How can I quit Suboxone without feeling sick from opioid withdrawal symptoms? Is a Suboxone taper the best solution?

Suboxone is a treatment drug used to help people beat opiate addiction. The main ingredient in the Suboxone film is buprenorphine.

The Suboxone withdrawal timeline depends on a variety of factors, including the current dosage and the amount of time since quitting opioids.

Overcoming Suboxone withdrawal is possible with a gradual drug taper. Regarding a Suboxone taper vs a benzo taper, which is more difficult?

As difficult as it can be to quit buprenorphine, it is significantly easier than quitting benzodiazepines. Fortunately, many patients are able to quit Suboxone after long-term treatment without post acute withdrawal syndrome issues.

How long does it take to taper off of Suboxone? The time to taper depends on the patient.

Some people are able to tolerate a faster taper, and others taper more gradually. The tapering process should always be patient directed.

Buprenorphine is an opioid drug. Unlike other opioid agonist drugs, buprenorphine is a partial agonist, and a full antagonist.

This means that the drug partially activates the opioid receptor and simultaneously blocks the receptor. Buprenorphine also has a higher binding affinity, so it stays on the receptor longer than other opioid drugs.

Suboxone is given in treatment programs as part of a medical detox for opiate addiction treatment. The current recommendation from addiction medicine doctors is to stay on maintenance treatment for at least one year.

Suboxone treatment helps to prevent opioid cravings and withdrawal. However, when the patient starts to cut back on their dosage, or tries quitting Suboxone, they quickly go into Suboxone withdrawal.

What are Suboxone withdrawal symptoms like?

The symptoms of buprenorphine withdrawal are similar to the physical withdrawal from other opioid and opiate drugs. There is anxiety, depression, chills, aches, insomnia, restless leg syndrome, and more.

In fact, during Suboxone detox, some patients have described the withdrawal as being worse than heroin withdrawal, fentanyl withdrawal, or oxycodone withdrawal. Some patients who take Suboxone long-term to treat opioid addiction say that they wish they never got started.

When the issue of Suboxone physical dependence arises, these patients complain that they would have been better off suffering through cold turkey heroin detox or fentanyl detox. Like ripping off a bandage, they reason, suffering the pain of a quick removal is better than doing it slowly.

Yet, with drug dependence, the analogy of ripping off the bandage quickly does not hold. There are certain drugs that cause a physical dependence in the central nervous system, and removing the drug quickly can have lasting consequences.

In the case of opioid dependence, quitting a drug such as heroin or fentanyl cold turkey can result in long-term powerful cravings. These cravings often lead to relapse.

Why is a drug taper necessary for drugs that cause physical dependence?

When the brain has developed a dependence on a drug, a gradual reduction is the best option. In the case of opioids, Suboxone makes the gradual opioid taper possible.

Buprenorphine removes addictive thinking from the equation. During medical Suboxone use, most patients report that they no longer have opioid obsessions during therapy.

Medication-assisted treatment helps to prevent both psychological withdrawal symptoms and physical withdrawal symptoms. During the initial year of treatment, the patient is able to gradually reduce their Suboxone dosage.

And, during this first year, the brain is able to heal from opioid use disorder. Addictive thinking goes away as brain pathways heal. The drug addiction goes into remission.

Some patients worry about Suboxone addiction. What they should be more concerned about is Suboxone physical dependence. A gradual taper from Suboxone helps to overcome the dependence and withdrawal issue.

Did Suboxone cause a new opioid dependence problem?

There is an analogy that helps to understand the opioid dependence issue before and during Suboxone therapy. Imagine going to the top of a tall building that has no stairs and only an up elevator.

When you arrive at the top of the building, there is no way to get down safely. Think of the height of the building as being the level of physical dependence on opioids.

One solution is to jump off the building. Unfortunately, landing is hard, and most jumpers regret taking the leap.

A better solution is to take a more gradual safer way to the ground. Now, imagine that the fire department arrives, but the only way they have to lower you is a long ramp.

As you slowly walk along the ramp, gradually getting closer to the ground, you may forget about your trip up the elevator to the top of the building. You start to blame the ramp for your issue with being so high up from the ground.

Yet, the ramp did not get you where you are, it was the trip to the top of the building. The ramp is simply the safest and least painful way to get down.

What are the risks of getting off Suboxone without medical supervision?

While getting off of Suboxone should always be done under medical supervision, there are people who quit on their own. The risk depends on how long the patient was in treatment and the therapy they received.

