How Is Suboxone Used in Opioid Detox?

Suboxone is used both in acute opioid detox and as maintenance treatment. The medication reduces short-term withdrawal symptoms, eases cravings, and can prevent relapse for the long term.

You might start taking Suboxone early in your recovery, and if it helps, you could keep taking the medication even indefinitely if you so chose. As long as it helps you stay on track in your recovery, there’s no reason to quit using it.

If you do decide to stop taking Suboxone, talk with your doctor first. You should develop a taper schedule to ensure your brain cells adjust to the drug’s absence slowly to avoid any withdrawal. 

Suboxone as Part of Opioid Detox 

The term detox refers to detoxification, which is often the earliest stage of addiction treatment right after a person stops using opioids. It refers to the acute period (usually a few days) of more severe withdrawal symptoms. 

After quitting opioids, people with a physical dependence will go through withdrawal. While symptoms can resolve without therapy, withdrawal can be challenging for many people. Without treatment, some people relapse to drugs to ease their discomfort.[1]

During detoxification, Suboxone alleviates uncomfortable withdrawal symptoms, such as these:

• Sweating
• Nausea
• Chills
• Pain 
• Diarrhea 
• Tremors
• Anxiety/aggression

Suboxone is a combination of two medications: buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. Buprenorphine is the most important component of Suboxone from the standpoint of withdrawal treatment. Naloxone is added to the buprenorphine in Suboxone to reduce the ability to tamper with the medication or to misuse it. If taken as instructed under the tongue, the Naloxone is not absorbed by the body and remains inactive. 

Suboxone should only be initiated or started in collaboration with your treatment provider. If you take Suboxone when opioids are still in your system, you could develop precipitated withdrawal symptoms. 

Your provider will likely start with a small dose to ensure the Suboxone will not accidentally trigger withdrawal and then can quickly increase your dose to prevent any cravings or withdrawal symptoms in the first 24-72 hours. Once you find a dose that works for you to prevent your withdrawal symptoms, you can continue taking that dose each day. 

Short term, Suboxone helps people get through the first few days of withdrawal. Long term, it can be continued to prevent cravings or return to opioid use.  

Clinical management of opioid withdrawal, including the use of medications like Suboxone, is a crucial bridge to long-term care and recovery of opioid use disorder (OUD).[2]

Starting Suboxone Treatment & Maintenance 

After acute detox, you’re hopefully not struggling with withdrawal symptoms, but you remain at risk for having cravings. Continuing Suboxone after the acute withdrawal process can help to prevent cravings over the first few months or years of your recovery. 

Many people remain on their maintenance dose of Suboxone for months, years, or even indefinitely.[3] The medication helps people focus on attending therapy and getting back to living their lives because it eliminates cravings for opioids and reduces other compulsive behaviors around drugs. 

Tapering Off Suboxone: Is It Necessary? 

Suboxone is a safe and effective medication for managing OUD. Tapering off this prescription medicine is an option, although many people choose to stay on Suboxone indefinitely.

While it is possible to only use suboxone for a few days to weeks during the acute withdrawal phase, there is good evidence that people who engage in longer use of Suboxone are able to sustain recovery better than those who use Suboxone only in the acute withdrawal setting. [4] Studies suggest tapering off even after six to nine months of maintenance treatment increases the risk of relapse and opioid use disorder recurrence compared to staying on Suboxone for longer.[5]

If you’re interested in a taper, your doctor can discuss the risks and benefits with you and help you develop the best plan for your sustained recovery. 

Sources

1. Review Article: Effective Management of Opioid Withdrawal Symptoms—A Gateway to Opioid Dependence Treatment. The American Journal on Addictions. https://onlinelibrary.wiley.com/doi/full/10.1111/ajad.12862. January 2019. Accessed January 2023.
2. Clinical Management of Opioid Withdrawal. Addiction. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15818. February 2022. Accessed January 2023.
3. Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment. January 2023. Accessed January 2023.
4. A Randomized, Double-Blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers. JAMA. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1761270. December 2013. Accessed January 2023.
5. Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder. American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19060612. December 2019. Accessed January 2023.