You’ve heard of drugs like heroin and morphine. As narcotics, they are useful for, and infamous for, causing a brief burst of euphoria, followed by powerfully drowsy and lethargic feelings in their users.
This can be very addictive, but simply discontinuing consumption of an addictive substance is much easier said than done. That’s why certain drugs are made and licensed to help wean patients off the harder substances they’re on, but even these come with their own risks. In the case of opioid dependence, Suboxone is a popular choice of detox drug, and one that poses its own caveats.
Suboxone: Buprenorphine and Naloxone
When we say “Suboxone,” we’re really talking about two drugs that are mixed together: buprenorphine and naloxone.
Buprenorphine is a partial opioid antagonist. This means that it can cause effects like that of other narcotics (it binds to the same receptors in the brain as heroin and methadone do), but not to the same extent. The euphoria is less pronounced and not as habit-forming (it takes between 24 and 60 hours for the body to get rid of half a dose of buprenorphine, according to the Substance Abuse and Mental Health Services Administration); therefore, there is a lower potential for abuse, and the withdrawal effects are relatively milder compared to those of other opioids like heroin.
For this reason, buprenorphine is used to help wean addicts off their current opioid dependency by providing them with a less harmful alternative. However, there is still an element of risk involved in downgrading a patient to a drug that they may consider safer, which is why the other ingredient of Suboxone is naloxone.
Naloxone is a narcotic, but unlike buprenorphine being a partial opioid antagonist, naloxone is a pure opioid antagonist. This means that it actually undoes the effects of other narcotics. But there is a reason heroin addicts are not simply prescribed a course of naloxone: the reversal effects can be so acute that patients can experience severe withdrawal symptoms that cannot be easily controlled. These may include:
- Rapid heart rate
- Nausea and vomiting
For that reason, the naloxone is bundled with buprenorphine: to simultaneously rewrite the drug-addled brain’s connections, while providing a safety net of gradually diminishing narcotic boosts. Put together, the two drugs become Suboxone.
Hooked on Suboxone
Suboxone enjoys popularity as an opioid addiction treatment, but even regular doses can become habit-forming, especially in patients whose dependence on narcotics has left them particularly vulnerable to any kind of opioid influence.
As a writer on The Fix says, he first took Suboxone to get off heroin; then he became hooked on the Suboxone. The writer mentions an article from Village Voice that asks if Suboxone is a “wonder drug” that truly helps heroin addicts get clean, or if it’s just another way for people to get high. New York City’s Special Narcotics Prosecutor tells Village Voice that addicts purchase Suboxone when their drug of choice is too expensive, or when they have to appear sober (one person who claimed to be a “professional, honest guy” with a family begged for Suboxone because he wanted to get off his drug habit without the withdrawal symptoms preventing him from working). While online sellers make a fortune by claiming to sell Suboxone to heroin addicts who want to kick their habit, the prosecutor says that the Suboxone trade is really about managing a pre-existing addiction.
A former heroin addict and current intervention specialist confirms to Village Voice that without actual treatment, patients are very likely to continue furthering their dependence on narcotics. There’s even a term for going back and forth between the drug of choice and the drug that you use to control your habit: “bridging.” A substance abuse counselor clarifies that a patient taking Suboxone on his own, without medical supervision, has no idea whether the drug is actually doing any good.
It was this that led the writer of The Fix article to seek out Suboxone as a treatment for his heroin problem. After trying methadone, Suboxone seemed like a good alternative for avoiding what he called “the Sickness,” the withdrawal symptoms of a physical addiction. But eight years after successfully putting his heroin habit behind him, he still has to take Suboxone, being told that less than two percent of the people who take Suboxone eventually get off the medication. The feeling that the sickness is at the door, waiting to sweep in as soon as the Suboxone is gone, is overpowering. The writer compares being on Suboxone to being like a heroin user again, only without the high.
It may sound dramatic, but Kentucky’s Courier Journal carries the story of a young man who resorted to dangerous methods to get more out of his Suboxone prescription after the medication helped him get over his addiction to OxyContin. When he started to acclimatize to the supposedly safer high of Suboxone, he began to dissolve the Suboxone strips he was prescribed in water, then shot the resultant mixture into his veins. That’s because “Suboxone addiction is huge,” in the words of the president of a treatment center. However, breaking or crushing a Suboxone tablet to snort the powder, or dissolving it in a liquid to inject into the veins, can be fatal.
Profiling the “blockbuster drug” with a dark side, The New York Times wrote of the case of a 20-year-old man who died after overdosing on Suboxone given to him by a friend who, now serving 71 months of a federal prison sentence, didn’t know it was possible to overdose on Suboxone. The Times analyzed federal data and found that Suboxone was a “primary drug” in 420 deaths reported to the U.S. Food and Drug Administration since 2003.
A young man who finally broke free of his Suboxone dependence described the process to Village Voice as “brutal,” claiming that while it probably protected him from overdosing on heroin, it didn’t address the underlying addiction issues and the withdrawal issues brought about by the Suboxone itself.
These withdrawal effects may include:
- Nausea and vomiting
- Muscle aches and cramps
- Abdominal pain and diarrhea
- Irritability and agitation
- Craving for more Suboxone
- Depression and anxiety
The severity of Suboxone withdrawal symptoms can depend on a number of factors: how long the patient has been taking Suboxone; their previous drug and medical history; how long since their last intake of Suboxone and the dosage thereof (Suboxone generally stays in the body for about 37 hours); whether the withdrawal effects are the result of tapering off, or an attempt to quit “cold turkey”; and whether they are other opioid drugs at play.
Those factors may also determine how long the detoxification process takes. Detoxification is a careful, supervised process where the patient is gradually denied access to the drug they were abusing, in order to let her body heal from the damage caused by the drug. This process should be carried out in a hospital or treatment facility, so that trained staff members can be on hand to supply the appropriate anti-anxiety or anti-convulsant medication to help carry the patient through the inevitable withdrawal (for example, benzodiazepines are often used to help people through the stages of alcohol detoxification).
Suboxone Detox and Further Treatment
Detoxing early, and under the purview of a rehabilitation facility, can reduce the length of the process and make it relatively more bearable for everyone involved. The Fix explains that detoxification puts a user (and their family) through an emotional and psychological wringer, but this is necessary to move the patient past the stage where he feels an overwhelming need to satisfy the body’s cravings. Depending on the user, his drug history and the depth of his addiction, Suboxone detox can take anywhere from one week to a month.
But as Suboxone users who found themselves replacing their heroin addiction with a Suboxone one find out, going clean means going deep. Whenever the detoxification process is complete (Mental Health Daily suggests waiting 90 days to ensure that the withdrawal symptoms have truly abated), the patient can begin drug counseling, whereby she works with a psychologist to address the issues that led her to her opioid dependence in the first place. Simply overcoming the physical temptation to use again is only half the job, as the user will more than likely fall back into her destructive habits when confronted with temptation, stress, boredom, isolation, or merely the opportunity to use Suboxone again.
Further Reading About Suboxone Detox: How Long?
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton