Suboxone: What it is, Uses, Benefits and Side Effects

Suboxone, a medication containing buprenorphine and naloxone, is used to treat opioid addiction. Buprenorphine reduces opioid cravings and withdrawal symptoms by activating the brain’s opioid receptors with less intensity than traditional opioids. Naloxone, an opioid antagonist, helps prevent misuse and overdose.

Suboxone is primarily used in medication-assisted treatment (MAT) programs, offering a convenient once-daily dosage that promotes adherence. However, it’s crucial to use Suboxone under medical supervision as part of a comprehensive treatment plan, including counseling and behavioral therapies.

According to a report published by SAMHSA (Substance Abuse and Mental Health Services Administration), in Florida during the years 2021 and 2022, 2.68% of individuals aged 12 and older reported misusing opioids in the past year. Since its FDA approval in 2002, Suboxone has become a valuable tool in managing withdrawal symptoms and cravings, supporting individuals in their recovery journey.

A study by Shulman, M. in 2019 indicates that Suboxone is prescribed for both detoxification induction and long-term maintenance therapy, helping stabilize individuals during the initial treatment phases and reducing withdrawal symptoms. As maintenance therapy, it mitigates cravings, allowing patients to focus on rehabilitation and decreasing the likelihood of relapse.

The benefits of Suboxone extend beyond symptom management, as studies show it improves treatment retention rates and reduces the risk of fatal opioid overdose. It serves as a safer alternative to illicit opioids, enhancing the quality of life and functional outcomes for those in recovery.

Suboxone may cause mild side effects such as headache, nausea, constipation, and insomnia, which should be monitored closely, especially during the initial treatment stages. Healthcare providers must tailor dosages and monitor patients to mitigate adverse effects and ensure optimal therapeutic outcomes.

What is Suboxone?

Suboxone is a medication used in the treatment of opioid addiction, combining buprenorphine and naloxone to reduce withdrawal symptoms and cravings while minimizing the risk of misuse and overdose

Buprenorphine is a partial opioid agonist that alleviates withdrawal symptoms without producing the full effects of opioids, while naloxone is an opioid antagonist that helps prevent misuse of the medication. Suboxone is typically prescribed as part of a comprehensive treatment plan that includes counseling and behavioral therapies.

Suboxone should only be used under medical supervision as part of a comprehensive treatment program that includes counseling and behavioral therapy. It is not a standalone solution for addiction but a tool to support recovery.

While Suboxone can be effective for many, it may not suit everyone. Factors such as medical history, current medications, and personal needs should be considered when determining treatment appropriateness.

What Does Suboxone Do?

Suboxone treats opioid addiction in adults by reducing withdrawal symptoms and cravings. It contains buprenorphine, which alleviates these symptoms, and naloxone, which helps lessen the risk of overdose when stopping opioid use.

As per a study conducted by Spreen, L. A in 2022, Buprenorphine is an effective treatment for opioid use disorder and pain, with traditional initiation and micro-dosing strategies showing success rates of 95.6% and 96%, respectively, in transitioning patients to sublingual buprenorphine.

How Does Suboxone Work for Addiction?

Suboxone works for addiction by combining buprenorphine, a partial opioid agonist, which alleviates withdrawal symptoms and cravings, with naloxone, an opioid antagonist that deters misuse. This combination helps stabilize individuals in recovery while reducing the potential for opioid overdose.

Buprenorphine is classified as a partial opioid agonist. It binds to brain opioid receptors, producing relatively weak opioid effects. This action helps reduce cravings and withdrawal symptoms without inducing the intense euphoria or respiratory depression associated with stronger opioids like heroin or fentanyl. Buprenorphine has a high binding affinity, which means it can block other opioids from activating these receptors, potentially deterring misuse. Additionally, it has an upper limit to its effects, which lowers the risk of misuse and overdose, and reduces the potential for respiratory depression, a serious risk in opioid overdose situations.

Naloxone is an opioid receptor antagonist included in Suboxone to prevent misuse. While naloxone is effective on its own for reversing opioid overdose, it is combined with buprenorphine in Suboxone to discourage intentional misuse. If someone attempts to misuse Suboxone by crushing or injecting it, naloxone will counteract the effects of buprenorphine, leading to withdrawal symptoms in opioid-dependent individuals.

