- Addiction & recovery
What Does Suboxone Do?
David Schwartz, MD
October 14, 2021
Suboxone has been in clinical use to treat opioid use disorder (OUD) since its approval by the U.S. Food and Drug Administration (FDA) in 2002. Suboxone is a prescription medication primarily used to help reduce cravings for potent opioids such as heroin, fentanyl, and oxycodone. Even though Suboxone is a relatively new medication for opioid use disorder (MOUD), the number of opioid treatment programs (OTP) offering Suboxone has significantly increased since 2003.
Suboxone is available in the following forms:
- Sublingual tablet (Zubsolv)
- Sublingual film (Cassipa)
- Monthly Injection (Sublocade)
- Transdermal Implant (Probuphine)
- Buccal film (Bunavail)
Suboxone is classified as a schedule III controlled medication that possesses a moderate risk of dependence. As a result, only medical professionals certified by the U.S. federal government can prescribe this medication. Suboxone is not intended to cure opioid use disorder, but it does play an important role in the recovery process. Suboxone treatment programs generally involve behavioral therapy, counseling, and psychological support as part of a “whole person” approach to substance use disorder treatment.
How Does Suboxone Work?
Suboxone contains a combination of buprenorphine and naloxone that work chemically to reduce the severity of withdrawal symptoms and dependence on opioids. While buprenorphine is an effective opioid pain reliever, it is also a partial opioid medication that activates the same brain receptors as other potent opioids. This function helps minimize opioid cravings and withdrawal symptoms without the full opioid potency or effect.
Naloxone, on the other hand, is an opioid antagonist (inhibitor) that completely blocks opioid receptors in the brain. This function helps rapidly reverse the effects of opioids if Suboxone is crushed and injected to help reduce the risk of overdose and relapse. Naloxone (Narcan) is generally used in emergency situations as a medication to counteract an opioid overdose. And thus, this combination medication provides a low-risk potential for misuse and overdose.
How Is Suboxone Taken?
Suboxone is taken as a sublingual film or tablet that’s placed under your tongue or between your gums and cheek (buccal) as a single daily dose. Suboxone films dissolve within eight minutes of administration, and the effects begin around 20 to 60 minutes following ingestion. The medication reaches peak level within two to three hours, and the effects can last up to 72 hours. For Suboxone to work effectively, the first dose is usually taken during the acute withdrawal stage.
As a starting point, health care practitioners typically start with a single dose of two to four milligrams of Suboxone. Individuals are then monitored throughout this period to help identify the most effective dose for each individual. Suboxone doses can be gradually increased during treatment, based on your specific needs and tolerance under the supervision of a treatment provider.
How Long Does Suboxone Stay In Your System?
The buprenorphine in Suboxone has an exceptionally long elimination half-life compared to other opioids. Elimination half-life refers to the amount of time it takes for half of a single dose to leave the body. For buprenorphine, this period lasts 24 to 42 hours, meaning that it can take over seven to nine days for Suboxone to leave the body completely.
Many factors can contribute to how long Suboxone stays in the system. These include:
- Metabolism speed
- The last dosage taken
- History of substance misuse
- Liver health
In addition, depending on the duration of treatment, traces of buprenorphine can remain detectable in the body for longer periods.
Side Effects of Suboxone
While Suboxone is an effective MOUD treatment, it does possess the risk of side effects. Individuals are more susceptible to experience these side effects if they attempt to misuse the medication.
The most common side effects of Suboxone include:
- Weakness or fatigue
- Rapid heartbeat
- Back pain
- Muscle pain
- Runny nose
- Trouble concentrating
The severe and less common side effects of Suboxone include:
- Blurred vision
- Loss of coordination
- Disturbance in attention
- Shallow breathing
- Adrenal insufficiency
- Respiratory depression
- Loss of consciousness
- Loss of appetite
- Low blood pressure
- Liver problems
- Severe allergic reactions (the most common signs of an allergic reaction include hives, difficult breathing, or swelling of the face, lips, tongue, or throat)
Individuals may require emergency medical attention if they experience severe side effects.
Is Suboxone Addictive?
The prolonged use of any opioid medication, including Suboxone, can lead to physical dependence. However, this possibility is lower than that of other opioids. In addition, Suboxone doesn’t have the same sedative properties as other opioids; therefore, it’s less likely to cause cravings.
