Suboxone — How It Works and Its Role In Addiction Recovery

Suboxone is one of several medications used in MAT. Suboxone treatment for opioid addiction has been shown to decrease the risk of overdose, prevent relapse and support a life without the burden of addiction. 

What Is Suboxone?

Suboxone is a drug that physicians use to help treat opioid dependence. It’s made from a combination of two different medications: a partial opioid agonist called buprenorphine and an opioid antagonist called naloxone. It was FDA approved for the treatment of opioid dependence in 2002 and is only available by prescription.

One of the primary ingredients of Suboxone, buprenorphine, is an opioid. It’s classified as a Schedule III drug. This means it has a moderate to low potential for physical dependence or a high potential for psychological dependence.

How Does Suboxone Work?

The two medications that Suboxone contains have a dual function. One helps to prevent withdrawal and cravings, while also tempering the “highs” if other opioids are used while taking it. 

The other component prevents the misuse of Suboxone by blocking the brain’s opioid receptors if the medication is injected instead of taken orally. This tempers the “highs” associated with opioid consumption. When a person on Suboxone takes an opioid, they often won’t get the euphoric effect that can trigger a relapse.

Buprenorphine binds to and partially activates the opioid receptors in the body, thus blocking other opioids. But buprenorphine produces a weaker effect than full opioid agonists such as methadone and heroin. It works to provide opioid receptor activity to prevent withdrawal symptoms and cravings but not enough to cause a “high” or euphoria. 

It can be used to treat pain but it’s more commonly used as a treatment for opioid use disorder. It offers several clinical benefits including a lower potential for misuse. This is partially due to the ceiling effect, which means that once a plateau is reached it will not provide more euphoria or pain relief benefits regardless of how much the dose increases. This means that taking higher doses of buprenorphine will not create a higher level of intoxication. 

The naloxone component of the drug is an opioid receptor antagonist. This means it attaches to opioid receptors and helps reverse and block the effects of opioids. 

However, it is minimally absorbed and remains inactive when Suboxone is taken orally as directed. It combines with buprenorphine to prevent individuals from getting “high” if they inject the medication instead. 

When Suboxone is injected it loses its ability to provide a “high” because in that form the naloxone’s effects oversride those of the buprenorphine. This blocks the euphoria and pain-relieving properties of the medication.

What is Suboxone Used For?

Suboxone is primarily used to treat opioid use disorder (OUD) and is a critical medication used in the medical detox process. When used in conjunction with psychotherapies and a structured treatment plan, it is considered the gold standard for opioid addiction treatment. 

Suboxone helps to reduce the effects of the intense withdrawal symptoms and cravings that can occur when stopping the use of other opioids. 

Some individuals use it after detox as a maintenance treatment to help to control their cravings and focus on their recovery journey.

This treatment approach has been shown to:

• Improve client survival
• Increase treatment retention
• Decrease illicit opioid use and criminal activity in people with substance use disorders
• Increase patients’ ability to gain and maintain employment
• Improve birth outcomes among pregnant women with substance use disorder

Suboxone is not commonly used for alcohol addiction because it does not help to suppress alcohol cravings. However it could be used in treatment plans for individuals with alcohol and opioid addiction. The medications of choice for alcohol withdrawal are disulfiram, naltrexone and acamprosate.

Suboxone can be prescribed “off label” to treat pain. It is generally used for individuals living with chronic pain who have developed opioid dependence or have developed a tolerance to other opioids. It is not considered a primary pain medication. 

Suboxone vs Other Medications

Suboxone was approved to treat opioid use disorder in 2002. Before this time, methadone was considered the MAT drug of choice. Methadone, a synthetic opioid, was originally developed to combat the shortage of morphine during World War II. It is currently used in MAT and also to treat moderate to severe pain. 

For individuals with opioid addiction it works by binding to receptors in the brain called mu-opioid receptors which results in less intense feelings of euphoria than with other opioids.

It also remains in the body for a longer period than other opioid drugs which helps ease withdrawal symptoms and cravings. Suboxone is considered a safer choice for use in MAT because it has a lower potential for misuse and overdose risk. 