When taken as directed, typically in the form of sublingual film or tablets, Suboxone is absorbed through the membranes in the mouth, enters the bloodstream, and attaches to brain opioid receptors. This process stabilizes withdrawal symptoms and reduces drug cravings, facilitating the recovery journey.

Suboxone has long-acting effects that last between 24 to 72 hours, making it suitable for maintenance treatment. It is essential that Suboxone is used under the supervision of an addiction medicine specialist, who will assess individual needs and create a comprehensive treatment plan. Regular follow-up appointments and monitoring are crucial to ensure safety and effectiveness throughout the treatment process.

What are the Benefits of Suboxone in Addiction Treatment?

The main benefits of Suboxone in addiction treatment include its ability to reduce withdrawal symptoms, prevent relapse, and facilitate long-term recovery for individuals seeking to overcome opioid addiction.

Following are the key benefits of Suboxone in addiction treatment, illustrating how it aids individuals in their recovery journey:

• Reduced Withdrawal Symptoms: Suboxone helps alleviate cravings and minimize withdrawal symptoms associated with opioid addiction. The combination of buprenorphine and naloxone (Suboxone®) is designed to deter misuse, further enhancing its effectiveness in treatment. According to the World Health Organization’s “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings” (2009), Suboxone (buprenorphine) is an effective medication for managing opioid withdrawal. It can help to alleviate symptoms such as nausea, vomiting, diarrhea, anxiety, and insomnia.
• Relapse Prevention: Suboxone blocks the effects of opioids, making it less tempting to use and reducing the risk of relapse. According to Lee, J. D.,’s 2018 study, “Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention” Participants on buprenorphine-naloxone (BUP-NX) reported more days without opioids compared to the combination of Extended-release naltrexone (XR-NTX). Participants on BUP-NX had significantly more opioid-negative urine samples compared to those on XR-NTX.
• Long-Lasting Effects: According to Maremmani et al.’s 2023 study, Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder, Buprenorphine in Suboxone offer significant long-lasting effects, with durations ranging from one week to six months. These formulations enhance treatment adherence by providing stable drug levels, reducing withdrawal symptoms and cravings without the peaks and troughs of daily dosing. They also lower stigma by minimizing the need for frequent clinic visits, thus improving patients’ social and occupational integration. Additionally, the risk of misuse and diversion is reduced, making these formulations a safer option for managing OUD. Overall, they represent a promising advancement in personalized addiction treatment.
• Outpatient Treatment: Unlike other addiction medications, Suboxone can be prescribed in an outpatient setting, allowing individuals to continue daily life while receiving treatment. As per Shulman, M.,’s 2019 study, “Buprenorphine Treatment for Opioid Use Disorder: An Overview”, Buprenorphine was first used as an outpatient treatment for opioid use disorder in France in the 1990s and received FDA approval in the U.S. in 2002. It is now approved for maintenance treatment in over 45 countries and is included in the World Health Organization’s essential drugs list.

What Are the Side Effects of Suboxone?

The common side effects of Suboxone include various physical and emotional symptoms that can impact daily life and well-being.

According to Bartoszko A.’s 2019 study patients reported dizziness and debilitating anxiety were the most disturbing side effects of suboxone.

Here are some of the common side effects:

• Dizziness
• Debilitating anxiety
• Negative emotions
• Feelings of disenfranchisement
• Social and clinical injustice
• Nausea
• Headaches
• Insomnia
• Constipation
• Sweating
• Loss of appetite

It is important to note that not everyone will experience these common side effects, and additional side effects may occur. If you have any concerns about side effects or if they persist or become severe, consult a healthcare professional.

What Is Suboxone Addiction?

Suboxone addiction is a dependence on the medication that leads to compulsive use and withdrawal symptoms. This dependence can develop even when Suboxone is initially prescribed to treat opioid addiction.

According to Kumar, Rachna et al.’s 2024 article buprenorphine is categorized as a Schedule III drug, which means it has a moderate-to-low potential for physical dependence or a high potential for psychological dependence.

