From the Guidelines
Suboxone withdrawal typically begins within 24-72 hours after the last dose and can last anywhere from a few weeks to several months, depending on various factors. The timeline varies based on the individual's dosage, duration of use, metabolism, and overall health. Early withdrawal symptoms often appear within the first 1-3 days and include anxiety, muscle aches, insomnia, and irritability. The acute phase of withdrawal usually peaks around days 3-5 and can last 1-2 weeks, with symptoms like nausea, vomiting, diarrhea, and intense cravings. Following this, a protracted withdrawal phase may continue for weeks or months with less intense but persistent symptoms such as mood disturbances, fatigue, and cravings. This extended timeline occurs because buprenorphine (the active ingredient in Suboxone) has a long half-life and binds strongly to opioid receptors, causing a slower but often less intense withdrawal compared to other opioids 1.
Some key factors to consider in Suboxone withdrawal include:
- Dosage: Higher doses can lead to longer and more severe withdrawal symptoms
- Duration of use: Longer use can lead to more intense withdrawal symptoms
- Metabolism: Individual metabolism can affect the rate of withdrawal
- Overall health: Underlying medical conditions can impact the severity of withdrawal symptoms
Tapering Suboxone gradually under medical supervision is recommended to minimize withdrawal severity rather than stopping abruptly 1. A daily dosage of 16 mg is sufficient to suppress illicit opioid use in most patients with OUD, but sufficient dosages vary and can range from 4-24 mg daily 1. It's essential to work with a healthcare provider to develop a personalized tapering plan to ensure a safe and effective withdrawal process.
In terms of managing withdrawal symptoms, some studies suggest that buprenorphine can be administered in a controlled environment to alleviate acute withdrawal symptoms 1. However, the most recent and highest quality study recommends a gradual tapering approach to minimize withdrawal severity 1.
Overall, a gradual tapering approach under medical supervision is the most effective way to manage Suboxone withdrawal and minimize the risk of relapse.
From the FDA Drug Label
Physical dependence may not occur to a clinically significant degree until after several days to weeks of continued use. If buprenorphine hydrochloride is abruptly discontinued in a physically-dependent patient, a withdrawal syndrome may occur, typically characterized by restlessness, lacrimation, rhinorrhea, perspiration, chills, myalgia, and mydriasis
The speed of suboxone withdrawal is not explicitly stated in the provided text, but it is mentioned that physical dependence may not occur until after several days to weeks of continued use.
- Withdrawal syndrome may occur if the drug is abruptly discontinued in a physically-dependent patient.
- The text does not provide a specific timeline for the onset of withdrawal symptoms after discontinuation of buprenorphine hydrochloride 2.
From the Research
Suboxone Withdrawal Timeline
- The timeline for Suboxone withdrawal can vary depending on several factors, including the individual's physical and mental health, the dosage and duration of Suboxone use, and the presence of other substances in the system 3, 4.
- Studies have shown that buprenorphine, the active ingredient in Suboxone, can alleviate opioid withdrawal symptoms and reduce the duration of withdrawal 3, 5, 4.
- Compared to clonidine, buprenorphine has been found to be more effective in managing opioid withdrawal symptoms, with patients staying in treatment for longer and being more likely to complete withdrawal treatment 3, 4.
- The severity of withdrawal symptoms can be similar for withdrawal managed with buprenorphine and withdrawal managed with methadone, but withdrawal symptoms may resolve more quickly with buprenorphine 3, 4.
Factors Influencing Withdrawal Duration
- The rate of buprenorphine dose reduction can affect the duration of withdrawal, but the evidence is limited and inconclusive 3, 4.
- Individual factors, such as sex and initial treatment plan, can also influence the response to withdrawal treatment, but more research is needed to fully understand these factors 3.
- The use of buprenorphine to support transition to naltrexone treatment is an area worthy of further research, as it may impact the duration and severity of withdrawal symptoms 3.
Managing Opioid Withdrawal Symptoms
- Non-opioid medications, such as α-2 adrenergic agonists, can facilitate opioid tapering and provide a gateway into long-term treatment with naltrexone or psychosocial therapies 6.
- Buprenorphine can be used to manage opioid withdrawal symptoms, particularly in patients with mild to moderate withdrawal, and can be an effective treatment for loperamide use disorder 7.