Suboxone: An Exit Strategy

Health Professional

Getting off of pain medications usually requires an exit strategy. Anyone who has tried to abruptly discontinue a regularly used opioid (a pain medication which is chemically similar to opium that binds to opioid receptors in the body) can attest to the severe discomfort of withdrawal syndrome. The symptoms of withdrawal include: nausea, vomiting, aches, sweating, diarrhea, yawning, insomnia, irritability and gooseflesh. These symptoms indicate that the body is physically dependent on the chemical. Chemical dependency is difficult to overcome without a good strategy. That strategy should reduce the occurrence of withdrawal syndrome, the risk of relapse, and the risk of toxicity. Suboxone can help someone get off pain medications because it reduces withdrawal symptoms, cravings, and the risk of overdose.

Because Suboxone contains buprenorphine (an opioid), it serves as a substitute for other opioids and satisfies the body's need for the chemical. One advantage in converting from one opioid to buprenorphine is the fact that buprenorphine is less likely to cause severe, frequent withdrawal symptoms. Buprenorphine hangs around in the body for longer periods of time; thus, eliminating the need to take pills all the time. Usually, Suboxone is taken once per day once a person is on a stable dose. If a person were to suddenly stop taking Suboxone, the withdrawal symptoms  would be less severe than from coming off  heroin and a shorter duration than from coming off methadone. The chemical stability of buprenorphine provides for a softer landing with less severe withdrawal symptoms. And a soft landing improves the chances of successfully getting off pain medications.

Breaking free from chemical dependency is often difficult because the cravings lead to relapse (returning to chemical use). When using Suboxone properly, a person is unlikely to have a craving for other opioids because the "mailbox is full". All of the opioid receptors (mailboxes) become blocked by buprenorphine. With buprenorphine, other opioids have no effect on the body and the body has no need for other opioids. However because buprenorphine has a unique relationship with the "mailbox", a person converting to Suboxone has to be in some mild withdrawals before initiating the first dose of Suboxone. If one were to take Suboxone prematurely without being off of opioids for 24 to 72 hours, withdrawal symptoms would be precipitated. In other words, Suboxone can cause withdrawal symptoms by being a "bully" that kicks everything out of the "mailbox". Once on a stable dose, the physical risk of relapse is minimized. But, the psychological risk of relapse still needs to be addressed with a counseling program. With Suboxone and counseling, chemical dependency can be a thing of the past.

Suboxone's biggest advantage is the fact that it blocks itself from causing an overdose. Technically, this effect is called a "ceiling effect". By itself, high doses of buprenorphine should not produce respiratory depression. However, if buprenorphine is combined with other sedating drugs like benzodiazepines (an example is Valium), severe reactions can occur, including death. When used properly, under the guidance of a certified doctor (only a few doctors can prescribe Suboxone), Suboxone is a safe exit strategy from opioid physical dependency.

Whatever the reason for wanting to get off of pain medications, a well thought out plan is important for success. Doing it alone is risky, uncomfortable, and often ineffective. Help is available in many places. Here are a few examples: ,, Suboxone treatment is just one type of treatment for opioid dependency. Other methods exist because Suboxone is not appropriate for everyone. The most important issue is to find help when the medications cause life to spin out of control.