The U.S. Food and Drug Administration (FDA) recognizes the potential for individuals to develop a dependence on Suboxone, particularly a psychological dependence.

While Suboxone is valuable in managing opioid use disorder, appropriate monitoring and patient education are necessary to mitigate the risk of addiction.

What are The Potential Risks and Precautions of Suboxone Treatment?

The main risks and precautions of Suboxone treatment involve potential adverse reactions and the need for careful monitoring of specific health conditions. 

The primary risk associated with Suboxone treatment is the potential for respiratory depression, which can lead to shallow or slowed breathing and requires vigilant monitoring. 

In contrast, the precautions necessary for safe use encompass a variety of factors, including medical history considerations, drug interactions, and special populations such as pregnant or breastfeeding women.

Understanding these guidelines can help users make informed decisions about their therapy. It is important to be aware of the following:

Category	Specific Precautions	Description
Respiratory Depression	Shallow or slowed breathing	Monitor for signs and seek medical help if difficulties arise
Allergic Reactions	Allergy to buprenorphine or naloxone	May cause rash, itching, swelling, severe dizziness, or difficulty breathing
Medical History	Liver/kidney disease, thyroid dysfunction, head injuries, seizures, prostatic hyperplasia, respiratory issues	Inform doctor to minimize potential risks
Overdose	Taking higher doses or combining with other substances	Can result in overdose and life-threatening complications
Drug Interactions	Interactions with antidepressants, antifungals, HIV medications	Inform healthcare provider about all medications
Pregnancy	Use during pregnancy	Can lead to infant dependence; potential risks to fetus should be carefully considered
Breastfeeding	Passes into breast milk	Consult doctor and monitor baby for severe drowsiness or slow breathing
Withdrawal Symptoms	Gradually reduce dosage under medical supervision	Minimizes discomfort when discontinuing treatment
Misuse and Addiction	Follow prescribed treatment plan and do not share	Prevents misuse and risk of addiction
CNS Depression	Caution in patients with CNS depression or coma	Increased risk of respiratory depression; monitor closely
Seizure Disorders	History of seizures	Buprenorphine may worsen preexisting seizures; exercise caution
Cardiovascular Disorders	Hypovolemia, recent myocardial infarction	Caution due to risk of hypotension; monitor for signs of low blood pressure
QTc Interval Prolongation	History of long QT syndrome or on certain antiarrhythmics	Avoid use; may exacerbate heart conditions
Pediatric Patients	Use unit-dose packaging	Prevent unintended exposure among young children
Older Patients	Altered absorption and metabolism	Increased risk of drug interactions due to polypharmacy; exercise caution

Before starting Suboxone treatment, it is important to disclose your medical history, including any liver or kidney problems, respiratory disorders, or mental health conditions. Open communication with healthcare providers ensures they take appropriate precautions to minimize the potential risks of this therapy.

What Is Suboxone Withdrawal Like?

Suboxone withdrawal feels like a range of physical and psychological symptoms that can vary in intensity and duration when discontinuing the medication. Individuals may experience symptoms such as muscle and joint aches, cold-like symptoms, anxiety, restlessness, and opioid cravings, among others. 

Understanding the withdrawal timeline is crucial for managing expectations and preparing for the recovery process, as symptoms typically peak by days 3-4 and last up to 2 weeks, with some persisting for a few months.

This table outlines the typical progression and duration of withdrawal symptoms when discontinuing opioid use, providing a general framework for understanding the physical and psychological effects of withdrawal over time.

Withdrawal Timeline	Symptoms
12-36 hours	Initial symptoms begin, which may include: anxiety, agitation, insomnia, sweating, runny nose, yawning.
1-3 days	Symptoms intensify and can involve: discomfort, pain, nausea, vomiting, exhaustion, anxiety, and cravings.
3-7 days	Withdrawal symptoms often peak; expect: muscle aches, nausea, diarrhea, abdominal cramps, increased heart rate, and significant cravings for opioids.
1-2 weeks	Physical symptoms may begin to diminish, but psychological symptoms like anxiety, depression, fatigue, and insomnia can persist.
2-4 weeks	Some residual discomfort may occur, with ongoing psychological symptoms, cravings, and issues with mood and sleep.
Post-acute withdrawal (months)	Extended withdrawal symptoms, which can include prolonged depression, anxiety, sleep disturbances, and cravings may persist for weeks or months after the initial withdrawal.

