From the Guidelines
No, you should not take oxycodone during Suboxone induction. Taking oxycodone or other full opioid agonists while starting Suboxone (buprenorphine/naloxone) can trigger precipitated withdrawal, which is much more severe than regular withdrawal, as noted in the context of buprenorphine initiation in patients taking opioids for pain 1. Suboxone contains buprenorphine, which has a higher binding affinity for opioid receptors than oxycodone, meaning it will displace oxycodone from receptors but only partially activate them. This sudden change can cause intense withdrawal symptoms.
For proper Suboxone induction, patients should discontinue all opioids the night before initiation, and after mild withdrawal is present, initiate 2-4 mg of buprenorphine, repeated at 2-hour intervals, if well tolerated, until resolution of withdrawal symptoms 1. Typically, 4-8 mg will be needed the first day, and the dose can be adjusted based on the patient's response.
For managing withdrawal symptoms during induction, non-opioid medications like clonidine for anxiety/restlessness, loperamide for diarrhea, and over-the-counter medications for other symptoms are recommended. The importance of helping patients avoid withdrawal symptoms and the use of adjuvant agents to preempt and treat withdrawal distress is underscored by recent guidelines 1. Always follow your healthcare provider's specific instructions for your Suboxone induction, as the protocol should be tailored to your individual situation.
It's also worth noting that while there are considerations for managing acute pain in patients on buprenorphine therapy, such as discontinuing buprenorphine and using full opioid agonist analgesics temporarily 1, this does not apply to the initiation of Suboxone treatment for opioid use disorder, where the goal is to manage withdrawal symptoms without precipitating withdrawal or causing harm.
From the Research
Opioid Withdrawal Symptoms and Suboxone Induction
- Opioid withdrawal symptoms are a key driver behind continued opioid use, and a barrier to opioid discontinuation 2
- Several opioid-based medications are available to treat patients with Opioid Use Disorder (OUD); these treatments can diminish opioid withdrawal symptoms and cravings as well as block opioid effects in the event of relapse 2, 3
Use of Oxycodone during Suboxone Induction
- There is no direct evidence to support the use of oxycodone as needed (prn) for withdrawal symptoms during the first few days of suboxone induction
- However, a study found that buprenorphine/naloxone (a component of suboxone) was effective in reducing pain and supplemental oxycodone use in patients with chronic pain and a history of opioid abuse 4
- Another study found that administration of buprenorphine-naloxone was more efficient in reducing the signs and symptoms of opioid withdrawal and in controlling the craving for the abused substance during the first few days of detoxification 5