Opioid addiction is dangerous and challenging to treat. Even transitioning off of opioids can cause serious side effects and even death. When you’re ready to live life without opioids, medication-assisted treatment (MAT) using Suboxone for pain can help you safely navigate this change. It helps minimize the symptoms of withdrawal, making it easier to reduce dependence on opioids and reduce risk of side effects. But how does Suboxone work? Here’s everything you need to know.
How Does Suboxone Work In The Brain And Body?
Suboxone is a medication that combines buprenorphine and naloxone to address two key aspects of addiction.
Buprenorphine is a partial opioid agonist. Although it binds to the main opiate receptor (the “mu” receptor) in the brain the same way that opioids do, its effects are much weaker than both prescription opioids and other narcotics such as heroin, morphine, or fentanyl. It does not cause the euphoria of opioids.
Buprenorphine also has a ceiling — the effects of this medication do not increase if you take more of it. This reduces cravings, dependency, and side effects that are the hallmarks of opioid addiction.
Naloxone functions as a critical check on how Suboxone works in the body. Suboxone is meant to be taken orally, but if it’s injected it results in the withdrawal symptoms you are trying to avoid. This makes it less attractive to people who might otherwise attempt to boost the effects of Suboxone in the body.
Naloxone (Narcan) is also administered in cases of overdose. It counteracts the effects of opioids and can save lives when administered quickly.
How Is Suboxone Taken?
Suboxone is available in a variety of forms that include:
- Sublingual (under the tongue) tablet
- Sublingual film
- Monthly injection
- Transdermal implant
- Buccal film (in the cheek)
The most common form is a tablet or film that dissolves under the tongue in less than ten minutes. Make sure that the tablets or film is dissolved completely before eating or drinking anything. This ensures that all of the medication is ingested properly and quickly enters the bloodstream for the most effective prevention of withdrawal symptoms.
The effects typically begin within an hour, peak within two to three hours, and wear off in three days. Your first dose is generally administered during the withdrawal period from opioids, with doses repeated once a day.
It is critical to take this medication only as prescribed by your doctor. Your doctor will also determine which form might work best for you.
Suboxone’s Role In Chronic Pain Management
Because many who are suffering from opioid dependence started with opioids for treating chronic pain, it’s important to consider how Suboxone works for chronic pain management.
The use of Suboxone in treating pain is not approved by the U.S. Food and Drug Administration (FDA), but some research has found that off-label use of Suboxone for pain is an effective way to not only treat pain but to also reduce the chance of opioid dependency.
These uses might include:
- Acute pain: Managing pain from surgery, trauma, or medical procedures
- Chronic pain: Neuropathic pain or pain from joints, back or cancer-related tumors
Although Suboxone is not approved for use in chronic pain management, buprenorphine alone is approved for some types of pain.
The extended-release skin patch and buprenorphine buccal film can be prescribed to treat moderate to severe chronic pain. These should only be prescribed for pain that cannot be managed in other ways and for which other treatments are inadequate. They are not appropriate for fast relief of acute pain from injury or trauma. A buprenorphine injection is also FDA-approved for pain that is severe enough to require an opioid analgesic.
It is important to note that risk of overdose and death increases when Suboxone is prescribed to treat pain in opioid-naïve patients (those who are not currently using opioids). Using opioids long term — including Suboxone — may also result in opioid-induced hyperalgesia (OIH). This occurs when people become more sensitive to pain.
Even with these risks, there are important potential benefits to consider for some types of patients.
- Chronic pain patients who swapped opioids for Suboxone reported a more than two point reduction of pain on a ten-point scale over two months.
- Patients with both opioid dependence and chronic pain were able to reduce their Suboxone use over time or stop altogether.
- Chronic pain patients with opioid addiction reduced their pain by more than 12% and were able to reduce their intake of other pain medications.
How Long Do The Effects Of Suboxone Last?
At 24 to 48 hours, Suboxone has a long elimination half-life. This is the period of time it takes for half of the dose to leave the body. The length of time Suboxone is detectable in the body depends on:
- Your age
- Your weight
- The speed of your metabolism
- Any history of substance use or misuse
- The health of your liver
To manage addiction, many doctors recommend taking Suboxone daily for six months to a year (and sometimes longer). This does not take the place of other types of treatment to support recovery from opioid addiction, but it can minimize the withdrawal symptoms and cravings as you journey back towards wellness.
