Suboxone FAQ

Opioid-replacement therapies such as Suboxone allow us to focus on our clients’ treatment, while ensuring they are safe and stable physiologically. Suboxone reduces the likelihood of clients returning to opiate use as it lessens the uncomfortable, sometimes agonizing, effects of withdrawal. 

Not all clients are suitable candidates for Suboxone. Our physician’s assessment will establish the need for Suboxone if there is one. Assessments focus on withdrawal history, prior addiction treatment, and rate of return to opioid use. Opioid maintenance therapy (e.g. Suboxone), in general, is an effective treatment for clients with chronic opioid dependence who have also not done well on Methadone maintenance therapy. If a client is not eligible to use Suboxone, we use other methods to lessen the discomfort of opiate withdrawal.

Medication-assisted treatment for opioid addiction and dependence is much like using medication to treat other chronic illnesses such as heart disease, asthma, or diabetes. Contrary to popular myths, taking medications for opioid addiction is not simply substituting one addictive drug for another.

Stopping Suboxone when you return home after addiction treatment may cause the uncomfortable physical symptoms of withdrawal to return. While you are not addicted to Suboxone, you may be physically dependent on it. Remember, addiction involves not only a physical need for the drug (dependence), but other factors such as continued use despite experiencing consequences.

If a client needs to continue on Suboxone after finishing our drug rehab program, we arrange with them to move their prescription to a physician and/or clinic in their home community. From there, the physician will continue to prescribe (or taper) Suboxone based on the client’s needs and requests. 

Typically patients feel no effect except a decreased need for opiates. Euphoria (feeling high), sedation, and/or nausea is possible if too high a dose of Suboxone is taken. Your stable dose is achieved over 24 hours to a few days (compared to a few weeks with Methadone).

Some people experience side effects, but overall Suboxone is well tolerated. The most common side effects include constipation (typical of all opiates), dizziness or drowsiness, or headache. Weight gain, sweating, and sexual side effects are much less common than with Methadone. Suboxone withdrawal symptoms like abdominal cramps, nausea, diarrhea, insomnia, restlessness, irritability, anxiety and muscle or joint pain may be part of the induction phase, but disappear quickly once a client’s dose is stabilized.

Taken as directed, Suboxone is very safe and does not cause long-term damage to organs, even after several years. Some people do get elevations in their liver enzymes, which reverse once the drug is stopped. In most cases this is not felt to be of any consequence.

A previous concern about Suboxone vs. Methadone was with respect to the treatment of acute pain. It was believed that Suboxone blocked the effect of other opioids. It is now known that increased opioids are required to treat acute pain in patients on any opioid therapy whether it is long term opioids for chronic pain, Methadone, or Buprenorphine for maintenance. The amount of extra opioids needed to treat pain is about the same regardless of whether you are on Methadone or Suboxone.

There are many reasons why Suboxone may be the preferred form of therapy. Some include:

• Less stigmatizing than Methadone.
• Stabilization or maintenance dose within the first or second day.
• A better safety profile (less likely to cause overdose, little to have no effect on heart rhythms).
• Easier to taper off of than Methadone.
• Longer acting than Methadone (may not require daily dosing).
• Fewer side effects, such as constipation.

• May not fully satisfy cravings or block withdrawal symptoms for those with high tolerances.
• May be more costly if not covered by Ontario Drug Benefit Program.
• Dose adjustments may be more difficult.
• May cause a “precipitated withdrawal”.

Suboxone is said to have “low intrinsic activity”. What this means is that once the molecule is attached to a receptor site in the brain, it does not activate or light up that receptor as intensely as other opioids do, including Methadone. A popular metaphor for this is a light switch. Methadone is like turning the light on, whereas Suboxone is like a dimmer switch.

Suboxone also has “high affinity”, meaning it is a very sticky molecule. Once attached to the receptor, it does not like to come off. This is one of the reasons it so long acting. So if an individual who takes Suboxone for the first time also has recently taken any other opioid, the Suboxone will be forced to compete with that other opioid for the receptor. Because of its “high affinity”, it often overtakes the other opioid and takes its place on receptor site instead. This alone does not cause precipitated withdrawal. 

Combined together, Suboxone does not light up the receptor to the same extent as the opioid that was just kicked out by Suboxone. This is what causes the precipitated withdrawal (e.g. a steep or abrupt onset to symptoms).