None of our patients want to take Suboxone for the rest of their lives, and understandably so. No one wants to take any medication for the rest of their lives. But in the case of Suboxone, most patients find it very difficult to stop. The opioid dependence that they have built up is very tough to beat. But why is it so difficult to quit Suboxone treatment?
This article will discuss the physical reasons why Suboxone is hard to stop taking and discuss the best course of action for stopping the use of this medication. We’ll also answer common questions, including:
- How long does Suboxone block opiates?
- Why do I go into withdrawal when I stop taking Suboxone?
- How can I quit taking Suboxone?
For evidence-based answers to these questions and more, keep reading!
Quitting Suboxone is difficult but not impossible. Here's why:
Long term opioid use causes "upregulation" of the receptors or an increase in the number of receptors. The more opiates one uses, the more receptors one develops and the higher the dose of opioids is needed to occupy those receptors. This is called building tolerance.
It is a vicious cycle of use and tolerance building. Long term use creates an overabundance of these receptors (upregulation) that makes abstinence very difficult without opiate replacement therapy. The receptors are numerous and screaming for both the endogenous (natural) and chemical opioids.
Understanding the Opioid Tolerance Cycle
When people stop using opioids, they begin to "downregulate” or reduce the number of opioid receptors in their brains. How long does it take for downregulation to occur? Meaning how long does it take for those receptors to return to a more normal number? We don’t know exactly, and it varies across patients. It usually takes weeks to months.
For Suboxone patients, it’s a slightly different process because they have moved from prescription or street opioids to replacement therapy. Suboxone only fills the receptors partially, which is why Suboxone does not get patients "high." By satisfying the demand of the receptors, Suboxone allows people to avoid cravings and withdrawal. But this means that while patients may have stopped the addictive behaviors associated with their opioid use, they are still physically dependent on opioids.
When patients start on their Suboxone regimen, their doctor generally prescribes at the lowest dose that allows them to avoid withdrawal. This dose maintains the number of opioid receptors in their brain needed to avoid withdrawal and cravings. When the patient is ready to taper off, they will start to reduce their dose, according to their doctor's instructions.
Why Do People Go Into Withdrawal When They Stop Taking Suboxone?
Suboxone has a very long half-life of 24 to 36 hours. The half-life describes how long it takes the body to process half the dose. The combination of a long half-life plus a higher than normal tolerance for opioids (more opioid receptors in the brain) leads to withdrawal symptoms that are as uncomfortable as withdrawal from any opioid.
Patients frequently report they get down to a low dose of Suboxone and can’t stop without experiencing withdrawal. Why is this? Greenwald et al. in 2003 found that PET scans showed that at 16 milligrams, 92% of receptors are occupied, and at 2mg, 48% of receptors are still occupied. This means that even if a patient is only taking 2 milligrams a day of Suboxone, half of their brain's opioid receptors are still being occupied by Suboxone.
Many practitioners say that staying on a low dose of Suboxone is a crutch, but PET scans show that the two milligrams dose is actually continuing to occupy receptors. There is a physical reason why it is difficult to go from two milligrams of Suboxone down to zero.
How to Get off of Suboxone
Practitioners need to recognize the physical dependence that comes from partially filled opioid receptors, which is what makes getting off a buprenorphine-based medication so difficult. The best course of action is to taper patients off Suboxone slowly and over a long period. Patients can slowly taper and spread out their doses to make that transition from low to zero more tolerable.
The reality is, patients will experience Suboxone withdrawal symptoms as they make the shift towards a Suboxone-free life. But moving gradually and forming a plan to prepare helps to ease the strain of the process.
Patients can also start more pleasurable activities like hiking, yoga, mediation, reading and other hobbies during this time. Additionally, increasing counseling sessions can make this time of transition to zero opiate replacement therapy more bearable.
Find Freedom from Opioid Addiction with MATClinics
As research continues to provide information about the effects of opioids on the brain, it’s clear that abstinence-based treatment programs fall short in many ways. Medication-assisted treatment is a much more effective approach to breaking addiction and helping individuals recover.
Whether you are struggling with opioid addiction or have a loved one who is, MATClinics is here to help. Contact the specialists at MATClinics today to find out which of our Maryland outpatient centers can form a treatment plan for you.