Is Suboxone for benzodiazepine withdrawal safe?

Suboxone is a brand-name medication that has in it both buprenorphine and naloxone. The drug is used as part of medication assisted treatment to treat opioid withdrawal symptoms and opioid addiction.

Benzodiazepine dependence is not an addiction problem. Benzo dependence is a physical dependence condition, making it difficult to quit benzos, due to benzo withdrawal symptoms.

Benzodiazepines include drugs such as Xanax, Valium, Ativan, Klonopin, and many others. These drugs are not opioids. They are not at all related to opiate or opioid drugs.

So, why would anyone suggest using Suboxone, a drug intended to treat opioid addiction, as a treatment for benzodiazepine withdrawal? How does it make sense to use a drug meant for opioid use disorder treatment to ease severe withdrawal symptoms caused by quitting a benzo?

Are there any concerns about using Suboxone to treat protracted withdrawal from benzodiazepines? Could buprenorphine treatment for severe withdrawal from a benzo cause more problems?

What are the major concerns about using Suboxone treatment for benzodiazepine withdrawal?

First, buprenorphine, the main active ingredient in Suboxone, is an opioid. To be exact, buprenorphine is a mixed partial agonist and antagonist of the opioid receptors.

What does this mean? Buprenorphine blocks the receptor, and it partially activates it at the same time. This mechanism is unique, and different from other opioids.

While buprenorphine is unlike other, more dangerous opioids, with fewer side effects and risks, it is still a member of the opioid family. All opioids are under regulatory scrutiny with concern over the potential for dependence, addiction, and abuse.

A person suffering from benzodiazepine withdrawal symptoms is a victim of iatrogenic injury. A medication prescribed by a healthcare professional has led to drug dependence, which has led to painful and unpleasant physical withdrawal symptoms.

There is a high risk of developing buprenorphine dependence if a person takes Suboxone long-term. Benzo patients will likely not be happy about the idea of developing a new drug dependence while they are trying to overcome benzo dependence.

Additionally, buprenorphine has a long list of potential side effects, such as respiratory depression, constipation, difficulty urinating, ankle swelling, insomnia, excessive sweating, headaches, and more. Benzo withdrawal patients tend to be sensitive to the effects of medications, and there may be an increased risk of suffering from uncommon Suboxone side effects.

Can Suboxone be taken by a patient who is opioid naive?

What does opioid naive mean? A person who is opioid naive has not taken opioids at all, or they have only taken low doses for short periods in the distant past. An opioid naive person has little or no tolerance to opioid drugs.

Buprenorphine is typically only given to patients who have at least some tolerance to opioids. There is a higher risk of side effects when giving Suboxone, or other buprenorphine drugs, to an opioid naive patient.

While there is a somewhat higher risk of side effects and adverse reactions when giving Suboxone to a patient who has not taken opioids, it is possible to proceed cautiously, at a low dosage.

Suboxone is available in a 2 mg and 8 mg film or tablet. For an opioid naive patient, even the 2 mg dose is likely too high.

If a doctor were to consider prescribing Suboxone to an opioid naive patient, they should start as low as possible. They could instruct the patient to take a small fraction of the Suboxone strip, or they could order a buprenorphine compound from a compounding pharmacy with a customized low dosage.

What benefit would Suboxone provide to a patient who is in severe protracted withdrawal caused by benzodiazepines?

Benzo withdrawal can cause a wide variety of unpleasant symptoms. There is benzo belly, dizziness, ringing in the ears, anxiety, depression, irritability, akathisia, and pain.

Benzo withdrawal patients often complain of headache pain, abdominal pain, and pelvic pain. Additionally, patients with akathisia, a movement disorder where they feel compelled to stand up and walk, describe having an internal pain that is so bad, they want to tear off their skin and claw their way out of it.

When a benzo withdrawal patient presents to the ER with the worst pain they have ever experienced in their life, and the pain is ongoing, persistent, and intractable, what does the emergency physician do? Often, they do nothing.

When scans come out negative, the ER doctor might assume the patient is malingering, hysterical, or otherwise exaggerating and overreporting pain levels. The fact is that benzo withdrawal can cause severe pain that is unimaginable to people who have not experienced it. Yet, the ER doctor does nothing to help relieve the pain.

Besides being an excellent treatment for opioid dependence and opioid addiction, Suboxone happens to be a highly effective pain reliever as well. Patients who take buprenorphine for opioid use disorder often report that it helps to make their chronic pain issues more tolerable.

