Tapering Off of Suboxone Successfully and Safely
Suboxone, a partial opioid antagonist comprised of a combination of buprenorphine and naloxone, is a medication approved by the Food and Drug Administration (FDA) to treat opioid use disorder.1 While some people will continue taking Suboxone long-term as a maintenance medication, others will follow a Suboxone taper protocol to help in weaning off Suboxone.
This page will explore the effectiveness of tapering off Suboxone, Suboxone withdrawal symptoms, and what a Suboxone taper schedule may look like.
Is Tapering Off Suboxone Effective?
When managed by a medical professional, detoxing slowly with a Suboxone taper schedule works well for many people. Methadone must be managed by methadone clinics while Suboxone can be prescribed for outpatient treatment, which is an important flexibility for people struggling with opioid misuse in the U.S.1
Suboxone abuse is a possibility, but it primarily occurs among people who have not misused other opioid drugs before.1
Suboxone is sometimes diverted for illicit sale, purchased for nonmedical reasons through the Internet, or illicit versions are occasionally sold on the black market; however, this medication is a vast improvement on past opioid addiction treatments even with any potential Suboxone side effects. This is because many people who try to quit opioid drugs and experience moderate or severe withdrawal symptoms are at great risk of relapsing back into opioid misuse, which increases their risk of overdosing on these drugs.
If someone taking Suboxone attempts to misuse an opioid drug like Vicodin, OxyContin, or even heroin, that opioid will not bind to the opioid receptors; instead, naloxone will prevent it from causing intoxication.1
While overdoses linked to buprenorphine are rare, mixing Suboxone and alcohol results in an increased risk of overdose and should be avoided.2
How Safe Is Tapering Off Suboxone?
Tapering off Suboxone can be safely done when following the guidance of a medical professional. Because Suboxone is a partial opioid agonist, stopping the medication abruptly can result in withdrawal effects that are similar to other opioids.3
Suboxone detox programs are available and can help make withdrawal from Suboxone as comfortable as possible. By slowly weaning off suboxone and methodically reducing the dosage of Suboxone over a longer period of time, it can help prevent Suboxone withdrawal symptoms.3
Suboxone Withdrawal Symptoms
Suboxone withdrawal symptoms can include the following:4
- Increased sweating.
- Feeling cold or hot more than usual.
- Watery eyes.
- Runny nose.
- Muscle aches.
The duration and severity of Suboxone withdrawal symptoms will vary depending on the dosage and how long a person has taken Suboxone.
How Do Medication-Assisted Treatments (MATs) Work?
Both buprenorphine and methadone attach to the opioid receptors in the brain similarly to narcotic drugs; however, unlike heroin, oxycodone, or fentanyl, neither methadone nor buprenorphine will cause a high in someone who is physically used to abusing opiate drugs.
In fact, buprenorphine is so effective at reducing withdrawal symptoms while preventing intoxication that it has become the preferred treatment among most physicians and addiction specialists in the U.S. It is also approved for prescription as a form of outpatient withdrawal management, making it one of the first opioid tapering drugs to help people who can safely live at home.
To ensure that buprenorphine is a safe approach to easing withdrawal symptoms, tapering the person off opioids until they are no longer physically dependent and avoiding intoxication that may trigger relapse, this partial opioid agonist has been combined with naloxone to create Suboxone, a very popular brand name medication-assisted treatment (MAT).
Naloxone is a drug that stops opioid drugs from binding to opioid receptors in the brain. Alone, naloxone is used to temporarily stop opioid overdoses so the person can get emergency medical treatment, but when combined with buprenorphine, it becomes an abuse deterrent.
If someone who is prescribed Suboxone takes it as prescribed, they will receive relief from uncomfortable withdrawal symptoms; if they abuse the drug to get high, naloxone acts before buprenorphine, preventing the medication from treating any withdrawal symptoms.
How to Get Off Suboxone: Short vs. Long Tapers
A 2009 study examined two Suboxone tapering schedules to understand whether short-term or long-term treatment would work best for the most people.5 It is important to know, no matter the results of the study, an addiction specialist will create an individual tapering plan based on medical guidelines, so they will focus on each client’s needs rather than one specific approach.
At the end of the study, 44 percent of the group tapering off Suboxone for seven days (one week) had completely ended their physical dependence on narcotics. In comparison, 30 percent of the 28-day (roughly one month) group had managed the same. At the one-month and three-month follow-up points, there were no differences between the two groups.
This suggests that a shorter Suboxone taper protocol may be appropriate for more people than long-term tapering; however, taking Suboxone as prescribed for longer than one week may be an important approach for people who have struggled with opioid addiction for a long time.
How Suboxone Taper Protocols Are Created
Before prescribing Suboxone and a tapering schedule for the medication, a physician will use at least one of several opioid withdrawal measurement surveys. Some of these include:
- The Clinical Opiate Withdrawal Scale (COWS).
- The Satisfaction Questionnaire (SQ).
- The Addiction Severity Index-Lite (ASI-Lite).
- The Adjective Rating Scale for Withdrawal (ARSW).
- The Visual Analog Scale (VAS).
These will be used alongside urine tests to measure how much opioid remains in the body and whether the individual has relapsed back into opioid misuse.
Opioid withdrawal can take one to two weeks, depending on which narcotic was used. Drugs like hydrocodone or heroin may be associated with uncomfortable withdrawal symptoms, but these fade after a week. Methadone, however, is a long-lasting opioid agonist, and it may take longer to leave the body.
Withdrawal symptoms associated with opioid drugs have two basic phases:6
- Early symptoms: These include anxiety, agitation, increased watering of the eyes, muscle aches, insomnia, sweating, runny nose, and excessive yawning.
- Later symptoms: Diarrhea, abdominal cramping, dilated pupils, nausea or vomiting, goosebumps, and other flu-like symptoms.
Cravings and mood swings are part of both phases, and these withdrawal symptoms are likely to remain after the physical symptoms have dissipated. Using Suboxone during this process may extend the amount of time it takes for drug withdrawal to go away—in many patients, these symptoms may clear up in five days or less—but it means that the physical discomfort and psychological stress are both managed. Going “cold turkey” is much more likely to lead to relapse than opting for MAT.
The American Society of Addiction Medicine (ASAM) released a guide for clinicians to manage opioid withdrawal, including a section on buprenorphine treatment.7 The guide recommends starting with a lower dose of buprenorphine compared to the equivalent of methadone, usually 2-4 mg.
However, after the introduction of buprenorphine management, the dose can be upped to 8 mg per day with potential daily doses as high as 16 mg. The FDA recommends no more than 24 mg per day, and this amount is rarely prescribed.
ASAM states that there is no limit to the amount of time buprenorphine tapering is safe, and if the individual switches medications (e.g., plans to move to naltrexone as a maintenance drug to reduce cravings during rehabilitation), they must spend at least 7-14 days off any medication treatment before switching.
It typically takes two or three days for the person taking this medication to feel stable. Although the taper may be one week long, there may be another week during which the body adjusts to the medication before tapering can begin.8
Professional Assistance in Weaning Off Suboxone
If you or someone you care about are looking into tapering off Suboxone, professional help is available. At River Oaks Treatment Center, our team of experienced medical professionals can customize your Suboxone taper schedule to help minimize Suboxone withdrawal symptoms.
Admissions navigators are available 24/7 to answer any questions you may have about treatment and walk you through the rehab admissions process.
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Don’t wait to get the support you deserve. Reach out to River Oaks today to find out more information about the various levels of addiction treatment available at our drug and alcohol rehab near Tampa, FL.