Suboxone addiction: signs, withdrawal, treatment, more

Suboxone is a prescription medication that treats opioid use disorder. It can help ease cravings and reduce symptoms of opioid withdrawal. However, if someone does not take it as their doctor prescribes, it can lead to misuse.

Suboxone can help people recover from opioid use disorder, and most people use this medication for this purpose. However, it is essential to take Suboxone exactly as a doctor recommends to avoid developing a substance use disorder, or addiction, to the drug. However, this is rare.

Read on to learn more about Suboxone, including the signs of a substance use disorder, recommended dosage, and when to see a doctor.

Suboxone is a Food and Drug Administration (FDA)-approved prescription medication that healthcare teams may use as part of a complete treatment plan that includes counseling and support for opioid use disorder. It contains two agents — buprenorphine and naloxone.

Learn more about suboxone here.

Buprenorphine is a partial opioid agonist that acts as an opioid while simultaneously blocking off other opioid effects. Like other opioids, it binds to opioid receptors but does not elicit an intense high feeling due to its ceiling effect. If a person stops using other opioids, buprenorphine is the active ingredient in Suboxone that lessens withdrawal symptoms.

Learn more about buprenorphine for opioid use disorder here.

Naloxone works as an opioid antagonist. When a person uses Suboxone appropriately by placing it under the tongue, naxolone remains an inactive ingredient. However, if a person uses Suboxone in another way, such as injecting or snorting, naxolone activates and blocks the effect of other opioids.

Learn more about naxolone here.

As a prescription, the buprenorphine-naloxone combination is available under other brand names, such as Zubsolv. It was also once available as the brand-name medications Bunavail and Cassipa before the parent drug companies discontinued its production in the United States.

Additionally, there are generic forms of buprenorphine-naloxone available.

Learn more about using buprenorphine and naloxone here.

Often, doctors do not administer Suboxone until a person’s body has metabolized the opioids and they have begun experiencing withdrawal symptoms. However, in some cases, doctors may start Suboxone treatment sooner with microdosing. This involves taking minute amounts of a drug to test its effectiveness and reduce potential side effects.

Research from 2018 and 2020 indicates that Suboxone is an effective treatment for opioid use disorder.

Additional reports suggest that Suboxone can offer relief to people who have both opioid use disorder and chronic pain. However, while the FDA approves the use of buprenorphine to treat pain, it has not approved the buprenorphine-naxolone combination for this use.

Learn about other ways to treat pain here.

According to the American Psychiatric Association (APA), substance use disorder is a complex chronic condition where people continue to use one or more substances despite experiencing harmful consequences.

The Drug Enforcement Administration (DEA) classifies Suboxone as a schedule III controlled substance. Schedule III drugs have a moderate to low potential for physical or psychological dependence.

This means Suboxone carries a low to moderate risk of changing the brain’s chemistry so that a person wants to take more of this medication. Additionally, like all opioids, if a person abruptly stops taking Suboxone, they may experience withdrawal symptoms. However, taking this medication under the supervision of a healthcare professional can significantly lessen these risks.

The National Institute on Drug Abuse states that about 16.1 million people, or 5.8% of the US population, over 12 years old misused prescription psychotherapeutic drugs in 2020.

For these reasons, the Substance Abuse and Mental Health Services Administration (SAMHSA), a government organization, recommends that people who want to use Suboxone do so under the supervision of a doctor specializing in treating Suboxone use disorder. This healthcare professional can be a specialist medical doctor or psychiatrist with a buprenorphine waiver certification.

However, the healthcare community believes that this position restricts access to this medication.

A person can use the SAMHSA physician locator tool to find a licensed Suboxone specialist nearest to them.

Learn more about addiction here.

The signs and symptoms of substance use disorder may vary from one person to another.

Certain signs can indicate that a person may be experiencing substance use disorder. These signs can be the same regardless of the substance.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, to receive a diagnosis of substance use disorder, a person must meet two of the following criteria within a 12 month period:

  • Regularly consuming greater amounts of a substance than intended or using a substance for a longer time than planned
  • expressing the desire to, or attempting to, cut down their intake of a substance without actually reducing it
  • spending long periods attempting to procure said substance or to recover from using it
  • craving the substance or expressing a strong desire to use
  • failing to fulfill responsibilities such as those relating to work, family, or education
  • giving up hobbies, passions, or social activities as a result of substance use
  • consuming the substance in places or situations that could cause physical injury
  • using a substance regularly despite causing or worsening social, emotional, or personal issues
  • consuming a substance despite being aware of any physical or psychological harm it is likely to have caused
  • developing an increased tolerance to a substance
  • withdrawal symptoms when not consuming the substance, such as sweating, nausea, and shaking

Learn more about the effects of drug misuse here.

