Suboxone (Buprenorphine) is a medication that is primarily used to help individuals that are struggling with opiate addiction. This substance works as a semi-synthetic opioid agonist on the Mu receptor of the brain. In high doses it works to treat people that are trying to kick their addiction with opiates. In lower doses, it can be prescribed to help with moderate chronic pain. Since it is prescribed to many people trying to overcome their opiate dependency, there are many individuals that have been taking this drug for extended periods of time.
Although most people tend to find that this medication works for its intended purposes, it is more difficult than many think to withdraw from. In fact, some people have gone on to say that their withdrawal from Suboxone was more difficult than from their actual opiates. Theoretically it should be easier to withdraw from Suboxone, but some people get so accustomed to the drug when they come off of it, they cannot cope with life. This is a very powerful medication and a “controlled substance” (Schedule III). Most people notice that when they come off of it, they go through an intense withdrawal period.
Factors that influence Suboxone withdrawal include
There are many factors that have an influence on how quickly the withdrawal symptoms will subside. These include things like time that you took the drug, the amount you took, your personal physiology, as well as whether you plan to taper or come off “cold turkey.”
Another factor that may play a role is whether you still need the substance to treat your opiate addiction. It is not recommended to withdraw from Suboxone until you have your addiction under control and have a stress-free environment. It’s not recommended to come off of this medication unless you are prepared for the withdrawal symptoms that are in store.
1. Time Span
How long were you taking Suboxone? Generally the longer you took the drug, the more difficult the withdrawal process. Someone that has taken it for months will likely have an easier time coming off of it in comparison to someone who has been on it for years. When you are on any drug for an extended period of time, your body becomes more reliant upon it for everyday functioning. With Suboxone your body is getting an opiate-based response which helps lower pain levels. Thus the longer you are on it, the longer it will take your body to build up its ability to naturally fight pain during the withdrawal process.
This drug can be taken transdermally (e.g. a “film” applied to the skin), orally (e.g. pill form), and with injections. The dose of Suboxone film tends to range from 4 mg/1 mg buprenorphine/naloxone to 24 mg/6 mg buprenorphine/naloxone per day. Most people agree that even fairly low doses can be just as effective as higher doses at treating symptoms. In pill form, the dosage range tends to typically fall between 1 mg and 16 mg.
3. Individual physiology
When coming off of any drug, two people aren’t going to have the same reaction. Some individuals may experience an array of painful symptoms, while others may experience very minimal symptoms. Your individual physiology and nervous system plays a huge role in determining how you react to coming off of the medication.
4. Cold turkey vs. tapering
Suboxone tends to have a pretty long half life (37 hours) – meaning the drug stays in your system for a pretty lengthy amount of time. Despite the longer half life, it is still recommended to not quit this medication “cold turkey.” If you quit without conducting a gradual taper, you are basically leaving your body and mind in a state of chemical chaos.
Your body is used to the drug and if you quit cold turkey from a high dose, you may experience much more pain than necessary. It is recommended to follow a tapering protocol off of Suboxone so that you minimize withdrwal symptoms as much as possible.
Suboxone Withdrawal Symptoms: List of Possibilities
For many people withdrawal from Suboxone is just as difficult as the opiate that they were initially addicted to. Some people have attempted to quit this drug multiple times and are unable to cope with Post-Acute Withdrawal Syndrome (PAWS). Many of the withdrawal symptoms are a result of the body and brain becoming reliant on the medication. Each day you are off of Suboxone, you should realize that your body will be working towards returning to physical and mental homeostasis.
- Anxiety: Many people report severe anxiety and some experience panic when dealing with the withdrawal symptoms. Suboxone tends to have a calming effect on people, so it would make sense that when stopping this medication some people experience significant anxiety.
- Body aches: It is common to report aches and pains throughout the body when quitting this medication. These aches may be somewhat painful, but do your best to cope with what you are feeling. Realize that these should gradually lessen as you make it further through withdrawal.
- Concentration problems: You may feel as if you are unable to focus on any task. Work and/or school may become increasingly difficult. Your brain’s functioning was influenced by Suboxone and now you cut off the supply. It is trying to sort itself out as you withdraw from this medication.
- Confusion: Some people report feeling a general sense of confusion when they quit this medication. Any drug that has an influence on the brain and neurotransmitters can result in a certain degree of confusion when you stop taking it.
- Cravings: Suboxone is a Schedule III drug for a reason – it’s extremely powerful and in some cases addicting. Most people will experience some cravings for Suboxone when they first withdraw. These cravings happen because people have a difficult time dealing with the withdrawal experience – some symptoms can be pretty intense.
- Depersonalization: You may not feel like yourself during the withdrawal, which may cause you to freak out. If you are feeling as though you have become a totally different person. And chemically, you have become a different person – your endorphin and neurotransmitters are different than they were when you started. It will take awhile to feel like your “old self” again.
- Depression: It is very common to experience a general state of dysphoria and depression when you are coming off of Suboxone. It can be difficult to not identify with the depression – especially since it is linked with inadequate levels of neurotransmitters and endorphins. Do your best to realize that this is merely part of the withdrawal process and know that you will get better with time. It has been found that Suboxone helps treatment-resistant depression – therefore it also serves as an “off label” antidepressant. It makes logical sense that coming off of this medication may result in increased depression.
