Suboxone is a medication used to treat addiction to opiates like heroin, according to the Substance Abuse and Mental Health Services Administration. Suboxone contains both buprenorphine and naloxone, and doctors prescribe it to people in addiction treatment to help alleviate opiate withdrawal and cravings.
That being said, buprenorphine itself is a partial opiate, meaning that it can create euphoria, much like heroin, although to a lesser extent. While the effects of Suboxone may not be as strong as with heroin, people still may abuse this medication and become addicted to it. After all, the Drug Enforcement Administration (DEA), labels Suboxone as a Schedule III Controlled Substance, indicating that users can become highly psychologically dependent upon it and develop low to moderate physical dependence upon the drug.
Unfortunately, with dependence comes withdrawal, which means that people may experience uncomfortable symptoms when detoxing off of Suboxone, whether they are using it legally as a doctor prescribes or abusing it in some fashion. Learning more about Suboxone withdrawal can help you to understand this condition better.
Why People Develop Suboxone Withdrawal
People can experience Suboxone withdrawal, even when they take the medication exactly as a doctor prescribes. This is because when someone repeatedly takes a drug or medication, the body becomes used to its presence, and the brain and nervous system adapt over time. If a person suddenly stops using the drug, the body falls out of balance and shows signs of withdrawal in the absence of the drug.
Someone who has been taking a Suboxone prescription each day therefore may show signs of withdrawal if he or she abruptly stops taking it. People can also develop Suboxone withdrawal when they abuse the drug. For example, some people may buy Suboxone illegally off of the street or steal someone else’s medication and then inject or snort it in an attempt to become high or treat their own symptoms of opiate withdrawal. If a person makes a habit of illegal Suboxone use and then stops using, withdrawal symptoms can appear.
Typical Opiate Withdrawal Symptoms
As previously stated, Suboxone is a partial opiate, so those who become dependent upon the substance may show signs typically associated with opiate withdrawal when they stop using Suboxone.
Common opiate withdrawal signs include the following, according to the World Health Organization:
- Nausea/Vomiting
- Anxiety
- Sleep Disturbance
- Sweating
- Cramping
- Runny Nose
- Watery Eyes
- Diarrhea
- Hot Flashes
Specific Symptoms Associated with Suboxone Withdrawal
Since Suboxone is used to treat withdrawal, there isn’t as much research on Suboxone withdrawal symptoms when compared to opiate withdrawal in general, but some case studies provide information about what to expect from Suboxone withdrawal. One case study, published in a 2014 edition of the Journal of Pharmacology and Experimental Therapeutics, found that Suboxone withdrawal symptoms are mild when compared to withdrawing from morphine, which is another medication used to treat opiate withdrawal.
On the other hand, a case study published in the Journal of Addiction Research and Therapy showed that a patient who was withdrawing from Suboxone had some severe symptoms. These included:
- Shaky Legs
- Severe Pain
- Upset Stomach
- Gastrointestinal Symptoms Like Nausea, Vomiting, and Diarrhea
- Headache
- Chills
- Hallucinations
In another case study, included in The American Journal of Psychiatry, a patient developed psychotic symptoms after he reduced his buprenorphine dose. The patient was 32 years old and had been taking 6 milligrams of buprenorphine per day for a year. Under medical supervision, the patient reduced his daily dose to 4 milligrams, and shortly after this reduction, he experienced some typical opiate withdrawal symptoms, including anxiety and sleep problems. Following another 2 milligram dose reduction, he developed hallucinations, paranoid thoughts, and agitated behavior.
While not everyone may experience such severe Suboxone withdrawal symptoms, it does seem that typical opiate withdrawal symptoms, such as sleep problems, anxiety, upset stomach, and diarrhea are possible when withdrawing from this drug. What is worth noting is that while Suboxone withdrawal may be similar to opiate withdrawal in general, it tends to come with a different timeline.
