Suboxone Withdrawal

Suboxone contains buprenorphine and naloxone. Buprenorphine is an opioid that works to reduce the symptoms associated with opioid dependence. Naloxone guards against misuse by lowering opioid levels; if a dependent person taking Suboxone uses another opioid, he will experience unpleasant withdrawal symptoms.

Doctors prescribe Suboxone to help someone overcome his addiction to opioids, such as heroin, codeine, morphine, OxyContin and Dilaudid. Suboxone is one medication used in Drug Replacement Therapy, or DRT, a treatment program that allows an individual to put off the detoxification process until after he has learned how to live without opioids. Methadone is another medication included in DRT programs.

Unlike methadone, which is available only through a specialized clinic, qualified doctors can prescribe Suboxone from their offices. Patients may take home a supply of Suboxone.

After counseling and behavior modification, the patient weans himself from Suboxone by taking smaller doses further apart, or participates in an inpatient detoxification program. Many patients have significant difficulties overcoming Suboxone withdrawal symptoms and spend years in DRT.

Definition

Suboxone withdrawal refers to the wide range of symptoms that appear after opioid-dependent person stops taking this medication. Rehabilitation specialists recognize withdrawal as a normal, predictable consequence of taking Suboxone for a long time.

Withdrawal manifests itself in a variety of overpowering physical symptoms that can last a week or more; psychological symptoms of withdrawal can linger, especially when left untreated or poorly treated.

Causes

The human body adjusts to the presence of certain chemicals introduced into the body, including opioids such as the buprenorphine in Suboxone. The body can grow tolerant of these substances; tolerance to opioids means the users has to take increasingly larger doses to get the same euphoric or pain-relieving effect.

Prolonged use increases the risk for dependence; this means the person must maintain a certain level of opioids for the body to feel normal. If opioid levels drop rapidly, the body struggles to maintain its chemical balance. This struggle manifests itself through uncomfortable, flu-like withdrawal symptoms. If the individual were to take another dose of opioids, his withdrawal symptoms would disappear because his body will have regained chemical balance.

Doctors prescribe Suboxone to treat these withdrawal symptoms. The opioid buprenorphine in Suboxone tricks the body into thinking it has gotten another dose of drugs, so the body maintains chemical stability and withdrawal symptoms fade, as long as the individual continues to take enough Suboxone.

The opioid component of Suboxone interacts with the central nervous system in the same way as other opioids, but Suboxone is an effective replacement drug because it does not produce the same euphoric effects. The effects of Suboxone last longer than other opioids. One dose of Suboxone lasts about 24 hours, as compared to a dose of heroin, which may last for only a couple of hours.

The opioid-dependent person will suffer Suboxone withdrawal symptoms if he stops taking Suboxone or if he takes insufficient doses. Consumers may experience withdrawal symptoms when they switch from Suboxone sublingual film to Suboxone sublingual tablets. Physicians should adjust Suboxone dosage accordingly.

Facts

Suboxone can cause dependents. Consumers can experience withdrawal symptoms after discontinuing Suboxone. Used as directed, Suboxone withdrawal symptoms are typically milder than are those associated with other opioids. Withdrawal symptoms may have a delayed onset. Withdrawal symptoms are painful and demoralizing, but usually not life threatening.

An infant born to a woman taking medications containing buprenorphine during pregnancy may exhibit neonatal withdrawal symptoms within the first one to eight days of life. Symptoms include abnormally tense muscles, tremor, agitation and muscle twitching. Some newborns struggle with convulsions, slow heart rate, stopped breathing and other respiratory problems.

Symptoms

Withdrawal from opioids is typically associated with physical symptoms similar to the flu, but withdrawal also causes psychological symptoms whose demoralizing affects can be just as overpowering as the physical symptoms of withdrawal.

Physical

Physical symptoms of withdrawal include:

  • Abdominal Cramps
  • Backache
  • Diarrhea
  • Difficulty Sleeping
  • Fever, Chills
  • Goose Bumps
  • Joint Aches
  • Loss of Appetite
  • Muscle Spasms
  • Nausea, Vomiting
  • Runny Nose
  • Sneezing
  • Sweating
  • Tears
  • Tremors
  • Weakness
  • Yawning

Psychological

Withdrawal has a profound psychological impact on the patient and can compromise his chances for recovery. Left unrecognized and untreated, psychological withdrawal symptoms can leave a Suboxone user feeling unable or unworthy of recovery. Psychological symptoms of withdrawal include:

  • Aggression
  • Agitation
  • Cravings
  • Irritability
  • Social Isolation

Possible Complications

Suboxone withdrawal is associated with the same complications as other opioids, including aspiration, where the patient vomits and then breathes stomach contents into the lungs. Aspiration can result in fluid in the lungs and respiratory infection. Extreme vomiting and diarrhea associated with Suboxone withdrawal can cause dangerous dehydration resulting in dangerous electrolyte imbalance.

The primary complication associated with Suboxone withdrawal is returning to opioid abuse. A person who uses opioids immediately after experiencing symptoms of Suboxone withdrawal stands a greater risk for overdose because the detoxification process reduced his tolerance to opioids. He can overdose on a much smaller dose than he used to take.

