingdon, England), 104(2), 256–265.
15. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville, MD: Center for Substance Abuse Treatment.