How Do I Stop Taking Suboxone Safely?

To stop taking Suboxone safely, it is recommended to taper off the medication gradually under medical supervision. This approach helps minimize withdrawal symptoms and ensures a safer transition.

A healthcare provider can develop a personalized tapering schedule, gradually reducing the dosage over weeks or months based on individual needs and medication duration.

During tapering, it’s essential to monitor for withdrawal symptoms like anxiety, insomnia, muscle aches, and cravings. If symptoms worsen, the provider may adjust the schedule or recommend temporary medications for relief.

Incorporating supportive therapies can enhance recovery. Behavioral therapies, such as cognitive-behavioral therapy (CBT), address underlying substance use disorders and build coping strategies. Support groups, both in-person and online, offer community and shared experiences.

Maintaining open communication with your healthcare provider is crucial for assessing progress, adjusting the tapering plan, and receiving emotional support. Engaging in healthy lifestyle practices, like regular exercise, a balanced diet, and mindfulness, can also support well-being during this transition.

The ultimate goal is a safe and sustainable recovery, and collaborating with a healthcare professional significantly increases the chances of success.

How Do Clinicians Dispense Suboxone?

To dispense Suboxone, clinicians use specific administration methods that includes:

1. Suboxone Film:
   • Place the dissolvable film under your tongue or inside your cheek.
   • Available strengths: 2mg/0.5mg, 4mg/1mg, 8mg/2mg, and 12mg/3mg.
   • Allow the film to dissolve naturally; do not chew or swallow.
2. Suboxone Tablet:
   • Similar to the film, dissolve the tablet under your tongue.
   • Same dosage strengths as the film: 2mg/0.5mg, 4mg/1mg, 8mg/2mg, and 12mg/3mg
   • Avoid chewing or swallowing the tablet.

What Is Suboxone Supposed to Feel Like?

Suboxone is supposed to help individuals feel more normal and comfortable by alleviating opioid withdrawal symptoms and cravings. It may produce a mild euphoric effect, but this effect is generally less intense and longer-lasting compared to full agonist opioids.

How Long Does Suboxone Stay in Your System?

Suboxone can stay in your system for 7 to 14 days, depending on usage and individual factors. According to Furo et al.’s 2024 study, Buprenorphine is typically detectable in urine for up to 7 days, while naloxone can be detected for up to 3 days. Additionally, norbuprenorphine, a metabolite of buprenorphine, may be detectable for up to 14 days. The exact duration that Suboxone stays in the system can depend on several factors, including dosage, frequency of use, metabolism, and individual health conditions

How Long Does It Take for Suboxone to Start Working?

Suboxone typically begins working within 30 to 60 minutes of the first dose. According to Khanna, I. K., & Pillarisetti, S.’s 2015 study, It can take up to 1 to 4 hours to reach its peak effectiveness, providing relief from opioid withdrawal symptoms and cravings.

What Happens if You Take Opiates While on Suboxone?

Taking opiates while on suboxone can reduce the effectiveness of buprenorphine, as it is a partial agonist at opioid receptors that may block the effects of full agonists like other opiates. According to McCance-Katz, E. F.,’s 2010 study named “Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and other Frequently Prescribed Medications” ” this can lead to the risk of precipitating withdrawal symptoms if the opiate taken is not sufficient to overcome buprenorphine’s receptor binding. Furthermore, combining these substances can increase the risk of adverse effects, including respiratory depression, particularly if other depressants are involved.

What Are the Alternatives to Suboxone? 

Some alternatives to Suboxone with similar effectiveness and potentially fewer side effects include Zubsolv, methadone, naltrexone, and Vivitrol. Zubsolv, like Suboxone, contains buprenorphine and naloxone but may have improved taste and faster dissolution. 

Methadone is effective but requires daily visits initially. Naltrexone and Vivitrol work differently by blocking opioid receptors. 

Each alternative has unique benefits and considerations, so consulting a healthcare provider is crucial to determine the most suitable option.