Are There Suboxone Side Effects?
As with all medications, there are potential Suboxone side effects to be aware of. These can include:
- Joint pain
- Muscle aches
Long-term use or misuse of Suboxone can also lead to symptoms that are similar to opioid withdrawal. These include:
- Mood disorders such as anxiety and depression
- Stomach cramps
Suboxone can also make you feel sleepy at first. In general, though, many people report feeling better— reduced cravings and withdrawal symptoms — after the first day or two. It can take some time to adjust to the medication, and everyone is affected differently. Stay in touch with your doctor, and let them know how you’re feeling.
It is important to make sure your doctor knows what other medications you are taking before you begin taking Suboxone.
Suboxone has been linked to serious issues when taking the following medications:
- St. John’s wort (an antidepressant herbal remedy)
Other medications that intensify the effects of Suboxone and should be avoided include:
- Specific antibiotics
- Some antidepressants
- Protease inhibitors taken for HIV infection
On the other hand, some medications decrease the effectiveness of Suboxone. These include:
- Certain seizure medications
Treating opioid addiction is challenging enough without a potentially life-threatening drug interaction. Be certain to disclose all of your medications to your doctor.
Is Suboxone addictive?
Because Suboxone contains naloxone, a medication that blocks the effects of buprenorphine at certain levels, you are less likely to become dependent on it. However, Suboxone is not meant to be a lifetime treatment for addiction or chronic pain. Long-term use or misuse of this medication can lead to dependence, with many of the same cravings and withdrawal symptoms associated with opioid dependence.
For the best results and to minimize your chances of dependence, it is critical to follow your doctor’s directions for its use precisely.
How Is Suboxone Different From Other Opioids?
The main way in which Suboxone is different from other opioids is that it is only a partial agonist of the opioid receptors in the brain. This means it simply does not produce the same euphoric effects of many other opioids such as heroin, fentanyl, and oxycodone.
And although Suboxone does have a risk of dependence, the inclusion of naloxone and the “ceiling” of relief work together to make this medication less likely to cause overdose. The opioid receptors are not as activated as with other opiates, and those who overdose do so when Suboxone is combined with other sedatives such as benzodiazepines. These medications lead to slower breathing that can contribute to overdose.
Another common misconception about people using Suboxone as part of medicated-assisted treatment for opioid dependence is that they aren’t really “in recovery.” This goes back to the early days of Alcoholics Anonymous when total abstinence was seen as the only way to treat substance abuse.
In reality, Suboxone works for those recovering from opioid use disorder to reduce the physical cravings and withdrawal symptoms so that other aspects of treatment have time to work. Insisting that medication-free treatment is the only way to be in recovery places a burden on those who need care and support to rebuild their lives. It’s similar to blaming Type 1 diabetics for needing insulin to treat a physical imbalance — inaccurate and unhelpful.
Will Suboxone Work For Me?
When trying to decide if Suboxone works for you, the best place to start is in your doctor’s office. Have a long conversation with your doctor that includes your feelings about your opioid use and how it has changed. They may be the one to approach you, especially if they notice a difference in your habits in refilling prescriptions.
It can be more challenging to summon the courage to ask for help if the opioids you are addicted to are not prescription, but your doctor is trained to address this type of opioid use as well.
It is important to note that Suboxone is not the best treatment for everyone. Your doctor may recommend another path if:
- You are on other medications that are dangerous to take with Suboxone
- You exhibit physical dependence without the signs of addiction (e.g., obsessive thoughts about opioids, increased cravings, increased use, etc.)
- You aren’t interested in reducing your opioid use or you’re not dependent on them
The Road To Recovery
Patients with the best chance of recovery from opioid dependence know that a multi-pronged approach is needed. MAT with Suboxone is just one of the many types of supports that can help you get your life back.
The Arizona Pain Mercy Care Center of Excellence program takes a holistic approach that addresses the needs of both mind and body. With appropriate MAT, counseling, community support, and follow-up tailored to each person who enters the program, we help treat patients with:
- Mental health issues
- Substance abuse
- Chronic pain
When you are ready to start on the path to recovery, we are here to help. We know the path is neither straight nor easy to travel, but we will be with you every step of the way. Get in touch to get started today.