Unfortunately, there are many people and institutions that encourage people to quit their Suboxone against medical advice. For example, Narcotics Anonymous is against Suboxone treatment.

The NA program has no official position on any other form of medical treatment. However, regarding Suboxone, they have no qualms about telling their members that they are going down the wrong path.

It is hard to say how much damage NA and other programs have caused by encouraging people to quit medical treatment prematurely. When a person quits Suboxone too soon, they often suffer drug cravings and other psychological symptoms that can lead them back to opioids and substance abuse.

On the other hand, there are people who have taken Suboxone for over a year, and they feel it is time to stop. If a person follows a reasonable gradual taper plan, reducing their Suboxone dose slowly, they may be able to quit Suboxone without continuing doctor visits.

Is Suboxone addiction and Suboxone abuse a problem?

It is critically important to differentiate between addiction and physical withdrawal. Addiction is a psychological dependence issue that is characterized by cravings, compulsions, continued use in spite of harm, and it is a chronic issue.

On the other hand, physical dependence means that when a person quits a drug cold turkey or reduces the dosage too quickly, they suffer from physical symptoms. Some drugs cause both addiction and physical dependence. others cause only one or the other.

For example, cocaine is a drug that mainly causes only addiction, not physical dependence. Benzodiazepines cause physical dependence in the central nervous system, but generally they do not cause addiction.

Opioids and alcohol share the properties of causing both addiction and physical dependence. Quitting either an opioid drug or alcohol can result in severe withdrawal symptoms.

Unfortunately, many people, including doctors, get confused about the difference. They may mistake buprenorphine dependence for buprenorphine addiction.

As a result, there have been people sent off to Suboxone addiction treatment or a Suboxone detox center, when what they really needed was a supervised gradual taper. This also occurs with benzodiazepine dependence.

Sending a person to rehab for drug dependence, when there is no addictive component is often the wrong decision. Rehabs can make the situation worse in many cases.

Can kratom be used for Suboxone withdrawal symptoms and Suboxone tapering?

This issue must be addressed, because kratom is a legal herbal supplement that is available in the US without a doctor’s order or prescription. Kratom is a plant-based substance that has opioid-like properties.

Kratom has been used to treat chronic pain syndromes. It is also used by some people to treat opioid addiction.

Unfortunately, kratom does not have the same solid track record as Suboxone. The supplement industry is largely unregulated, so there is great variation in the quality and potency of kratom preparations.

The greatest danger of using kratom for treating opioid addiction, or Suboxone dependence, is that it can stimulate opioid cravings. Many people have switched from Suboxone to kratom in early addiction treatment, and then relapsed on heroin or fentanyl.

Hence, the results of using kratom for opioid addiction treatment can be deadly. We understand very well how buprenorphine works at the opioid receptor level, and kratom does not share the same beneficial receptor activity.

The blocking, or antagonist activity, of buprenorphine, as well as the receptor affinity make a big difference. Kratom tends to work at the opioid receptor similarly to short acting opioids than can stimulate cravings for a more potent opiate drug.

If I go for heroin addiction treatment, should I worry when they recommend long-term Suboxone treatment?

Going on Suboxone is not trading one addiction for another. Technically, it is trading one opioid for another, but the differences between buprenorphine and opioids of abuse are significant.

Medication assisted treatment with buprenorphine is currently the gold standard for treating opioid addiction. Long-term treatment is recommended over short-term opioid detox.

There has been a fear for many years of Suboxone clinics fueling the next wave of pill mills. Will rogue doctors prescribing buprenorphine/naloxone cause a new opioid epidemic?

It is critical that we understand that the opioid epidemic is fueled by opioids that are short acting, and have a low affinity for the opioid receptor.

Morphine, oxycodone, heroin, fentanyl, dilaudid, and many other opioids have a low receptor affinity, so they bounce on and off the receptor quickly. This activity leads to addiction and dependence within a short time.

Yes, buprenorphine is an opioid. Yet, it is a very different kind of opioid with a high receptor affinity. Because of the way the buprenorphine in Suboxone works, it treats opioid addiction, it does not cause opioid addiction.

When Suboxone therapy has been completed to the satisfaction of the doctor, psychotherapist, and the patient, then a tapering plan may be used to quit Suboxone. Suboxone treatment should be long-term to fully treat opioid addiction, but it does not have to be life-long for most patients.