Is Suboxone withdrawal worse than heroin detox? What's the deal with quitting Suboxone? We answer your questions, and put your fears to rest.
At Workit, we hear a lot of questions about what happens when someone stops taking Suboxone for good. There is a lot of anxiety about the detoxification process, which can result in withdrawal, so we decided to answer some questions about Suboxone detox or discontinuation.
Q: I'm ready to quit taking Suboxone. Is detoxing a good idea?
A: Suboxone is recommended for long-term use. New research shows that it takes up to two years for the regions of your brain responsible for cravings to go back from addicted-mode to something more similar to normal. However, sometimes people want to get off of opioids (including Suboxone) for good.
If you are in stable, long-term recovery, meaning you haven’t relapsed and your cravings are under control, and you have a desire to quit taking Suboxone, we'd recommend talking to your healthcare provider. We look at it this way: if someone is suffering from depression, and stabilizes on antidepressants, there is no rush to then get off antidepressants. The same goes with insulin for diabetics. We don't encourage them to stop taking insulin once they've stabilized. However, this sort of attitude persists in recovery communities about Suboxone and other recovery meds.
A quick note: discontinuing Suboxone after years of use is different than the short-term Suboxone tapers some providers use to help patients quickly detox off of opioids. This short-term style detox is no longer the recommend treatment for opioid addiction, and may increase your risk of overdose. It is also different from a short discontinuation you may need if you are in need of acute pain management after a surgery or injury.
Q: I’ve heard that detoxing from of Suboxone is the worst. I’m nervous!
A: There are a lot of stories out there on the internet of long-term Suboxone users struggling with the detox process. Some claim the experience is worse than a heroin or pain pill detox. If you read these stories, of course you will be nervous!
The reality: detoxing from any substance that causes physical dependence is no walk in the park.
While everyone’s experience while detoxing from Suboxone is different, let's see what medical science has to say about what can you expect:
According to several clinical studies, withdrawal from buprenorphine (the main ingredient in Suboxone) is actually milder than withdrawal from opioids such as morphine!
If you are currently on medication-assisted treatment then you have probably taken the COWS and/or SOWS test (clinical/subjective opioid withdrawal symptoms test). These tests help providers gauge how bad a person’s withdrawal is by evaluating both physical symptoms (like joint pain and tremors) and how you feel about your symptoms (e.g. I feel anxious, I feel like vomiting).
In those studies I mentioned earlier, both COWS and SOWS scores for people in withdrawal from Suboxone were lesser than the scores of people detoxing from morphine. So, not only were their symptoms less severe but they also felt like their symptoms were milder.
Again, everyone’s experience with detox is different. Talk to your healthcare provider about any concerns you have.
Q: How does Suboxone’s longer half-life change the detox experience?
A: The half-life of a drug is how long it takes for half of the dose of the drug you took to be metabolized by your body. Essentially, after one half-life, you have half as much medicine working in your body.
The half-life for a pain pill, say hydrocodone (aka Norco), is about 4 hours whereas the half-life for Suboxone is closer to 32 hours (learn more about how Suboxone works). That’s an eight-fold difference between Norco and Suboxone!
Because it stays active in the body longer, the symptoms of Suboxone detox are often delayed when compared to heroin or pain pills. This means that you may feel these symptoms for longer which might explain why some people think Suboxone detox is so bad.
But remember, detox from Suboxone is milder than detox from other opioids (which is what you are avoiding by taking Suboxone in the first place).
Q: What can I take to help me through Suboxone detox?
A: Just like with any other detox, you should get plenty of rest and stay hydrated (learn more about how to make detox easier). It is also important to have emotional support from family, friends and/or a peer recovery coach who has been there.
Once you have decided to discontinue Suboxone, your provider may prescribe you clonidine and/or zofran to help with withdrawal symptoms such as nausea. If you experience pain during the detox, you can take a non-opioid painkiller like tylenol or aspirin to help with those symptoms.
If you have chronic pain and are worried about it coming back after you discontinue Suboxone, you should see a pain management specialist to discuss non-opioid treatment options such as physical therapy.
Finally, if cravings are still an issue for you at the time you wish to discontinue Suboxone, talk to your provider about Vivitrol. This medication reduces cravings but, unlike Suboxone, is not an opioid. It is important to note that you must have detoxed from all opioids, including Suboxone, for 7-10 days before starting Vivitrol.
Whatever your path to recovery looks like, the team at Workit Health is here for you!
Workit Health offers recovery meds and online therapy.
Ali Safawi is a humble intern with big dreams of connecting communities and institutions to tackle addiction.