Suboxone FAQ

In October of 2002 the U.S. Food and Drug Administration approved Suboxone for drug treatment, and then later in 2006 it was approved for the same purpose in Europe. Canada began using Suboxone in 2007.  In the meantime though, in 2003 the first ever Suboxone-based addiction treatment program was launched in the United States at Columbia University.

It is important to be in mild-to-moderate withdrawal when you take your first dose of Suboxone. If you have high levels of another opioid in your system, Suboxone will compete with the other opioid molecules and knock them off the receptors. Suboxone then replaces those opioid molecules on the receptors, but because Suboxone has less opioid effects than full opioid agonists, you may go into withdrawal and feel sick. This is called precipitated withdrawal. If you are already in the first stages of withdrawal when you take your first dose, Suboxone will make you feel better, not worse. Once your doctor has assessed your withdrawal symptoms and decided that you are ready to start Suboxone, you will begin Induction

Taken on its own, Suboxone has lower potential for fatal overdose than a full opioid agonist because it has a limited effect on reducing breathing. Taking more Suboxone does not affect breathing as much as full opioid agonists can, so it is less likely to cause death in cases of accidental or deliberate overdose when taken in the absence of benzodiazepines, sedatives, tranquilizers, antidepressants, or alcohol. Intravenous misuse of buprenorphine, usually in combination with benzodiazepines or other central nervous system (CNS) depressants, has been associated with significant respiratory depression and death.

All opioids can cause physical dependence. If you are ready to start treatment, that means that you are already dependent on opiates. Suboxone belongs to a class of opioids called partial opioid agonists. As a partial agonist, buprenorphine appears to produce less physical dependence, limited euphoria, and less potential for abuse compared with a full agonist, eg, heroin, oxycodone, and hydrocodone. Suboxone has potential for abuse and produces dependence of the opioid type with a milder withdrawal syndrome than full agonists. When patients are ready to stop taking Suboxone, the dose is slowly and gradually tapered. The withdrawal symptoms of Suboxone are milder than those seen with a full opioid agonist and can be managed with your doctor’s supervision.

It is possible to switch to Suboxone from methadone treatment, but because everyone’s situation is different, switching should first be discussed with your doctor.

The length of your Suboxone treatment depends on what your doctor, you, and, possibly, your counselor or therapist decide is best for your needs. Although short-term treatment may be an effective option for some, for others it may not allow enough time to address the psychological and behavioral aspects of their condition. The chance of relapsing can be higher with short-term treatment because patients have less time to learn the skills needed to maintain an opioid-free lifestyle. In general, suppressing cravings with Suboxone (for as long as necessary), together with counseling, offers the best likelihood for treatment success. Discontinuing Suboxone abruptly can cause withdrawal symptoms, so when you are ready, your doctor will gradually taper your Suboxone dose. You should be aware of signs of relapse or withdrawal symptoms. Discard any leftover pills to ensure that they aren’t used by anyone else.

Intravenous misuse of buprenorphine, usually in combination with benzodiazepines or other CNS depressants (including alcohol) has been associated with significant respiratory depression and death.

It can be dangerous to mix Suboxone with drugs like benzodiazepines, alcohol, sleeping pills and other tranquilizers, certain antidepressants, or other opioid medications, especially when not under the care of a doctor or in doses different from those prescribed by your doctor. Mixing these drugs can lead to drowsiness, sedation, unconsciousness, and death, especially if injected. It is important to let your doctor know about all medications and substances you are taking. Your doctor can provide guidance if any of these medications are prescribed for the treatment of other medical conditions you may have.