Opioids, the catalyst behind the worst drug crisis in American history, appears to have few answers. Suboxone, one remedy that treats the effects of opioid withdrawal, can also act as a substance of abuse.
It’s the classic case of medicine morphing into poison when abused. This was especially the case for a 20-year-old man from Maine who used Suboxone recreationally and died in 2010, according to a report from The New York Times.
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His friend got 71 months in prison for providing him the treatment drug that killed him.
Media reports have chronicled Suboxone as a substance of abuse. Another article from The New York Times profiled a southwestern Virginia town that got rocked by Suboxone or “Box,” the nickname used for the combination drug.
The Times reported that 80 to 90 percent of all crimes committed in the home county of this town were drug-related and mostly involved Suboxone. Read on to learn about the withdrawal symptoms of this supposed treatment medication, along with available treatment options.
How Does Suboxone Work?
Suboxone is a combination drug made up of the opioid buprenorphine and the anti-overdose medication naloxone. The active ingredient in Suboxone is buprenorphine, which is a partial opioid agonist that binds to receptors in the brain. However, the buprenorphine partially binds to those receptors.
This partial binding produces much weaker effects than full-on opioid agonist drugs like heroin and oxycodone, which attach fully to those receptors. Naloxone, an opioid blocker, is often employed by itself as an opioid overdose medication.
The U.S. Food and Drug Administration (FDA) approved Suboxone to treat opioid dependence, and it is employed as an opioid maintenance medication, much like methadone. It comes as an oral film that dissolves in your mouth, to be placed under the tongue or between the gums and cheek.
The National Institute on Drug Abuse (NIDA) states that Suboxone, just like methadone, is useful for the treatment of opioid use disorders. “A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended-release naltrexone formulation are similarly effective in treating opioid use disorder.”
And like methadone, Suboxone is typically employed in medication-assisted treatment (MAT), an approach where patients are administered medication along with behavioral therapy and counseling. Suboxone has abuse-deterrent properties. The fact that it is comprised of a partial opioid agonist and an opioid blocker means that while abuse will yield some euphoric effects, these sensations will level off at a certain point. This is referred to as a ceiling effect.
However, even this pharmacological effect has not deterred people from abusing it. The Drug Enforcement Administration (DEA) classifies Suboxone (and other buprenorphine medications) as a Schedule III controlled substance, meaning that “abuse may lead to moderate or low physical dependence or high psychological dependence.”
Suboxone Withdrawal Symptoms
Suboxone’s symptoms of withdrawal occur when someone misses a dose or tries to quit cold turkey. When a person experiences withdrawal symptoms, it means they have become physically dependent.
According to Verywell Mind, the physical symptoms of Suboxone withdrawal include:
- Stomach cramps
- Runny nose
- Teary eyes
- Nausea or vomiting
- Muscles aches/pain
- Drug cravings
Timeline of Suboxone Withdrawal
Suboxone withdrawal symptoms take longer to occur because the drug stays in the body a lot longer than standard opioids. The buprenorphine portion of the drug has a half-life of about 24 to 42 hours.
There is no standard withdrawal timeline for opioid medications. How and when withdrawal occurs will depend on factors such as the health and substance abuse history of the individual. The dose amount and whether abuse occurred with other substances will also influence withdrawal.
However, the following serves as a general timeline for Suboxone withdrawal:
Days 1-3: The most physically unpleasant part of withdrawal occurs during the first three days. In about six to 12 hours of detox, symptoms such as nausea, diarrhea, and cramps will manifest.
Days 4-7: By the fourth day, psychological symptoms like insomnia will manifest. Between days five and seven, someone in withdrawal can experience more insomnia and other psychological symptoms like anxiety and agitation.
Weeks 2-4: After a week in Suboxone withdrawal, depression can set in as well as intense cravings, making relapse a genuine threat.
Month 2 and beyond: It is not unusual for Suboxone cravings to linger years after a patient has undergone detox. Relapse is common after the first month of Suboxone detox.
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How Professional Treatment Helps
Suboxone withdrawal can be dangerous. A professional treatment program will start with medical detoxification, where the substance is gradually removed from the body, and the withdrawal symptoms mentioned above are medically addressed.
In detox, a team of doctors, nurses, and other medical personnel monitor you around the clock.
Once detox is completed, residential or outpatient treatment may be recommended for you. If your case is deemed severe, then you likely will be approved for a residential program, where you live onsite at the rehabilitation facility and receive comprehensive therapy and care.
Milder cases are usually recommended for outpatient, where you can still receive treatment yet live at home or in some other living arrangement.
Drug Enforcement Agency (DEA). (n.d.). List of Controlled Substances. Retrieved from from https://www.deadiversion.usdoj.gov/schedules/
Healthline. (n.d.). Suboxone: Side Effects, Dosage, Uses, and More. Retrieved from from https://www.healthline.com/health/cdi/suboxone#withdrawal
Macy, B. (2016, May 28). Addicted to a Treatment for Addiction. Retrieved from from https://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html
National Institute on Drug Abuse. (n.d.). Effective Treatments for Opioid Addiction. Retrieved from from https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction
Osborn, C. O. (2019, February 26). How Long Does Withdrawal From Suboxone Last? Retrieved from from https://www.verywellmind.com/suboxone-withdrawal-4178344
Sontag, D. (2013, November 16). Addiction Treatment With a Dark Side. Retrieved from from https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html