Buprenorphine (Suboxone): Complete Guide to Uses, Doses & Side Effects
Buprenorphine (Suboxone): a guide to uses, doses and side effects
If you are reading this, Suboxone is probably in front of your doctor’s desk. It is one of the treatments for opioid withdrawal, and your doctor writes the prescription for your case.
Suboxone is one of the medications used in an opioid detox program . Your doctor decides whether to prescribe it.
Most people meet Suboxone in the first days of getting off opioids, when withdrawal is at its worst.
- What Suboxone is How buprenorphine and naloxone work, and how Suboxone compares with methadone and Subutex.
- Suboxone withdrawal What withdrawal from Suboxone feels like, and Suboxone detox.
- Programs for opioid addiction Support systems, including 12 step programs, that keep recovery on track.
- Signs of addiction in a loved one How to notice when someone you love is struggling, and how to get them help.
- Frequently asked questions How it works, what it costs, and how to taper off it.
Opioids have taken a hold on you or someone you care about? Talk with Pines Recovery Life by contacting us today.
What is Suboxone (buprenorphine and naloxone)?
Heroin and other opioids are full opioid agonists. They bind to opioid receptors, causing an intense rush for a short while with potentially deadly effects over time.
Some major side effects of opioids include:
- Clouded mental function
- Respiratory distress
- Depression
- Death in some cases
Over time the body gets used to opioids, and people need more to feel high, which raises the chance of overdose. The drug changes brain chemistry, and the body comes to rely on it just to stay level. That dependency brings on intense withdrawal, especially for long term users. Finding more takes over their thoughts and their days, often at the cost of relationships, careers, and in some cases lives.
Opioid withdrawal is rarely deadly on its own, though acute symptoms can still land someone in the hospital. Suboxone is one of the treatments for it. It was designed as a non-intoxicating treatment for opioid addiction, and the pill dissolves under the tongue. It combines two opioid medications: buprenorphine, a partial opioid agonist, and naloxone, a full opioid antagonist.
Buprenorphine only partially binds to opioid receptors, so it triggers them slightly, much the way methadone does. It reduces urges without the euphoria. It also blocks other opioids from binding, so there is nothing to gain from chasing a high. Naloxone (Narcan) is an opioid receptor blocker, added to discourage misuse of buprenorphine.
Swallowed, the naloxone in Suboxone does almost nothing. Injected or snorted, it brings on opioid withdrawal immediately. Do not misuse any medication.
Buprenorphine is long-acting and lasts up to 3 days. It starts working 30 to 45 minutes after you take it and gives opioid receptors steady, mild stimulation, which holds off withdrawal and heavy cravings. That lowers the risk of relapse. On its own it is used as a pain reliever, mainly in Europe.
Side by side comparisons
Suboxone is not the only option. Ask your doctor whether it is right for you.
Suboxone was developed in response to misuse of the other medications. It should be used alongside a full drug treatment program.
Suboxone vs methadone
Since 1947, Methadone was widely used to wean users off opioids. For years it was seen as the most effective treatment, until misuse of it grew and researchers went looking for alternatives. Suboxone was created in 2002 and sold as an alternative to methadone that is harder to misuse.
Ease of access
Suboxone can be prescribed by most medical doctors, while methadone must be prescribed by a specialist.
Effectiveness
With Suboxone, 49% of users reported reduced misuse of prescription pain killers . Methadone showed 33% fewer opioid positive drug tests, and people on it were 4.44 times more likely to stay in treatment. .
Safety
Suboxone is about 6 times safer than methadone, most likely because of the added naloxone.
Suboxone vs Subutex
Subutex is the brand name for buprenorphine, with no naloxone added. Same active ingredient, so it works the same as Suboxone. Suboxone is much harder to misuse, which makes it the better choice for someone with a severe opioid addiction.
Suboxone treatment uses
It is prescribed as a safer alternative to methadone, for opioid or heroin addiction. It eases opioid withdrawal and has mild pain-killing effects, which makes the symptoms easier to manage.
How to use Suboxone
Only use it as your doctor prescribes. Your doctor knows your case and can tell you what fits you.