According to a study in African Health Sciences, Suboxone withdrawal tends to peak rather late; participants in the study experienced the most intense symptoms of Suboxone withdrawal 21 days after they stopped using the drug. Another finding in this study was that Suboxone withdrawal tended to be mild, reinforcing that not everyone will experience severe withdrawal symptoms with discontinuation of this drug. It is noted that most participants in the study were injecting buprenorphine, so their experiences with withdrawal may differ from those of people who have been taking Suboxone tablets as a part of opiate addiction treatment.
Protracted Withdrawal
Suboxone withdrawal may not always be severe, but there is a possibility of protracted, or prolonged withdrawal with this drug. According to the Semel Institute for Neuroscience and Human Behavior at UCLA, the clinical term for this condition is post-acute withdrawal syndrome (PAWS), and it lasts for weeks or even months after a person stops using a drug. PAWS occurs because the brain changes with ongoing substance use, and when a person undergoes withdrawal, the brain has difficulty managing stress. This results in long-lasting withdrawal symptoms, including some or all of the following:
- Impaired Learning and Problem-Solving Abilities
- Anxiety and Panic
- Depression
- Relationship Problems
- Drug Cravings
- Sleep Problems
- Pessimism
- Susceptibility to Stress
The above post-acute withdrawal symptoms can be discouraging and make it difficult to remain abstinent from opiates, especially for those who have been in treatment for opiate addiction. A study in the American Journal on Addictions found that when people in opiate addiction treatment completed a 28-day tapering of buprenorphine, a majority of them relapsed to using opiates. The study’s authors theorized that relapse might have been due to drug cravings and the desire to experience the positive effects of drugs. Those who are withdrawing from Suboxone can therefore expect to be faced with increased risk of relapse if they experience the unpleasant psychological side effects that come with prolonged withdrawal.
Tapering Dosages to Manage Withdrawal: What to Expect
For those who have been taking Suboxone and wish to discontinue the use of this drug, tapering to a lower dose is typically the recommended method of coming off of the drug without experiencing significant withdrawal symptoms. According to the National Alliance of Advocates for Buprenorphine treatment, severe symptoms of Suboxone withdrawal are uncommon when patients utilize a gradual taper from the drug, and the best results are achieved with the most gradual taper. This organization also reports that while severe symptoms are uncommon, patients may experience some mild symptoms such as reduced energy, lack of appetite, irritability, and sleep problems after stopping Suboxone use, but these symptoms are usually temporary and last for just a few days.
Ultimately, a patient and doctor will work together to determine an appropriate dose tapering schedule, but in general, dose reduction will depend upon how much Suboxone a patient was taking each day. For example, experts recommend the following dose-tapering schedule for guidance:
- Reducing dose by 4 mg every 1-2 weeks for patients taking 16 mg or more of Suboxone daily
- Reducing dose by 2-4 mg every 1-2 weeks for patients taking between 8 and 16 mg of Suboxone daily
- Reducing dose by 2 mg every 1-2 weeks for patients taking under 8 mg of Suboxone daily
Using an appropriate tapering regimen can help the body adjust to operating without Suboxone so that withdrawal side effects are minimized.
Medical Treatments for Withdrawal
While it is possible to minimize withdrawal symptoms with gradual tapering, some people may still experience unpleasant Suboxone withdrawal and require medical treatment in a Suboxone detox facility. For instance, some people may find that they experience depression, anxiety, or sleep problems, and doctors may prescribe medications to address these concerns.
Researchers have also studied the effects of some prescription medications that may specifically treat Suboxone withdrawal. For example, a study In The American Journal on Addictions found that a medication called pramipexole was especially effective for treating the restlessness associated with Suboxone withdrawal. The study authors also noted that some people may find relief with clonidine and benzodiazepines, but these drugs are not always effective.
