Withdrawal After Brief Suboxone Exposure
Yes, you can experience withdrawal symptoms after stopping Suboxone following just 2 days of treatment at 24mg/day, though the severity will be significantly less than withdrawal from full opioid agonists due to buprenorphine's unique pharmacology.
Understanding Buprenorphine's Physical Dependence Profile
Buprenorphine causes physical dependence, but this develops more gradually than with full opioid agonists due to its partial agonist properties and slow dissociation from mu-opioid receptors 1, 2. Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued use 1.
After only 2 days of exposure at 24mg/day, you are in a critical window where some physical dependence has likely begun but is not yet fully established 1, 2.
Expected Withdrawal Symptoms
If withdrawal occurs after this brief exposure, symptoms would likely include 1:
- Mild to moderate symptoms: restlessness, anxiety, irritability
- Physical symptoms: lacrimation (tearing), rhinorrhea (runny nose), perspiration, chills
- Gastrointestinal effects: abdominal cramps, nausea, possible diarrhea
- Sleep disturbances: insomnia
- Musculoskeletal: myalgia (muscle aches), backache, joint pain
The severity after only 2 days would be substantially less than withdrawal after weeks or months of treatment 2.
Critical Pharmacologic Considerations
At 24mg/day, buprenorphine occupies approximately 95% of mu-opioid receptors 3. After 2 days of this high receptor occupancy, abrupt cessation will cause some degree of receptor adaptation, but the slow dissociation kinetics of buprenorphine mean withdrawal onset will be delayed (typically 24-72 hours after last dose) and protracted compared to short-acting full agonists 2.
Buprenorphine should not be abruptly discontinued in a physically-dependent patient; gradual dose reduction is recommended over rapid reduction or abrupt cessation 1, 2.
Recommended Approach for Discontinuation
Rather than abrupt cessation after 2 days at 24mg/day:
- Taper the dose rapidly over 3-5 days (e.g., 16mg day 3, 8mg day 4, 4mg day 5, then stop) to minimize withdrawal symptoms 2
- Monitor using Clinical Opiate Withdrawal Scale (COWS) - significant withdrawal is defined as 6+ point increase within 60 minutes 3
- Provide supportive care including hydration, anti-diarrheals, NSAIDs for myalgias, and sleep aids if needed 3
Critical Safety Warning
The highest risk period is not the withdrawal itself, but the return to opioid use after discontinuation 4. If the reason for stopping Suboxone is to return to full opioid agonist use, understand that:
- Tolerance to respiratory depression decreases rapidly
- Risk of fatal overdose is markedly elevated after buprenorphine discontinuation 4
- Patients who discontinue treatment have mortality rates of 1.82 per 100 person-years 4
Common Pitfall to Avoid
Do not confuse the ability to stop after 2 days with the appropriateness of stopping. If Suboxone was initiated for opioid use disorder treatment, discontinuing after only 2 days represents premature treatment termination and significantly increases overdose risk 5, 4. The standard induction protocol targets 16mg on day 1 with maintenance treatment, not brief exposure 5.