Suboxone comes as a peach-colored hexagonal pill or as a generic oral film. It is a sublingual medication, taken under the tongue and left to dissolve.
That is a more direct route to the bloodstream, without going through the digestive tract, so the medicine works faster and hits harder. It also helps people who have trouble swallowing pills.
Make sure your hands are dry when using Suboxone to avoid absorption through the skin.
Suboxone comes in several strengths:
- 2 mg buprenorphine / 0.5 mg naloxone
- 4 mg buprenorphine / 1 mg naloxone
- 8 mg buprenorphine / 2 mg naloxone
- 12 mg buprenorphine / 3 mg naloxone
That is a ratio of 4 buprenorphine to 1 naloxone. Your doctor writes the prescription for your case.
Possible Suboxone (buprenorphine and naloxone) side effects
Every prescription medication has side effects worth knowing about. Talk to your doctor about any acute symptom, because it can be a sign of something more serious.
- Respiratory issues: Respiratory depression is a common problem with opioids and one of the more severe side effects. Breathing can become shallow or slow right down. That starves the body of oxygen and can kill.
- Burning tongue
- Irritated mouth
- Constipation
- Depression
- Insomnia
- Lower sex hormones
Suboxone and drug tests
It is a Schedule III prescription drug and a controlled substance. It does not show up on a standard drug test and will not cause false positives. Buprenorphine is similar to other opioids but has a different chemical make-up, and it breaks down into its own metabolites. It will not show up unless someone tests for it specifically.
Suboxone withdrawals
Suboxone is used for opioid addiction, and it is still a partial opioid. It causes physical and psychological dependence in a lot of people. Quitting cold turkey without a doctor is never a good idea. A Suboxone detox comes down in small steps instead. Many of the withdrawal symptoms are the same as opioid withdrawal, because you are still dependent while you taper. The taper runs over weeks or months, and you stay functional through it until you are off the drug.
Suboxone withdrawal usually starts 1 to 3 days after your last dose, later than with other opioids, because the drug lasts so long in the body. That catches people out. They can go days feeling fine and then be in full withdrawal out of nowhere.
Physical withdrawal
Most physical symptoms peak around 3 to 5 days and can last about 2 weeks, then they settle. You need a doctor watching you through that stretch in case of complications, and you need to be somewhere safe and clean.
Physical symptoms include:
- Chills
- Restlessness
- Sweating
- Headache
- Stomach pain
- Liver damage
Psychological and emotional withdrawal
The psychological effects last longer than the physical ones. People who used for a long time can feel opioid withdrawal for months, and in severe cases for years.
- Depression
Not being able to feel pleasure is common after opioid use. The euphoria from opioids wrecks the body’s own ability to produce it, and that damage can last a long time.
- Anxiety
- Insomnia
- Lethargy
- Mood swings
Those are the main symptoms. People get them to different degrees, and some get none of them. Most do not need hospital care. This list is not everything, so talk the side effects through with your doctor.
Steps to help with Suboxone detox
Your physician manages the detox. For some people it is straightforward. For others it is hard to get through, and a doctor managing it as it happens is the biggest thing working in your favor.
- Drink lots of water
Water helps your body get back to normal while you detox. Most people do not drink enough anyway, and withdrawal makes it matter more.
- Eat healthy, nutrient-rich foods
Your body loses a lot of nutrients during withdrawal, and it needs them back to heal.
- Meditation for anxiety
Plenty of people who have beaten an opioid addiction used meditation alongside their treatment.
- Therapy/support group
Access to a support group matters, in treatment and after it.
Responsible use
High doses have serious side effects, and because Suboxone is opioid-based, misuse can kill. Some rules:
- Keep all your drugs in a safe place and out of reach of children or pets.
- Safety of use during pregnancy is determined by your doctor; long-term use can cause withdrawal symptoms in the fetus once born and can be deadly.
- Do not take it unless your doctor prescribes it
- Misuse can lead to adverse, irreversible side effects, including death if you overdose.
- Seek medical attention right away if you pass out, experience dizziness or extreme drowsiness. These might be signs of an overdose.
