When will Suboxone be out of my system and out of my urine?
Suboxone stays in your system for about a week after the last dose, and sometimes longer. The Suboxone prescribing information gives buprenorphine, its active ingredient, a half-life of 24 to 42 hours, and a drug is not gone until about five half-lives have passed.
That is the short answer. While the number is the same for everyone, what it means depends on why you are asking, and Dr. Leeds hears this question for four different reasons.
First, you have run out of Suboxone and want to know when withdrawal will start. Second, you have an employment drug test coming and you are worried that it will show buprenorphine. Third, your family or your friends in recovery pressured you to quit, you did, and now they say you look high. Fourth, you want to switch to naltrexone and need to know when you can start.
And, a fifth question rides along with all of them. How long does Suboxone block opiates, or any other opioid? So, let’s take them one at a time.
I ran out of Suboxone. When will I start feeling sick?
Suboxone is a buprenorphine medication, with a little naloxone added, prescribed for opioid dependence and opioid addiction. Buprenorphine is a partial opioid agonist, meaning that it turns the opioid receptor on part of the way. It also holds the receptor so tightly that other opioids cannot get in.
After the last film or tablet, you may feel fine for a while. Patients have described the day after their last dose as an ordinary day, and the day after that as the start of what feels like a cold coming on.
Why the delay? The reason is the half-life. With a half-life of 24 to 42 hours, withdrawal usually begins one to two days after the last dose, and a day and a half is a common report. Some people feel it sooner, depending on their dose and their metabolism.
While buprenorphine withdrawal comes on more slowly than withdrawal from heroin or fentanyl, it does come, and it can last for weeks. If you are down to your last few films, that is the time to call your doctor, not the day after you run out.
I have to take a drug test. Will Suboxone show up in my urine?
Only if the test is looking for it, and most are not. The basic panel that most employers order checks for marijuana, cocaine, amphetamines, PCP, or phencyclidine, and opiates, and the opiate line reacts to morphine and codeine, not to buprenorphine.
Buprenorphine shows up only when someone orders the specific buprenorphine test. While treatment programs and courts order that test on purpose, most employers never do. Most drug test panels were designed to catch heroin, not a prescription with a co-pay.
What if the test does look for buprenorphine? Stopping a few days ahead will not help you. With each half-life, only half of the drug leaves, and five half-lives of 24 to 42 hours is five to nine days. Urine tests that look for buprenorphine and its metabolite, norbuprenorphine, can stay positive for a week, and in some people two.
So, the practical answer is that most tests never look, and the ones that do will find it for longer than you think. Which raises the better question. Should you be stopping at all?
Is it a good idea to stop Suboxone to pass a drug test?
No. Buprenorphine protects you against relapsing on opioids, and it lets you function at your best and stay off of the drugs that were tearing your life apart. A drug test is not a reason to give that up.
If you stop taking Suboxone suddenly, you will likely get very sick with withdrawal symptoms, unless you taper very gradually over a long period of time. And, the danger is not only the withdrawal. Tolerance fades quickly once an opioid is gone, and a relapse after a break is when a dose that used to be ordinary can stop a person’s breathing.
While an employer’s test may look for buprenorphine, a valid prescription is a valid prescription. Talk to your doctor about how to document your treatment, and talk to your doctor before you decide anything about stopping.
When and whether to come off of buprenorphine is a real question, and how long you will be taking Suboxone deserves a real answer. The week of a drug test is not the time to answer it.
You were pressured to quit Suboxone and you did. Now they say you seem high.
Unfortunately, our society sends mixed messages about treating opioid dependence with medication. There are many so-called experts who are against methadone and buprenorphine, and their argument is that you are trading one addiction for another. This is simply not true.
Physical dependence is not addiction. A person taking buprenorphine every day is physically dependent on it, the way anyone taking a daily opioid is. While that dependence is real, it is a medical condition, and when the time comes to stop, it is handled with a taper, not a lecture. Addiction is a pattern of behavior, and a person who takes a prescribed dose every morning and goes to work is not living in an addictive state.
So, what happens when you give in to the pressure and quit? Within a few days you will likely feel withdrawal symptoms. A runny nose, yawning, sweating, restlessness, poor sleep, and wide pupils look, to a worried family, exactly like drug use. It is an easy mistake to make, and it is still a mistake.
Dr. Leeds recommends that you speak with your doctor before considering stopping a prescribed medication, and that you not let anyone else decide this for you. When someone pressures you to stop a medication that is keeping you alive, they are wrong, however much they love you. Your medical treatment is between you and your doctor.
How long does Suboxone block opiates and other opioids?
This is an excellent question, and it comes with three smaller ones. Does a small dose block as well as a large one? Does the block last as long as the drug stays in the body? Does the naloxone have anything to do with it? No, no, and no.
The blocking is done by buprenorphine, not by naloxone, and how long it lasts depends on how much buprenorphine is sitting on the receptors. Opiates, the older word for morphine, codeine, and heroin, are blocked the same way as every other opioid. How long depends on the dose you take and on how many hours have passed since you took it. So, the block depends on the dose, not on the calendar.
An analogy that might help is a parking lot with a fixed number of spaces. Heroin, fentanyl, and oxycodone are cars that pull in, sit for a while, and pull out again, so the lot fills and empties several times a day. Buprenorphine pulls in, sets the parking brake, and leaves the engine idling at half speed, and while the space is taken, nothing else can park there.
While this is not a perfect analogy, it answers the question. A larger daily dose fills more of the lot, so on a full dose, another opioid has nowhere to park and does very little. On a small dose, or two days after the last dose, spaces are opening up, and the block fades well before the last of the buprenorphine has left the body.