Psychological Treatment for Suboxone Withdrawal
There are some medications available for treating Suboxone withdrawal, but it is also critical to consider psychological treatments, such as counseling and support groups. Medications can only alleviate the immediate symptoms of Suboxone withdrawal, whereas psychological treatments address the underlying causes of addiction. For instance, the following psychological treatments may be useful for those who are experiencing Suboxone withdrawal:
- One-on-One Therapy: By working with a therapist, people who are undergoing withdrawal from Suboxone can uncover and address some of the underlying causes that led them to develop an opiate addiction. In therapy, they can work through these issues and learn healthier ways of coping that do not include drugs. For instance, a specific type of therapy called cognitive-behavioral therapy teaches people new ways of thinking that can lead to desired behaviors. In the case of addiction, a person may believe that he or she cannot cope with the symptoms of withdrawal or cannot live without drugs, but therapy can help the person to replace this negative thought with a more positive outlook like, “Withdrawing may be difficult, but I have the tools to overcome it.”
- Support Groups– Attending support groups such as Narcotics Anonymous can also equip people with the tools to cope with Suboxone withdrawal. In these groups, people can connect with others who are living through the same struggles and share advice and success stories.
- Relapse Prevention Groups– As the research has shown, coming off of Suboxone can cause people to relapse, because they may begin to crave opiates again. In relapse prevention groups, people can learn to identify and cope with relapse triggers in a healthy way so they do not begin using again. They can also learn ways of coping that do not involve turning to drugs. These groups can help people to remain abstinent as they discontinue Suboxone use.
Psychological treatments provide new coping mechanisms and change the patterns of thinking that contribute to addiction, so they are an important consideration when withdrawing from Suboxone. Hopefully, doctors who are assisting patients with Suboxone tapering will refer them to appropriate therapies. In most cases, people who have been taking Suboxone will already be participating in psychological treatment, since the law typically requires it for those receiving medications to treat opiate addiction. It is important that these therapies continue for as long as needed after Suboxone use stops, as a person may be at high risk of relapsing if no supportive services are in place.
Suboxone Withdrawal: Key Points
Researchers and addiction treatment experts have weighed in on Suboxone withdrawal, providing helpful information about what to expect from the process. Overall, it is important to remember the following key points about withdrawing from Suboxone:
- Suboxone is a prescription medication with legitimate uses, but that doesn’t mean there will be no withdrawal.
- Each person’s experience with Suboxone withdrawal will be different. Much of the research suggests that withdrawal symptoms are mild, but some people do experience severe side effects, such as nausea and vomiting, hallucinations, or even psychosis.
- Experts believe that Suboxone withdrawal symptoms can be minimized if patients work with a doctor to gradually taper their doses.
- Suboxone withdrawal can lead to relapse, because people may experience distressing psychological symptoms, like drug cravings, depression, anxiety, and a generally pessimistic mood.
- Medications can be helpful for treating some symptoms of Suboxone withdrawal, but psychological treatments like therapy and support groups are necessary for preventing relapse after a person stops using Suboxone.
- Withdrawal symptoms are generally short-lived, but some people may experience post-acute withdrawal symptoms, which can last for several months.
- Suboxone is considered a partial opiate drug, so it may share some withdrawal symptoms that are seen with drugs like heroin.
- There is some evidence that Suboxone withdrawal may peak after about 21 days of abstinence among people who abuse the drug, but experts report that people who take prescribed Suboxone tend to experience mild withdrawal symptoms that disappear after a few days.
There is a significant amount of information available about Suboxone withdrawal, but each person’s specific experiences will vary. Some people may experience no or very mild symptoms, whereas others may have more severe symptoms that require treatment. Fortunately, help is available.
Sources & Additional Resources
- httpss://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
- httpss://www.deadiversion.usdoj.gov/schedules/
- httpss://www.ncbi.nlm.nih.gov/books/NBK310652/
- https://jpet.aspetjournals.org/content/348/2/217.short
- httpss://medlineplus.gov/druginfo/meds/a697029.html
- httpss://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835595/
- httpss://www.ajol.info/index.php/ahs/article/view/152542
- httpss://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS
- httpss://www.tandfonline.com/doi/abs/10.1080/105504901750227778
- https://www.naabt.org/documents/Suboxone_Dosing_guide.pdf
- httpss://onlinelibrary.wiley.com/doi/abs/10.1111/j.1521-0391.2014.12133.x
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