- Do not use it with alcohol
- Read all the side effects and instructions given to you by your pharmacist
Many doctors recommend tapering off Suboxone slowly. Bringing the daily dose down is one of the best ways to prevent a relapse. In a supervised Suboxone detox, a physician sets the pace of that taper and manages the withdrawal that follows.
Let your doctor know if you:
- Have ever had an allergic reaction to Buprenorphine
- Have liver disease or a heart condition
- Have asthma or other respiratory issues
- Are taking other medications
- Are pregnant or breastfeeding
- Are taking blood pressure medication
- Have any other medical conditions
Your doctor needs as much information as possible to get the dose right. Telling them your medical history and your concerns is on you.
Grapefruit can increase the drug’s side effects. Cut it out while you are taking Suboxone.
Suboxone detox versus other opioids
Detox from Suboxone is usually milder than from a full opioid, though not always. As the dose comes down week by week the symptoms ease, and the mental side of the addiction can last much longer.
Finding the right support system
Medication is often necessary, and the right support system is what keeps you on track. It gets easier over time. People relapse because they have no one to turn to, because something happens in their life, or because the nights get unbearable. Being able to talk to someone who has been through it and come out the other side can be the thing that gets you through. A support group can be a professional group like NA, or a handful of other people who have been through addiction and recovery.
In NA a person in recovery finds a sponsor to guide them through the 12 steps.
The 12 steps of Narcotics Anonymous (NA):
- Step 1: We admitted we were powerless over our addiction, that our lives had become unmanageable.
- Step 2: We came to believe that a Power greater than ourselves could restore us to sanity.
- Step 3: We made a decision to turn our will and our lives over to the care of God as we understood Him.
- Step 4: We made a searching and fearless moral inventory of ourselves.
- Step 5: We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Step 6: We were entirely ready to have God remove all these defects of character.
- Step 7: We humbly asked Him to remove our shortcomings.
- Step 8: We made a list of all persons we had harmed, and became willing to make amends to them all.
- Step 9: We made direct amends to such people wherever possible, except when to do so would injure them or others.
- Step 10: We continued to take personal inventory and when we were wrong promptly admitted it.
- Step 11: We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Step 12: Having had a spiritual awakening as the result of these steps, we tried to carry this message to people with addiction, and to practice these principles in all our affairs.
Narcotics Anonymous exists to help people fight their addiction. Nobody can do it alone, and nobody should have to. NA is worldwide, with meetings in every major US city, and also offers virtual meetings. You are never alone.
Read more about NA and find local Narcotics Anonymous meetings at na.org.
Is someone you love in trouble?
Watching someone you love struggle with addiction is heartbreaking. People lie to hide it, and some get very good at hiding it from the people closest to them. If you suspect an opioid addiction, these are the things to look for:
Frequent drowsiness or flu-like symptoms
On its own this means nothing, but alongside other behavior it matters, especially in someone who is normally healthy. It can point to opioid misuse, or to alcohol.
Difficulty managing cravings
If someone you love is having trouble controlling their cravings for their pain medication, keep an eye on how much they are using. As use goes up, the body becomes dependent and needs more to get high. Running out of a prescription early every month means they are taking more than the recommended dose. Getting it from illicit sources means it has gone a long way, and it will start to hit the rest of their life.
Missing work
As the dependency takes over it matters more to them than almost anything else. Child care, appointments, work: all of it slips. An intervention is often what it takes at this point, before they throw their life away to get high. Creating an intervention that holds takes planning, from who is in the room to the treatment plan on the table.
Stealing
Once the addiction has drained someone financially, they look for other ways to get the drug. It starts with borrowing money, and when that runs out some people steal. At that point you have to act.
Lying
People hide the habit by lying about how much they use and where they have been. The stories are usually poorly thought out and do not add up to a sober mind. To them it makes sense, and they want the questions over with fast. The more you ask, the more likely you are to find the hole in the story.
General lethargy and lack of hygiene
This shows most when they are coming down. People in withdrawal get depressed and stop taking care of themselves. The body cannot produce the chemicals that make them feel good, and that grinds them down for as long as the symptoms last.