Similar medications used for MAT include Subutex, Sublocade and Zubsolv. These drugs differ from Suboxone because of their ingredients, formulations, and the ways they are administered. Subutex and Sublocade contain buprenorphine but Suboxone and Zubosolv contain buprenorphine and naloxone. 

Because of the naloxone Suboxone is considered a safer option for the treatment of opioid addiction. Buprenorphine alone has the potential for misuse and should be used with caution. 

Suboxone Therapy and Detox

Suboxone is one of the main medications used during medically supported opioid detox. It works by safely minimizing withdrawal symptoms and cravings. Its use allows for the stabilization of the opioid receptor in the brain.

During medical detox, Suboxone is given sublingually once withdrawal symptoms appear. This is usually between 12 to 24 hours after the last dose of opioids.

Suboxone Withdrawal: What to Expect

 Withdrawal from Suboxone occurs when a person stops taking it or significantly lowers the usual dose. The amount of time it will take an individual to fully withdraw depends on several factors including dosage, length of time on Suboxone, metabolism rate and the tapering schedule. 

Withdrawal generally begins within one to three days from the last dose, peaks around day three and by days 14 to 28, most withdrawal symptoms have subsided. Some people will continue to have withdrawal symptoms of anxiety, depression and insomnia for months but these usually improve and lessen over time.

Individuals can manage their withdrawal symptoms by tapering the dose under the direction of a medical professional.

Symptoms of Suboxone withdrawal include:

• Intense drug cravings
• Anxiety and irritability
• Insomnia and restlessness
• Depression 
• Runny nose or sneezing 
• Severe muscle aches and pains
• Abdominal cramps, nausea and vomiting
• Fever or chills, goosebumps and sweating. 
• Nausea 
• Vomiting
• Headaches

Side Effects and Risks

Common Suboxone side effects include:

• Feeling faint, dizzy or lightheaded
• Headache
• Sweating
• Difficulty with having a bowel movement
• Stomach pain
• Trouble sleeping
• Diarrhea
• Irritability
• Mood swings
• Poor concentration

Less common or rare side effective include:

• Chills
• Fever
• Flushing or redness of the skin, especially on the face and neck
• Feeling of warmth or heat
• Fatigue
• Irritated, tingling, or sore feeling inside the mouth
• Decline or loss of sexual desire
• Anaphylaxis

Risk of Dependency

One component of Suboxone is buprenorphine which is a partial opioid agonist with a potential for abuse. This means individuals could become addicted to the drug. To lessen the risk of misuse, naloxone, an opioid antagonist, was added to the buprenorphine to create Suboxone. 

It works by blocking the opioid from attaching to receptors in the brain if the medication is dissolved and injected into a vein. This prevents the “high” associated with these types of drugs.

How Long Does Suboxone Stay in Your System?

Suboxone will remain in your system for up to seven days. It remains detectable in hair for three months, in saliva for a few days to more than a week and urine for two weeks. 

Individuals who take a standard drug test (one that is usually given for employment or probation) will not test positive on most standard opioid drug screens when taking buprenorphine. There will only be positive results on tests that specifically look for buprenorphine. 

Tapering off Suboxone: When and How

Individuals should always taper off Suboxone under medical supervision. Typically the tapering schedule for Suboxone involves a dose reduction between 5% and 20% every few weeks. Depending on the circumstances some individuals may need to withdraw in a facility where they can receive around the clock support and intervention.

Individuals who have used Suboxone as a component of their opioid addiction treatment plan should continue to seek support from individual or group therapy, peer support groups or relapse prevention services. 

Understanding and Using Suboxone Properly

The use of Suboxone is a crucial component of successful opioid addiction treatment for many people. Individuals who participate in MAT that includes Suboxone have a reduction in withdrawal symptoms and cravings which makes the earliest stages of recovery less physically and mentally difficult. 

Research has shown that MAT reduces the risk of overdose, stabilizes brain and bodily functions, decreases the risk of infectious disease transmission and lowers the chances of being involved in criminal activity associated with addiction.

Along with the support of individual and group counseling, peer support groups and positive lifestyle changes this helps individuals regain control over their lives and look forward to a future without the burden of addiction. 

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