Treatment Options

The American Society of Addictive Medicine warns that addiction to opioids or other substances may result in "disability or premature death, especially when left untreated or treated inadequately." This is true for even those medications, like Suboxone, intended to treat opioid addiction.

Treatment usually consists of two phases: detoxification and rehabilitation. Detoxification is the physiological process of lowering opioids to non-toxic levels in the patient's body.

A patient takes Suboxone to put off the detoxification phase while he engages in rehabilitation but he cannot stay on Suboxone forever. He will eventually need to stop taking Suboxone and face detoxification and withdrawal symptoms. By the time the patient reaches a point where he faces Suboxone withdrawal, he has already participated in some form of rehabilitation for his original opioid addiction. This rehabilitation focused on changing the cognitive and behavioral aspects of opioid addiction, teaching him how to live without opioids. Rehabilitation usually includes behavior modification techniques along with individual, group and family counseling. With proper guidance, the patient applies these same techniques to overcoming his dependence on Suboxone.

Detoxification

Some addicted individuals try to quit Suboxone alone, without the help of trained professionals or medicines to ease physical and psychological symptoms. Powerful withdrawal symptoms often drive these individuals back to using opioids.

Other Suboxone patients develop a homemade treatment plan to ease withdrawal symptoms. One such home remedy is the Thomas Recipe, in which individuals use prescription medications to ease anxiety, over-the-counter drugs to stop diarrhea along with vitamins, supplements and hot baths to reduce Suboxone withdrawal symptoms.

While the Thomas Recipe relieves the physical withdrawal symptoms, it does not protect the individual from dangerous complications nor does it address the psychological symptoms that cause many people to relapse to opioid abuse.

Overdose

Relapse can lead to fatal overdose. The detoxification process reduces a person's tolerance to opioids; there is a greater risk for overdose immediately following Suboxone detoxification and withdrawal. After even a short attempt at detoxification, a person can potentially overdose on a lesser amount of Suboxone than he used to take before going through the withdrawal process.

Overdose of Suboxone or any other drug is a serious, life threatening medical emergency. If you think you or someone you know has overdosed on Suboxone, contact poison control center at 1-800-222-1222 or go to the nearest hospital.

Overdose symptoms include:

  • Blue Lips
  • Cold, Clammy Skin
  • Coma
  • Confusion
  • Diarrhea
  • Extreme Drowsiness
  • Fainting
  • Muscle Weakness
  • Nausea
  • Pinpoint Pupils
  • Ringing in the Ears
  • Shallow Breathing or No Breathing
  • Slow Heart Rate
  • Vomiting
  • Weak Pulse

Emergency department, doctors and nurses administer naloxone or other drugs to drop Suboxone to non-toxic levels quickly. Nurses will establish an airway to help the individual breathe, start intravenous fluids and remove excess Suboxone from the stomach. They will also perform emergency, life-saving treatments such as CPR to save the patient's life whenever necessary.

Once the individual is out of mortal danger, he can resume the behavioral modification portion of his rehabilitation.

Drug Replacement Therapy

Suboxone is just one type of Medically-Assisted Treatment, or MAT, in which physicians administer medications that decrease opioid levels and ease ensuing withdrawal symptoms. Standard inpatient detoxification and rapid detox are other types of MAT used to help patients overcome Suboxone withdrawal symptoms.

Research shows MAT such as Suboxone provides many benefits to the consumer, including:

  • Decreased Criminal Activities
  • Decreased Illicit Opioid Use
  • Decreased Risk for Hepatitis and HIV
  • Improved Birth Outcomes for Pregnant Women Battling Addiction
  • Improved Survival Rates
  • Increased Employment
  • Increased Retention in Treatment

Inpatient detoxification is another form of MAT. During standard detoxification, doctors administer naloxone to lower opioid levels along with other medications to relieve the resulting withdrawal symptoms. While this type of detoxification process reduces the severity and duration of Suboxone withdrawal symptoms somewhat, the patient must still suffer the demoralizing and demeaning psychological symptoms associated with Suboxone withdrawal.

Rapid Detox is now the most humane way to help a person overcome Suboxone withdrawal. During rapid detox, board certified anesthesiologists administer sedatives and anesthesia along with the usual detoxification medications so that the patient dozes in a pleasant "twilight sleep." A few hours later, she awakens refreshed, unaware of the Suboxone withdrawal symptoms or psychological complications associated with the detoxification process.

Rehabilitation

Successful recovery from dependence on Suboxone often includes continuing rehabilitation and behavior modification. Opioid dependence and Suboxone treatment is complex process that affects brain function and behavior. Individual, family and group counseling, along with other behavioral therapy are a large part of successful Suboxone treatments. While no single therapy works for everyone, treatment does needs to be readily available to be effective.

Effective treatment focuses on the complex and multiple needs of the individual rather than simply addressing his dependence on Suboxone. Many people with drug problems have other mental disorders that prevent or slow down the rehabilitative process.

Suboxone is an important element of recovery for many patients, especially when therapists combine Suboxone with counseling and other behavioral therapies. Suboxone is only one aspect of treatment for opioid dependence and, by itself, does little to change long-term drug abuse.