Addiction hides well, and the people closest to someone are often the last to see it. Do not look away when someone is hurting.
The right support system is what keeps someone on track, in treatment and after it.
With the right treatment, medication like Suboxone and a plan from a doctor, people do get out. For some, that includes maintenance therapy, a prescribed medication a physician manages while the rest of recovery takes hold. Needing help along the way is nothing to be ashamed of. Do not give up on the people you love.
FAQs
Is Suboxone an opioid?
Buprenorphine is a partial opioid agonist. It binds to opioid receptors, but only partially, so the effect has a ceiling.
Does Suboxone get you high?
No. Compared with full opioids, Suboxone has a very weak effect. It gives slight pain relief and reduces withdrawal symptoms. Because it is only a partial agonist, it has a ceiling effect: past a certain point the effects plateau.
How long does Suboxone block opiates?
For 24 to 60 hours, depending on metabolism, weight and other factors. Full opioids like Oxycodone, Percocet and Morphine will have no effect, and you can still overdose if you keep taking more.
How long does it take for Suboxone to dissolve in your mouth?
On average, once under the tongue it takes about 4 to 8 minutes to completely disintegrate.
Can you take sleeping medications along with Suboxone?
No. Any sedatives, antidepressants, or sleeping medications are strongly discouraged when taking Suboxone.
How much does Suboxone cost?
Cost varies based on individual cases and needs. Lower doses cost around $5, so a treatment regimen can be as little as $59 or up to $220.
Can I become addicted to Suboxone?
You can become physically dependent on it. The process manages the addiction, it does not end it, and withdrawal is common. Most people report it over the long term.
Can you drink while on Suboxone?
No. Mixing Suboxone and alcohol can be fatal. It amplifies the bad effects and causes severe breathing problems, and it can lead to loss of consciousness or coma.
Do you have an opioid dependence?
Typically people go in for a surgery or other procedure and afterward a prescribed pain medication. This can be in the form of Percocet, Oxycodone, or even Morphine.
Plenty of people develop a dependency through no fault of their own. Over time they need more of the drug to feel what they felt at the start, and the more they take the deeper the dependency goes. Some try to quit cold turkey, and the withdrawal, physical and mental, is harsh enough to stop them.
In 2018 alone, over 70% of drug overdoses involved a prescription or illicit opioid. Opioid addiction is hard to beat, and a doctor may prescribe medication to take the edge off the symptoms.
Talk it through with Pines Recovery Life, and we will check your insurance coverage. Call (855) 981-8935.
Additional resources
Risk Evaluation and Mitigation Strategy (REMS)
5 myths about using Suboxone to treat opiate addiction
New York State Medicaid Drug Information Response Center
The CARA Buprenorphine Prescribing for APNs
Clinical Review Report: Buprenorphine extended-release injection (Sublocade)
Video resources
Frequently Asked Questions
What is Suboxone used for?
Suboxone (buprenorphine/naloxone) is an FDA-approved medication for opioid use disorder. It reduces cravings, blocks the effect of other opioids and prevents withdrawal, so people can stabilize and do the long-term work of recovery.
How does Suboxone work?
Buprenorphine is a partial opioid agonist: it activates opioid receptors enough to relieve cravings and withdrawal, but has a ceiling effect that limits euphoria and overdose risk. Naloxone is added to deter misuse by injection.
What are the side effects of Suboxone?
The most common side effects are headache, nausea, constipation, sweating, and sleep disturbance during induction. Most resolve within the first week. Serious side effects are uncommon when Suboxone is taken as prescribed.
How long should someone stay on Suboxone?
Treatment length is individual. Evidence supports long-term maintenance, 12 months or longer, for many people, because it cuts overdose risk and relapse sharply. A decision to taper should be deliberate and clinically guided.
Is Suboxone addictive?
Physical dependence on Suboxone is real, and stopping abruptly causes withdrawal. Dependence is not the same as addiction. Taken as prescribed for opioid use disorder, Suboxone is a treatment that saves lives.
Does Pines Recovery Life offer Suboxone induction?
Our 24/7 physician-supervised medical detox includes Suboxone induction and stabilization, and we plan your step-down before you leave.