With buprenorphine being one of the safest opioids, and being effective in treating pain, why not consider using it to treat protracted benzo withdrawal pain? If a person has suffered with pain for so long, they are having suicidal thoughts, why not treat their pain with an effective pain medication?

Are there any other Suboxone benefits besides the effects of opioid pain relief?

Suboxone contains the opioid, buprenorphine, which helps to relieve pain. Yet, it has additional effects that may be beneficial.

Buprenorphine has been studied and found to have anxiolytic effects and antidepressant effects. At least some of this effect is believed to be due to buprenorphine blocking the kappa opioid receptors.

Additionally, there is another aspect of opioid receptor blocking to consider. Suboxone contains naloxone, a short-acting, potent opioid receptor blocker.

The purpose of naloxone is to be an abuse-deterrent. When a drug abuser attempts to shoot Suboxone directly into their vein, they will get sick with precipitated withdrawal, caused by naloxone.

Interestingly, very small amounts of naloxone are absorbed when a patient takes Suboxone as directed. While naloxone does not cause sickness when the patient takes Suboxone as directed, they do get some naloxone absorbed.

The small amount of naloxone introduced to the system is reminiscent of something called ultra-low dose naltrexone therapy. Naltrexone is an opioid blocker, like naloxone, and it can be given in small amounts as a treatment for various autoimmune-related pain syndromes.

Should the risk of Suboxone dependence stop doctors from considering Suboxone as a benzo withdrawal treatment?

As with any medical therapy, it is important to weigh risks versus benefits, and also to consider alternatives. If the doctor decides that the treatment is worth the risk, they must explain all aspects of risks, benefits, and alternatives with the patient. This is known as informed consent.

If the patient is experiencing severe protracted withdrawal from quitting benzos, the benefit of treating their pain with an effective analgesic may outweigh the risk of becoming opioid dependent. As difficult as it can be to overcome opioid dependence, it is considered by many to not be nearly as bad as benzo withdrawal.

When pain is so bad that a person cannot function, they have a right to medical assistance in relieving that pain. For severe, intractable pain, opioids are often the best choice for pain relief.

Other medications that interact with various neurotransmitter receptors, including serotonin, dopamine, norepinephrine, and the GABA receptor, can cause a worsening of symptoms for a patient in benzo withdrawal. The choice of a medication to relieve pain must be made carefully.

When choosing an opioid, the doctor should consider the risks of various opioids. Most opioids quickly induce tolerance, so the patient must take more of the medication to achieve the same level of pain relief.

Buprenorphine is unique in many respects compared to other opioids. One unique feature is that buprenorphine is less likely to cause opioid tolerance. Patients are more likely to continue to get pain relief at a low dose without having to constantly up the dose.

While Suboxone dependence is a concern when prescribing Suboxone, the doctor, and the patient, may arrive at the conclusion that the risk of dependence is acceptable. If the patient only takes Suboxone for up to a few weeks, they will likely not become dependent.

Yet, if the patient takes it for longer, it may be worth the risk of developing dependence. When the time is right, the patient can taper off Suboxone. Suboxone tapering may involve opioid withdrawal symptoms, but the symptoms are thought to be far more tolerable than benzo withdrawal symptoms.

Can any Suboxone doctor prescribe Suboxone for benzo withdrawal?

Suboxone doctors are often seen as one-trick-ponies who do little more than fire off Suboxone prescriptions to opioid-addicted patients. While this characterization is unfair to many addiction treatment doctors, it may be true for some.

There are more Suboxone doctors, and Suboxone nurse-practitioners, than ever before. New online Suboxone telemedicine companies offering Subox treatment pop up on Google all the time.

Yet, many of these doctors will likely be uncomfortable with the idea of prescribing Suboxone off-label for benzo withdrawal pain. It is outside their comfort zone and the parameters that their company has allowed them to work within.

Ideally, if a patient, or loved one of a patient, is interested in learning more about this treatment, they should seek out a doctor with experience in both treating opioid addiction and benzodiazepine physical dependence.

The doctor should be familiar with the unique functioning of sublingual buprenorphine, and how to prescribe it at low dosages to a patient who may be opioid naive. They should also have experience in tapering patients off benzodiazepines and helping their patients through protracted withdrawal.

Additionally, the decision to use Suboxone in this regard must be considered carefully, looking first at all other options. The patient and family members authorized to be involved in their medical care must be provided with thorough informed consent.