That matters in two directions. If you need surgery, the ordinary opioid pain medications may work poorly while the lot is full. Tell the surgeon and the anesthesiologist that you take buprenorphine, and ask your buprenorphine doctor to speak with them, rather than stopping on your own. And, if someone takes a large dose of a street opioid to push past the block, that block is the only thing standing between the dose and an overdose, and it is fading by the hour.
How long does buprenorphine stay on the opioid receptors?
Longer than most opioids, and that is my working explanation for something patients describe over and over. Coming off of buprenorphine is not the crash they remember from stopping heroin or oxycodone. It is a long, gentle fade.
Buprenorphine binds to the mu-opioid receptor with a very high affinity and lets go of it slowly. While it does come off eventually, how quickly the receptors themselves are replaced by new ones is not established. In my opinion, the slow release from the receptor is the best explanation we have, and it is an observation, not a proven timeline.
Getting back to the parking lot, the buprenorphine cars do leave. They just leave slowly, one at a time, so the lot empties over days rather than hours, and the person feels the change as a slow slope rather than a cliff.
Fortunately, that is also why the end of a buprenorphine taper can be done in small steps. At low doses, each remaining car matters more, and Dr. Leeds’ tapers take smaller cuts as the dose gets lower, at the patient’s pace, with the patient deciding when the next cut comes.
What about naloxone, the other ingredient in Suboxone?
Naloxone is in Suboxone as a deterrent to injecting the medication, and for the patient who dissolves a film or tablet under the tongue as directed, it does almost nothing. Very little naloxone is absorbed that way, which is why most patients never notice it.
While almost none of it gets in under the tongue, an injection absorbs all of it at once. That can set off precipitated withdrawal, a sudden and severe withdrawal caused by knocking an opioid off of its receptors.
Yet, naloxone is a short-acting drug. The Suboxone prescribing information gives it a half-life of 2 to 12 hours, against 24 to 42 hours for buprenorphine, and as a nasal spray it is closer to two hours. So, naloxone is not much of a deterrent after all.
Still, the combination is the standard prescription. Buprenorphine without naloxone, the version once sold as Subutex, is kept for a patient who has reacted to naloxone, and some doctors still prefer it in pregnancy. The better answer to the deterrent problem turned out to be the long-acting injections, Sublocade and Brixadi, which are given in the office and cannot be taken home in a bottle.
If you are on Sublocade, the answer to this article’s title is months rather than days, and how long Sublocade stays in your system has its own page.
Isn’t naloxone the same as Narcan?
Yes. Narcan is naloxone in a nasal spray, and reversing an opioid overdose is a far better use of the drug than sitting mostly unabsorbed under someone’s tongue. It is a cornerstone of harm reduction, meaning protecting a person’s safety until they can get out of harm’s way.
In March 2023 the U.S. Food and Drug Administration, or FDA, approved Narcan 4 mg nasal spray for sale without a prescription, and it is now sold in pharmacies, grocery stores, and online. Ideally, we should all carry it, the way many of us now carry hand sanitizer. The more Narcan there is in the world, the more overdoses get reversed, and using Narcan to save lives is worth reading before you ever need it.
Yet, the short half-life that makes naloxone useless as a deterrent is a serious problem here. While Narcan wakes a person up, fentanyl and the other opioids that slow breathing can outlast a dose of it. A person who wakes up can slip back under when it wears off.
The Narcan label is plain about it. Call 911, give the spray, and if the person does not respond or starts to slip back under, give another dose in the other nostril after two to three minutes. Narcan buys time, and the ambulance brings the rest.
You want to switch from Suboxone to naltrexone. When can you start?
Naltrexone is an opioid blocker, an antagonist, meaning that it sits on the receptor without turning it on. As a daily tablet or as the monthly Vivitrol injection, it works well for some people who want to be off of opioids entirely, and naltrexone vs. Suboxone is a comparison worth reading before you decide.
The difficulty is the wait. Why wait at all? If there is even a little buprenorphine left on the receptors when the first naltrexone dose arrives, naltrexone will knock it off all at once, and the result is precipitated withdrawal. In practice, the wait is usually seven to fourteen days after the last sublingual film or tablet.
While that sounds long, the wait after Sublocade is far longer, because the depot keeps releasing buprenorphine for months. Those days in between are the risky part, and they are the reason this transition should be planned with a doctor rather than improvised. It can be done as an outpatient, by telemedicine, with a plan for each day of the gap, and it does not require a residential program.
Everyone is different, and every switch is a bit different. Your doctor can time the first dose, choose the form of naltrexone, and stay in touch through the gap, and the decision to make the switch at all stays with you.
Dr. Leeds treats opioid dependence with buprenorphine for patients in Florida.
Dr. Leeds prescribes buprenorphine, including Suboxone and ZubSolv, for patients throughout Florida, with visits by telemedicine and no group meetings. Patients set the pace, whether that means long-term maintenance, a gradual taper with smaller cuts toward the end, or a planned switch to naltrexone with the gap covered.
Anyone with questions about how long Suboxone stays in the system, about a drug test, or about coming off of buprenorphine safely can contact Dr. Leeds through the form on this website.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
About the physician
Dr. Leeds is an osteopathic physician providing concierge telemedicine care focused on medication dependence treatment and deprescribing, including buprenorphine treatment for opioid dependence. He serves on the medical advisory board of the Benzodiazepine Information Coalition and hosts The Rehab Podcast on the Mental Health News Radio Network. Medical management is available for patients in Florida.