- Diarrhea: Most people experience some sort of diarrhea when they quit Suboxone. This is because narcotics tend to cause constipation – coming off of them produces the opposite effect. An easy solution to this symptom is to buy some Imodium – which is available over-the-counter.
- Discomfort: Most people coming off of this medication describe a sense of overall discomfort or malaise that they experience. If you are feeling especially uncomfortable, this is to be expected.
- Dizziness: You may feel dizzy or experience vertigo when you quit this drug. Although this isn’t as commonly reported as other symptoms, it is still possible that you could feel dizzy – especially if you don’t gradually taper.
- Fatigue: It is very obvious that you are going to experience fatigue when you stop taking Suboxone. This is a result of your body relying on the drug to give you energy throughout the day. Eventually the fatigue will subside and your energy levels will return to normal. Keep in mind that this may take an extended period of time.
- Fear of going crazy: You may fear as if you are about to snap or as though you really cannot put up with these symptoms. Just keep in mind that this is the withdrawal process and your anxiety levels are high during this time.
- Flu-like symptoms: Some people report feeling “sick” when they come off of this drug. Many of the symptoms including aches, pains, nausea, and sweating can feel similar to the flu.
- Headaches: It is common to experience headaches during withdrawal from Suboxone. If they become extreme, you may want to conduct a more gradual taper and/or consider headache relief medication.
- Insomnia: Many people will struggle to get a good night’s sleep when they initially stop taking Suboxone. This is due to the fact that they are no longer receiving the same degree of opioidergic and GABAergic stimulation to facilitate CNS depression. When stopping the drug, some individuals may experience severe insomnia despite feeling mentally and physically exhausted.
- Irritability: Some individuals report feeling highly irritable and grouchy when they first stop taking the drug. This may keep up for an extended period of time until a person re-establishes proper neurotransmitter levels.
- Malaise: Something may not feel right and you may notice that you just feel “off.” This is a general state of feeling ill or as if something is wrong. You should eventually recover from this feeling as time continues to pass.
- Mood swings: Not everyone will experience mood swings, but those who do may find them very difficult to cope with. One minute you may feel as if things are turning a corner for the better, and the next you may feel depressed, discouraged, and angry. Take a step back and realize that it is completely normal to have fluctuations in mood as you heal.
- Muscle tension: Many individuals report feeling especially tense during their withdrawal. Your muscles may feel very rigid and unable to relax. The best way to deal with this symptom is to work on guided relaxation in which you focus on mentally relaxing various parts of your body.
- Nausea: You may feel nauseated throughout the day – in some cases to an extreme. This nausea may lead to vomiting in some cases. Recognize that this may be tough to cope with in the early stages of withdrawal, but will subside.
- Pain: Since Suboxone is used by some people to help with chronic pain, you may feel more intense pain when coming off of it. This is because your body has gotten used to the drug doing most of the work to treat the pain and the natural endorphin production has significantly declined. In most cases it will take a good 30 days before your body’s natural endorphin levels start to rise again. Expect the pain to be more severe than prior to starting Suboxone during the withdrawal process.
- Restlessness: Many individuals report that they experience restlessness when they first come off of this drug. Specifically reported is the fact that people have restless leg or twitching in their legs that is only relieved with movement.
- Runny nose: When withdrawing you may experience an excessively runny nose. This is inevitable and is associated with the withdrawal process. Having a runny nose is not generally a debilitating symptom, but may be annoying in the early stages of withdrawal.
- Sleepiness: For many people, the Suboxone contributed significantly towards everyday functioning and task performance. When you cut off the supply during withdrawal, your body is basically going to be left without any energy. You may experience excessive sleepiness as your body and mind attempt to heal.
Note: The amount of time Suboxone stays in your system following discontinuation is subject to significant variation among users. Due to its long half-life, it can take up to 10 days after complete cessation to fully excrete the drug; this could be why symptoms become most severe 1-2 weeks into withdrawal.
Suboxone withdrawal timeline: How long does it last?
The withdrawal process differs for everyone – I recommend giving it 90 days before re-evaluating symptoms. There are a number of physiological and environmental factors that will play a role in determining your success when coming off of this substance. You should always be working closely with a professional who knows what to expect and can guide you through the symptoms. Some people are able to withdraw within weeks, while for others the process takes months, and/or years for their body and brains to reset to homeostatic functioning.
By waiting 90 days (3 months), you will have likely recovered some, but most people suggest that this is the turning point – things should gradually keep improving from here. There is no set time period that universally applies to everyone for withdrawal. You may feel better by the 90 day marker, or you may still feel pretty crappy – keep in mind that everyone has a unique situation. It may take one person a full year to completely recover from withdrawal symptoms and it may take a different person just a few weeks or months.
During withdrawal from Suboxone it is highly recommended to engage in healthy activities. Take the time to get outside, get sunlight, exercise, stay busy throughout the day, and socialize with good friends and family. It is not going to be easy, but do your best to push yourself out of your comfort zone. For example, even if you feel extremely fatigued, try to go for a walk or go to the gym. Even if you don’t feel like working or talking to anyone, do it anyways. Try to stay as productive and healthy as you can during withdrawal – this will ensure quicker recovery.