Suboxone withdrawal

Long-term use of Suboxone can cause physical and psychological dependence. Physical dependence can cause mild withdrawal symptoms if Suboxone use is abruptly stopped. To help prevent these symptoms, if you’ll be stopping use of Suboxone, your dosage should be slowly tapered with the help of your doctor.

Examples of Suboxone withdrawal symptoms include:

  • nausea
  • diarrhea
  • headache
  • muscle aches
  • insomnia (trouble sleeping)
  • anxiety
  • irritability
  • drug cravings
  • sweating

Suboxone dosage

The Suboxone dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of opioid dependence
  • the stage of treatment you’re in
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Drug forms and strengths

Suboxone is only available as an oral film that can be placed under the tongue (sublingual) or in the cheek (buccal). It comes in four strengths:

  • 2 mg buprenorphine / 0.5 mg naloxone
  • 4 mg buprenorphine / 1 mg naloxone
  • 8 mg buprenorphine / 2 mg naloxone
  • 12 mg buprenorphine / 3 mg naloxone

Suboxone is also available as a generic version that comes in other forms. These forms include a sublingual film and a sublingual tablet.

Other drug forms

Suboxone contains two drugs: buprenorphine and naloxone. These individual drugs come in additional forms. Buprenorphine forms include a sublingual tablet, a skin patch, an implant for under the skin, and a solution for injection. Naloxone forms include a nasal spray and a solution for injection. (These forms of the two drugs are not all used to treat opioid dependence.)

Dosage for opioid dependence

Suboxone is FDA-approved to treat opioid dependence. Treatment of opioid dependence occurs in two phases: induction and maintenance.

During the induction phase (see “How Suboxone works” above), Suboxone is used to reduce withdrawal symptoms when opioid use is being decreased or stopped. During the maintenance phase, Suboxone is continued at a stable dose for a time ranging from several months to over a year.

Below are examples of how your induction and maintenance dosages may be administered.

Induction dosage

  • Induction details
    • Induction treatment with Suboxone takes place in your doctor’s office or clinic.
    • Suboxone is only used for induction treatment if you’re dependent on short-acting opioids such as heroin, codeine, morphine, or oxycodone (Roxicodone, RoxyBond).
    • You should use Suboxone oral film under your tongue during induction treatment. Don’t use it in your cheek because this is more likely to cause withdrawal symptoms.
    • Suboxone induction shouldn’t start until:
      • at least six hours after your last use of a short-acting opioid
      • you start to have moderate opioid withdrawal symptoms
  • On day 1:
    • In your doctor’s office, your doctor will start you on a low Suboxone dose. This dose might be 2 mg buprenorphine / 0.5 mg naloxone or 4 mg buprenorphine / 1 mg naloxone.
    • Your doctor will evaluate your withdrawal symptoms for about two hours. If needed, they’ll give you another dose of Suboxone.
    • The maximum total dose on the first day is 8 mg buprenorphine / 2 mg naloxone.
  • On day 2:
    • Your doctor will evaluate your withdrawal symptoms. If your symptoms are controlled, your doctor will give you the same total dose you received on day 1. If your symptoms are not controlled, your doctor will give you what you received on day 1, plus an additional amount of 2 mg buprenorphine / 0.5 mg naloxone or 4 mg buprenorphine / 1 mg naloxone.
    • Your doctor will evaluate your symptoms again in about two hours. If needed, they’ll give you another dose of Suboxone.
  • Additional days:
    • This stepwise process may continue for additional days until your withdrawal symptoms are controlled and stabilized for two or more days. During induction, your Suboxone dose may be increased to a maximum of 32 mg buprenorphine / 8 mg naloxone once daily.

Maintenance dosage

  • Maintenance details:
    • When you reach a Suboxone dose that keeps you stable, your treatment will be continued with this dose during the maintenance phase.
    • During this phase, you can use Suboxone oral film under your tongue or in your cheek.
    • The length of your maintenance treatment will depend on your needs and goals. It may last from a few weeks or months, to more than a year.
    • During this time, you may have weekly or monthly appointments with your doctor.
    • If you continue to use opioids during the maintenance phase, or if you misuse Suboxone, your doctor may recommend a different treatment program for you.
  • Suboxone taper:
    • You and your doctor will decide together when it might be the right time to end your treatment with Suboxone.
    • When the decision is made to stop Suboxone, your dosage of the medication will be slowly decreased over time. This tapering off of your dosage may take several weeks or months.
    • If your withdrawal symptoms or cravings return during the taper, your doctor may temporarily increase your dosage.
  • Maximum dosage: The maximum daily dose during the maintenance phase is 32 mg buprenorphine / 8 mg naloxone.

What if I miss a dose?

If you miss a dose during the maintenance phase, take it as soon as you remember. If it’s almost time for your next dose, just take that one dose. Don’t try to catch up by taking two doses at once.

Will I need to use this drug long-term?

Yes, when Suboxone is used to treat opioid dependence, it’s often used long-term.

Does Suboxone use lead to tolerance?

When certain opioids are used long-term for treating pain or for a “high,” tolerance to those effects can happen over time. This means your body gets used to the drug and you need higher and higher doses to get the same effect.

Drug tolerance has not been seen with Suboxone or with either of the drugs it contains (buprenorphine or naloxone). When Suboxone is used long-term for opioid dependence, tolerance to the beneficial effects of Suboxone doesn’t occur.

Suboxone drug test

While taking Suboxone for opioid dependence, you may be required to do frequent drug tests for the use of opioids.

Urine test

There are different types of urine drug tests. Some of these tests, including the tests often used in those who take Suboxone for opioid dependence, can detect the presence of Suboxone and other opioid drugs.

Most opioids can be detected within one to three days after use. However, Suboxone is long-lasting. It may be detected for longer periods of time.

Home drug test

Most home urine drug tests check for opioids, but don’t usually test for the drugs contained in Suboxone. However, there are some home drug tests that do check for buprenorphine, one of the drugs in Suboxone. This, of course, means a positive result for buprenorphine is a positive result for Suboxone.