Suboxone is available in two forms, an oral film and an oral tablet. Both the film and the tablet are sublingual medications. This means a person should place the tablet under their tongue or between the tongue and cheeks where it will dissolve.

A person can drink water to moisten their mouth before taking Suboxone to help the films dissolve easily.

Also, while it dissolves in the mouth, people should avoid:

  • cutting, chewing, or swallowing the tablet
  • eating or drinking until the film dissolves fully

Suboxone is available in four strengths:

  • 2 milligrams (mg) buprenorphine / 0.5 mg naloxone
  • 4 mg buprenorphine / 1 mg naloxone
  • 8 mg buprenorphine / 2 mg naloxone
  • 12 mg buprenorphine / 3 mg naloxone

Before prescribing any Suboxone dosage, a doctor will assess a person’s:

  • medical history
  • their type and severity of opioid use disorder
  • their stage of treatment

After assessing a person, the doctor will start them on the most appropriate dosage and adjust it over time to suit their needs.

induction phase

During the induction phase of treatment, when a person initially reduces or stops using opioids, Suboxone can help to minimize withdrawal symptoms.

Doctors usually administer Suboxone during the induction treatment for people dependent on short-acting or long-acting opioids.

On day 1:

  • The doctor can place a person on a low dose of Suboxone. This can be 2 mg buprenorphine / 0.5 mg naloxone or 4 mg buprenorphine / 1 mg naloxone
  • After 2 hours, the doctor will assess a person’s withdrawal symptoms and decide whether they need an additional dose.
  • The maximum dose on the first day is 8 mg buprenorphine / 2 mg naloxone.

On day 2:

  • The doctor will evaluate a person’s withdrawal symptoms. If symptoms improve, the doctor will give the same dose as on day 1. However, if symptoms don’t improve, the doctor will administer the day 1 dose and an additional dose.
  • After 2 hours, the doctor will re-evaluate a person’s withdrawal symptoms and may give another dose of Suboxone.

Additional days:

The doctor will continue the drug administration process for additional days until Suboxone can control and stabilize a person’s symptoms.

However, doctors may also recommend microdosing. This method may be more beneficial than other methods that are impractical or unaffordable or that a person does not respond well to.

maintenance phase

A doctor will recommend a stable dosage of Suboxone for an extended period during the maintenance phase of treatment once a person’s withdrawal symptom improves. This can help a person ease withdrawal symptoms that may lead to using opioids again.

This phase may last several months or indefinitely. However, a person and their doctor can have ongoing discussions about stopping Suboxone or gradually reducing their dose as appropriate.

If a person’s withdrawal symptom increases during the tapering phase, the doctor may increase their dose until their symptoms improve.

Learn more about treatment for substance use disorder here.

If a person stops taking Suboxone without gradually tapering off their dose, they may experience withdrawal symptoms similar to other opioids. A person’s symptoms may vary depending on the dosage and duration of their Suboxone treatment.

Reports of Suboxone withdrawal showed that most symptoms typically peak by withdrawal day 3 and can last for the first 2 weeks.

Below is a chart showing possible Suboxone withdrawal symptoms and a timeline of how long they may last.

Learn more about opioid withdrawal symptoms here.

Using more than the recommended dosage of Suboxone can increase a person’s risk of severe side effects. A person should not use more Suboxone than their doctor recommends.

Overdose symptoms

Symptoms of overdose may include:

While there is a very small risk of overdosing on Suboxone, people should not exceed the dose that a doctor prescribes.

Learn how to recognize an opioid overdose here.

If a person has any symptoms of opioid overdose or has taken a large amount of Suboxone accidentally, they should contact a doctor or call the American Association of Poisons Control Centers at 800-222-1222 or use their online tool.

However, if symptoms are severe, they should call 911 or immediately go to their nearest emergency room.

To avoid overdosing on opioids or other medications, a person should avoid:

  • taking higher amounts than prescribed
  • using it alongside alcohol or sedatives
  • taking it immediately after using other opioids
  • injecting it

Anyone who thinks they are experiencing substance use disorder relating to Suboxone should speak with a doctor for guidance and supervision.

The doctor will evaluate a person’s medical history, their dosage of Suboxone, and how long they have been using it to map out the best treatment plan for them.

After a person starts treatment, they should contact a doctor if:

  • they take a different dose than their doctor recommends
  • their withdrawal symptoms get worse
  • they start using Suboxone or other opioids again

Suboxone is a prescription brand-name medication used to help people recover from opioid use disorder. Although infrequent, Suboxone is prone to misuse. Substance misuse of Suboxone can affect a person’s health, so people should only take it as the doctor prescribes.

If a person notices symptoms of Suboxone misuse in themselves or others, they should contact a doctor. The doctor will assess the person’s condition and determine the most suitable treatment.

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