Opioid withdrawal is the first obstacle you have to overcome when you decide to overcome your opioid addiction. However, withdrawal can be physically painful and emotionally daunting, so it’s always important to detox under medical supervision.
Doctors can prescribe medications like Suboxone to treat opioid withdrawal. This medication can effectively reduce withdrawal symptoms and alleviate drug cravings, but if you take it too early, severe reactions may occur. While you may be in a hurry to start taking Suboxone to get some relief, you should wait at least 12-24 hours after taking an opioid before starting the medication.
What is Suboxone and How Does it Work?
Suboxone is a brand-name prescription medication used to treat opioid dependence and addiction. It is a sublingual film that dissolves under the tongue and contains two drugs: buprenorphine and naloxone.[1]
Buprenorphine is a partial opioid agonist meaning it binds to opioid receptors and activates them, but to a lesser degree than full opioid agonists do. By binding to and activating opioid receptors, buprenorphine can relieve symptoms of opioid withdrawal.
Naloxone, on the other hand, is an opioid antagonist that is added to Suboxone to deter possible buprenorphine abuse. Naloxone doesn’t do anything unless you inject buprenorphine or take another opioid. When you try to get high by taking an opioid or try injecting your Suboxone, naloxone will prevent you from getting high and may cause withdrawal symptoms.
Suboxone may be given 12-24 hours after your last dose of opioids to help alleviate symptoms of opioid withdrawal and mitigate drug cravings. The medication is most often used during detox, but it can also be used after detox to keep cravings at bay and reduce the risk of relapse. When combined with behavioral therapy, counseling, and peer support, Suboxone can improve treatment outcomes by helping you stay sober.
How Long Should You Wait Before Taking Suboxone?
Generally, doctors and pharmacists recommend that you wait at least 12-24 hours after using opioids before starting Suboxone.[2] The exact timeline depends on what kind of opioid you were using.
Some opioids are short-acting. Short-acting opioids have short half-lives, so they don’t last very long. Examples of short-acting opioids are oxycodone (Percocet), hydrocodone (Vicodin), morphine, and heroin. You can start treating opioid withdrawal with Suboxone 12-24 hours after your last dose of a short-acting opioid.
Other opioids are long-acting. These opioids last longer and stay in the system longer than short-acting ones do. Examples of long-acting opioids are oxycodone-ER (OxyContin/MS Contin) and methadone. You should wait 36 hours after taking OxyContin and 48 hours after taking methadone to start taking Suboxone.
Some people, depending on the dose they were taking and how long they have been taking opioids, will need to wait longer than others before starting Suboxone. So how do you know when you’ve waited long enough? Well, the best way is to tell your doctor about your drug use as accurately as you can so he or she can come up with the right dosing regimen for you. Then, you must listen to your doctor, and avoid taking Suboxone until you have been directed to do so.
For a general rule of thumb, you should be experiencing mild to moderate withdrawal symptoms for at least a few hours before you can safely start taking Suboxone.
If you are detoxing at an opioid detox center, the healthcare provider may use the Clinical Opioid Withdrawal Scale (COWS) to determine when you should start taking Suboxone. The COWS looks at several factors, such as pulse rate, sweating, pupil size, body aches, runny nose, anxiety, irritability, tremors, and gastrointestinal upset, scoring these items on a scale based on severity.
When your COWS score is greater than 12 it is usually safe to start taking Suboxone.
What Happens if You Take Suboxone Too Soon After Using Opioids?
When you stop using opioids, the drugs slowly leave your body, and opioid molecules leave your opioid receptors gradually. This results in a slow onset of withdrawal symptoms that get worse as time goes on. However, if you take products containing naloxone (such as Suboxone) while opioids are still in your system, opioid molecules are immediately displaced by naloxone as it knocks opioids off of the receptors all at once. This results in a sudden onset of severe withdrawal symptoms.
If you take Suboxone too early, you could experience this sudden onset of advanced withdrawal symptoms, a condition known as precipitated withdrawal.[3] Precipitated withdrawal occurs when medications used in medication-assisted treatment (MAT), in this case, Suboxone, produce sudden and severe withdrawal symptoms.
Symptoms of precipitated withdrawal include:
- Agitation and restlessness
- Anxiety and panic attacks
- Muscle aches and pains
- Nausea and vomiting
- Diarrhea
- Dilated pupils
- Sweating and chills
- Runny nose and watery eyes
- Insomnia and difficulty sleeping
- Increased heart rate and blood pressure
- Goosebumps or “cold turkey” skin
- Cravings for opioids
- Depression and mood swings
- Fatigue and lack of energy
- Irritability and agitation
Precipitated withdrawal can vary in terms of symptom intensity and duration, but it can be very severe. Precipitated withdrawal is generally considered a medical emergency. If you think you or someone you love are experiencing precipitated withdrawal, you must seek immediate medical attention.
Coping With Opioid Withdrawal Before Starting Suboxone
Since you can’t take Suboxone immediately after the effects of opioids wear off, you may experience some withdrawal symptoms in the early stages of detox. Fortunately, there are ways you can cope with your symptoms.
- Support groups – Support groups, such as Narcotics Anonymous (NA) or SMART Recovery, offer a supportive community of individuals who have gone through similar experiences. These groups provide encouragement, understanding, and a sense of belonging.
- Lifestyle changes – Adopting a healthy lifestyle can aid in coping with withdrawal. Regular exercise, a balanced diet, adequate sleep, and stress reduction techniques like meditation or deep breathing exercises can help alleviate withdrawal symptoms and promote overall well-being.
- Distraction and relaxation techniques – Engaging in activities that divert attention away from withdrawal symptoms can be helpful during the early hours of opioid withdrawal. Examples include reading, listening to music, watching movies, practicing relaxation techniques, or engaging in hobbies.
- Self-care – Taking care of yourself during opioid withdrawal is essential. This includes staying hydrated, eating nutritious meals, and practicing good hygiene. Simple acts of self-care, such as taking warm baths or showers, can provide temporary relief from discomfort.
Never start taking Suboxone until you are directed to do so. Speak with your doctor about alternative medications to help treat your withdrawal symptoms until you can start Suboxone.
Find a Suboxone Treatment Clinic Today
If you are interested in learning more about Suboxone treatment or need to find an opioid detox center near you, please contact our team at Moving Mountains Recovery today. Our dedicated admissions counselors are available 24 hours a day to help you begin your recovery journey. Call now to get started.
References:
- National Library of Medicine: Suboxone: Rationale, Science, Misconceptions, Retrieved May 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/
- Addiction Science & Clinical Practice: Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review, Retrieved May 2023 from https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-021-00244-8
- National Library of Medicine: Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series, Retrieved May 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871399/
