starting suboxone

What is Suboxone?

Suboxone is a brand name medication that contains buprenorphine and naloxone. Buprenorphine works as a partial agonist on the opioid receptor while also working as a blocker at the same time. This means that opiates, such as heroin, will not be able to stimulate the receptors blocked by Suboxone. The naloxone is an abuse deterrent. It is inactive when you take your Suboxone as directed.

What about other buprenorphine medications?

Since Suboxone treatment has been around for so long, it has become a household name. So, when I refer to Suboxone, I am talking about a class of medications for addiction treatment that include buprenorphine. Brand names include Subutex, Suboxone and ZubSolv. If you take one of these meds for opioid addiction, you place each dose under your tongue to dissolve on a daily basis. Starting Suboxone requires a brief waiting period between your last opioid use and your first Suboxone dose. 

What kind of doctor can prescribe Suboxone?

Any doctor who has met certain requirements can prescribe Suboxone. The doctor does not have to specialize in a particular area. Even your family doctor or primary care physician can prescribe Suboxone if they get certified. This means that a Suboxone treatment program can be a part of your regular doctor’s medical practice. More doctors are getting certified all the time. 

Should I start Suboxone?

The answer to this question depends on your particular situation. If you have experienced an opiate overdose or if you believe that your are addicted to an opiate or opioid, such as heroin or pain pills, you may want to consider a buprenorphine treatment program. Even the painkiller, percocet can be highly dangerous if you are misusing it. Medication-assisted treatment for opioid addiction has a high success rate. Craving suppression and preventing withdrawal symptoms are two major benefits of buprenorphine treatment that help to support long-term recovery and prevent relapse.

Why do I have to wait to get started?

If you are taking opioids and then you take Suboxone right away, you will get sick with withdrawal symptoms. When a person takes Suboxone too soon after taking an opiate or opioid and they get withdrawal sickness, it is called “precipitated withdrawal”. Before you start treatment you have to wait a while. This waiting period can take up to 24 hours for most short-acting opiates and opioids. If you are taking a long-acting opioid, the waiting time can be a bit longer. And, if you are trying to quit Methadone, you will have to wait for at least 36 hours. During this waiting time, you will start to feel opioid withdrawal symptoms.

Waiting for withdrawal.

You will likely be ready to start Suboxone when you have moderate withdrawal symptoms. For example, when your pupils dilate, you have nausea, muscle aches, chills and other symptoms of withdrawal, you may be ready for the induction phase. This is when you are given the first sublingual dose of buprenorphine. If you experience side effects, you should let your doctor know right away. After the induction phase, you will be monitored closely and eventually enter the maintenance phase.

Why do I have to wait?

Even though you are not taking opioids anymore, they stay in your system for a while. You may not feel the effects anymore, but it takes time for your body to eliminate them fully. If you are starting buprenorphine and enough opioid remains in your system, the two medications compete for the mu receptor. This causes a sudden onset of withdrawal symptoms. While usually not dangerous, it is unpleasant.

How do I know when I am ready for starting Suboxone?

Here is an excellent reference to help you to assess your level of readiness. Click or tap here to read the document. This reference is provided by The National Alliance of Advocates for Buprenorphine Treatment. The second page has a flowsheet where you can track your progress based on your withdrawal symptoms after quitting opioids. This document is based on the Clinical Opiate Withdrawal Scale.

What is a good Suboxone starting dose?

This will vary from one patient to another. Deciding on the milligram dosage to start a patient on is based on many factors. Were you using heroin? Painkillers? Percocet? Hydrocodone? Fentanyl? How much were you using daily? How long were you using opiates? How did you use them? swallowing, snorting, injecting? The doctor will take many factors into account to calculate an appropriate starting dose.

How do I get through the waiting period?

I realize that you may be struggling to not use more opioids. Addiction is a difficult thing to overcome. You are going to have to make an effort to wait out the hours it will take until you are ready for Suboxone. If you cannot make it for about 18-24 hours, you might want to consider Methadone as an alternative. However, if you go that route, you will have to go to a maintenance clinic every morning for treatment.

This may help you.

If the waiting period is difficult, you may find that recovery literature and recordings will motivate you. Here is one of my favorites. I hope that you find it helpful. Click or tap here for the audio page. It is one of the great convention speakers from NA. I also recommend getting the NA basic text, which you can get on Amazon or Apple iBooks.

Making an appointment.

If you are ready to get started now and quit heroin or painkillers, such as percocet or hydrocodone, simply call or send us a message to schedule an appointment. Dr. Leeds would be happy to sit down with you to discuss opioid addiction with you and how medication assisted treatment can help. Click here to contact Dr. Leeds to get started.