Shouldn’t I feel better when I take Suboxone?
You should feel better when you take Suboxone after quitting opioids. However, when you take Suboxone for the first time, you may feel worse. Why does that happen?
Suboxone is a complicated drug. The main ingredient, buprenorphine, works in two different ways. It is a partial opioid agonist, which means it stimulates the opioid receptor. And, it is an opioid antagonist. This means that it blocks the opioid receptor.
When you start Suboxone, the fact that it is a blocker is what can cause you to have opioid withdrawal symptoms and feel worse. The secret to avoiding feeling bad from your Suboxone is to wait long enough before taking it.
How long do you have to wait to take Suboxone?
Taking Suboxone too early can make you feel sick. It is called precipitated withdrawal. Buprenorphine blocks the opioid receptors, quickly taking away any remain effect of opioids lingering in your system. The partial agonist effect of buprenorphine, the part that acts like an opioid, is not strong enough to counter this precipitated opioid withdrawal.
The typical waiting period after taking a short acting prescription opioid is usually about 18-24 hours. It could be even as little as 12 hours. The best indicator is when you start to have mild to moderate opiate withdrawal symptoms.
How long does precipitated withdrawal last from Suboxone?
If you take Suboxone, and it is too soon, you may feel worse. You might have muscle aches, pains, cramping, cold sweats. How long will it take for these symptoms to go away?
It could take hours for the effects of precipitated withdrawal to dissipate. Because Suboxone is such a long-lasting drug, it does not wear off quickly. The withdrawal symptoms will last until your body adjusts to Suboxone treatment.
Fortunately, your doctor can help you to get through precipitated withdrawal. When Suboxone makes you feel sick if you take it too soon, it is because your sympathetic nervous system is reacting. The “fight or flight” system in your body has been activated.
There are medications to overcome the withdrawal symptoms. Your doctor will likely prescribe these “comfort meds” to help you to feel better and get some rest. Sleeping through the precipitated withdrawal is a great way to wait it out until you start to feel better.
What do I do next after I took Suboxone too early?
You may have waited long enough and felt ready to take your first Suboxone and it might still make you feel worse. This is especially true if you were using heroin. These days, heroin is often contaminated with fentanyl analogs that get stuck in your fat cells, causing it to stick around for a long time.
While most opioids wear off quickly so you can start Suboxone within about a day, heroin/fentanyl can extend the waiting period to at least several days. Your doctor may recommend on of several options.
One thing that the doctor may have you do is to take a much smaller dosage of Suboxone the next time. By taking a smaller dosage, you are able to move forward with treatment with less of a chance of precipitated withdrawal. Some doctors might refer to this as “microdosing.”
Another option is to wait for a longer time period to start Suboxone. Your doctor may adjust the medications to help with opioid withdrawal and check in with you regularly to see how you are feeling. While it is no fun to have to wait an extra day or two, it will be well worth the wait.
Should I go to the methadone clinic instead?
If you are very concerned about waiting for heroin with fentanyl analogs to leave your system before starting Suboxone, going to a methadone clinic is an alternative. Unlike Suboxone, you can start methadone right away. There is no issue with precipitated withdrawal.
However, methadone is a more potent drug, so methadone maintenance clinics are highly regulated. You will have to show up to the clinic early every morning and wait in line for your daily dose.
Suboxone, on the other hand, can be prescribed weekly or even monthly. You have much more freedom with Suboxone treatment. If you work or travel, Suboxone will be the better option.
Suboxone is often the best long-term choice.
While it is possible to switch from methadone to Suboxone, it is not easy. The transition can be difficult due to the high potency and long-acting nature of methadone. If you are able to stick with the early transition from opioids to getting started Suboxone, even though it can sometimes be a bit difficult, you will be happy that you stuck with it.
Suboxone has very few, if any, side effects for most patients. In fact, many patients report that they don’t feel as if they are taking anything. Yet, they quickly return to being an earlier version of their selves from before they used drugs. Mental cloudiness clears up and energy and motivation return.
If you have been on Suboxone for a month or more, you know what I am talking about. You may feel as if you never had an addiction problem. Most people stick with Suboxone treatment for at least a year. That is about how long it takes for the brain to heal where opioid addiction fades away.
After a year, you have the choice of considering tapering your dosage and completing treatment, or continuing treatment. This is an individual decision that depends on where you are in life and how you are feeling. You will discuss this with your doctor and come to a decision about the best path to take, moving forward.