Unlike other opioids, buprenorphine in Suboxone contains a “ceiling effect.” As a result, while a person’s tolerance to buprenorphine can grow, they cannot overcome that tolerance by compulsively increasing the amount of medication they take. This effect also helps reduce the risk of misuse.
Can You Overdose on Suboxone?
Suboxone is a relatively safe medication, but overdose is a possibility if the medication is misused. As such, combining Suboxone with other substances like benzodiazepines or alcohol may bypass the ceiling effect and cause an overdose.
Symptoms of Suboxone overdose may include:
- Nausea and vomiting
- Abdominal pain
- Mood swings
- Shallow or slow breathing
- Loss of physical coordination
- Difficulty concentrating
Misuse of this medication can cause severe side effects, including a fatal overdose. Individuals suffering symptoms of an overdose must seek immediate medical attention to avoid fatal consequences.
In the event of a Suboxone overdose, Narcan/naloxone should be administered to the person who has overdosed immediately. The next step would be to call 911 (even if the person appears to wake up or come out of it because the effects of naloxone could wear off) and wait with the person for an ambulance to arrive. Check with your prescriber or pharmacist for information on how to obtain Narcan/naloxone.
Prolonged use of Suboxone can cause withdrawal symptoms if the medication is abruptly stopped. For this reason, health care practitioners progressively reduce Suboxone doses to alleviate the risk of withdrawals.
Suboxone withdrawal is relatively less intense than other opioid withdrawals and includes symptoms such as:
- Dilated pupils
- Runny nose
- Stomach pain
- Tremors or twitching
- Muscle aches
- Nausea or vomiting
Suboxone withdrawals generally occur within 24 hours of the last dose, peak within 72 hours, and last for approximately a month.
Candidates for Suboxone Treatment
A suboxone doctor will conduct a comprehensive evaluation to determine your candidacy for Suboxone treatment. During this evaluation, your treatment provider will also consider your recovery goals and medical history to develop a complete treatment plan.
Suboxone may be an appropriate treatment option for individuals who are:
- Interested in the treatment for opioid use disorder
- Have no contraindications to Suboxone treatment
- Can be expected to be reasonably compliant with such treatment
- Understand the risks and benefits of Suboxone treatment
- Willing to follow safety precautions for Suboxone treatment
- Agree to Suboxone treatment after a review of treatment options
Likewise, individuals who are less likely to be candidates for Suboxone treatment are individuals whose circumstances or conditions include:
- Comorbidity dependence
- Untreated mental health disorders
- Suicidal or homicidal ideation or attempts
- Multiple treatment attempts for substance misuse with frequent relapses
- Poor response to prior treatment attempts with buprenorphine
- Severe medical complications (such as breathing disorders, liver or kidney disease, problems with the gallbladder, adrenal gland, or thyroid)
If an individual is not a suitable candidate for Suboxone treatment owing to an underlying health concern, health care professionals can prescribe alternative medications to combat opioid use disorder.
Certain opioid-containing medications and over-the-counter herbal remedies or supplements can cause negative effects when taken with Suboxone. Below is a condensed list of medications that interact with Suboxone.
- Cholesterol-lowering medications
- Oral contraceptives
- HIV-treatment medications
Inform your health care provider of all medications and supplements currently in use before starting Suboxone treatment.
Using Suboxone While Pregnant
Substance use disorders during pregnancy can result in low birth weight, preterm birth, and fetal death. Thus, it’s important to seek appropriate MOUD treatment to mitigate the risk of harmful consequences of opioid dependence during pregnancy. According to the National Center for Biotechnology Information (NCBI), Suboxone treatment during pregnancy has been proven to be a safe and effective medication for OUD. Suboxone effectively lowers relapse rates and opioid overdoses when combined with behavioral therapy while improving birth outcomes in opioid-dependent mothers.
However, buprenorphine during pregnancy can expose newborn infants to neonatal abstinence syndrome (NAS) after birth and can also be passed into breast milk. For this reason, women who are breastfeeding, pregnant, or planning to get pregnant must inform their healthcare professionals about their condition before starting Suboxone treatment. It’s important to note that infants born to mothers who used Suboxone correctly during pregnancy experienced minor fetal distress and other symptoms after birth.
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