Tapering off Suboxone after using it for opioid addiction treatment can be an uncomfortable and lengthy process, but it is recommended over quitting cold turkey.
Before diving headfirst into determining how to taper off Suboxone, it is helpful to understand what a taper prevents. An individual on a Suboxone regimen may have never felt what it was like to go through an opioid withdrawal before. These events, especially heroin withdrawals, can be particularly debilitating. Suboxone is prescribed to avoid such opioid withdrawals in the first place.
Article at a Glance:
- Suboxone is used to help wean people off stronger opioids, such as heroin, but it can cause a dependence itself as well.
- Suboxone withdrawals can take a long time, with withdrawal symptoms starting 12-48 hours after the last dose and lasting up to 20 days.
- It is advised to taper off of suboxone slowly, day by day.
- Suboxone tapering should be done under the supervision of a medical professional.
Suboxone is interesting in that a “Suboxone taper” really has two separate meanings. For anyone attempting to find out how to taper off Suboxone, it is key to understand this distinction going in.
Meaning One – Using Suboxone as a Taper
The first definition is using a Suboxone as medication-assisted treatment (MAT) to wean off stronger opioids such as heroin. This method uses Suboxone as a safer and measurable substitute. In these cases, Suboxone treatment is often indefinite because the risk of relapse increases if you stop taking Suboxone. Some people may be on Suboxone for the rest of their lives.
Meaning Two – Needing to Taper off Suboxone
Tapering off Suboxone has a second connotation. Because Suboxone contains buprenorphine, an opioid, it can result in dependence itself. It is possible for people taking Suboxone as MAT to become dependent on the drug. If someone takes Suboxone when they have not been prescribed the agent, they may become addicted to it as well.
For the sake of this explanation, the focus will be on the later interpretation — tapering off Suboxone as opposed to using it as a taper for other opioids.
Why Taper Off Suboxone vs. Quitting Cold Turkey
As it stands, a Suboxone withdrawal can be extremely uncomfortable in its own right. Suboxone is a long-acting drug, so its withdrawals can be long-lasting as well. To put that in perspective, quitting a short-acting opioid — such as heroin —can result in a ten-day-long withdrawal. These withdrawals are arguably more painful, but some consider Suboxone withdrawals worse, given the extended timeframe.
If an individual decides to forgo a Suboxone taper schedule and quit the medicine cold turkey, they can expect withdrawal symptoms to begin between 12 and 48 hours after the final dose. Physical symptoms continue for up to 20 days and then may be replaced by cravings or depression. These psychological side effects contribute to the likelihood of relapse. A full detox is recommended in a clinical setting where support and structure are abundant.
Luckily, tapering off Suboxone is almost always going to be done in the presence of medical professionals. These rehabilitation experts will develop an appropriate Suboxone taper chart personalized to each patient’s unique needs.
Example of a Suboxone Taper Chart
A Suboxone taper chart can take many forms. Below is an example of how the chart’s content may look over 6 days:
Initial Dose: 16 mg/day
- Day 1:12 mg/day
- Day 2:10 mg/day
- Day 3:8 mg/day
- Day 4: 4 mg/day
- Day 5:2 mg/day
- Day 6: 2 mg/day
Note: This is just one tapering model. Many different examples exist. The length of the taper and the cutback amounts will vary by patient.
Tapering off Suboxone is a lengthy endeavor. However, having overcome a far worse opioid addiction to get to this point, patients certainly have the resolve to take on such a challenge.
Other FAQs About Suboxone
At an ingredient level, Suboxone combines two specific medications to accomplish this task. The first, buprenorphine, is the key ingredient. Buprenorphine functions similarly to traditional opioids by binding to the same receptors in the central nervous system. Here, the medicine works to suppress opioid cravings, while also offsetting the associated withdrawal symptoms.
Naloxone is the second most important active ingredient found in the prescription. It blocks opioid receptors in the brain to reverse an overdose. The chief duty of naloxone in Suboxone is to trigger withdrawal symptoms if the medicine is being misused. The naloxone found in Suboxone remains dormant unless tampered with — think of it as a sort of failsafe. Whenever Suboxone is not used as directed, the naloxone kicks in to block a pleasurable opioid high and imitate a withdrawal instead.
Suboxone is one of several drugs designed for opioid detox. These methods can differ by approach at different rehabilitation facilities, but most refer to the general principle as medication-assisted treatment or MAT. In MAT, you taper off stronger opioids and use Suboxone as a less-harmful replacement. Quitting opioids outright leaves people susceptible to unbearable withdrawal symptoms. Doctors use MAT to tackle this problem by lessening or eliminating symptoms and adjusting the body to life beyond the drug’s clutches.
Ling, Walter; Hillhouse, Maureen; Domier, Catherine; et al. “Buprenorphine tapering schedule and illicit opioid use.” Addiction, 2009. Accessed June 21, 2020.
U.S. National Library of Medicine. “Suboxone.” October 31, 2019. Accessed June 21, 2020.
American Society of Addiction Medicine. “National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.” 2015. Accessed June 21, 2020.
World Health Organization. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” Published 2009. Accessed June 21, 2020.
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