A Guide to Suboxone Detox for Heroin Addiction
Many heroin recovery medications must be closely monitored in order to prevent abuse. This means that recovering heroin users must either stay at an inpatient treatment facility or get their medication doses only at particular times in particular places.
For many, this limited access to the medications makes recovery difficult to stick with. Suboxone is one of the first medications to address this issue, allowing the recovering user to take vital medications at home as prescribed for outpatient use. While Suboxone isn’t for everyone, it has offered notable help for certain individuals.
What Is Suboxone Detox?
Suboxone is a brand-name medication used in Medication-Assisted Treatment (MAT) which contains buprenorphine and naloxone.1 Suboxone helps to reduce cravings by blocking the euphoric effects of heroin.2 Suboxone helps to reduce cravings by blocking the euphoric effect of heroin.2 This FDA-approved buprenorphine product is used to help with heroin detoxification and recovery from heroin addiction safely and effectively.3
Buprenorphine, the opioid in Suboxone, was developed in the 1970s as a safer pain management alternative to morphine and heroin.4 Suboxone also contains naloxone which is added to decrease the likelihood of diversion and misuse of the buprenorphine component of the product.2
How Does Suboxone Work During Detox?
Suboxone can help treatment-seeking individuals with a heroin addiction during the detoxification stage.1 Namely, Suboxone is a combination medication containing buprenorphine and naloxone, both of which have different effects that help with heroin recovery:
Buprenorphine is a partial agonist opioid medication – meaning that it partially mimics the effects of heroin by activating the same types of receptors that heroin does. But because it lacks the intense, euphoric “high” that heroin produces, buprenorphine should not be habit-forming when taken as prescribed.3 The drug also does not have many of the risky side effects that other opioid medications do.4
Naloxone is an opioid antagonist medication that works in the opposite way.2 Naloxone actually blocks opioid receptors in the brain, immediately preventing heroin from having its normal effects on the body. It is often used in emergency situations and is injected to treat heroin overdose by putting a halt to the drug’s effects.1
The purpose of combining these two drugs, known as Suboxone, is to reduce cravings (the effect of buprenorphine) without the risk of overdose or drug abuse (the effect of naloxone).
Functionally speaking, there is no difference between buprenorphine and Suboxone. The two would be interchangeable therapeutic measures as long as the heroin user in recovery is not at risk for or already abusing buprenorphine.
How Is Suboxone Taken?
Suboxone is a combination drug product that was developed to address the need for an at-home prescription recovery regimen that heroin users would use for self-treatment and have an easier time adhering to and accessing.4
- Suboxone is initially administered in the sublingual form, i.e., under the tongue – either in sublingual tablet form or as a sublingual film.5
- Suboxone used as maintenance therapy may also be administered as a buccal film that is applied to the inside of the cheek.6
- The naloxone component is intended to reverse the effects of heroin and related drugs.3 But it is this component that might precipitate immediate heroin withdrawal symptoms if users misuse Suboxone by self-injection.7 If taken orally as prescribed, however, this risk is non-existent.
- Suboxone is normally taken at higher, more frequent doses early in the stabilization process, with gradually decreasing doses as detox is accomplished and as maintenance medication treatment begins (if maintenance is needed).8
- Doctors often recommend medication maintenance therapy to help patients with a heroin addiction cope better with longer-lasting withdrawal symptoms and avoid relapse. The starting dose will vary by the individual and by the severity of heroin use. Once a person is in the maintenance phase of recovery, however, Suboxone is typically dosed as a single administration of the drug per day.9
What Are the Pros and Cons?
As with almost any therapeutic treatment, there are a number of both pros and cons to consider when evaluating with your healthcare professional whether or not Suboxone detox is right for you.
- Suboxone has demonstrated efficacy in helping people stop using heroin, as long as it is combined with behavioral therapy within a whole-person approach to treatment.1
- FDA has approved generic forms of Suboxone, increasing access to this form of treatment and making this medication more affordable.5
- Because the naloxone in Suboxone helps prevent abuse, it can be self-administered at home, which is one of the reasons why buprenorphine is co-formulated with naloxone as Suboxone.10 For this to be possible, the person would need to have a prescription.6
- Cravings are suppressed and reduced without the addictive “high” of heroin because the medication also blocks the euphoric and sedative effects of the drug.1
- Cognitive performance and decision-making are improved compared to methadone.4
- Less intense side effects are experienced compared to other heroin detox medications.4
- Improved respiratory function, compared to detox with methadone.2
- Suboxone causes fewer adverse interactions with other drugs compared to methadone, which also has more than 4 times the risk of overdose than buprenorphine.4
- Some heroin abusers may use Suboxone as a “filler” to prevent uncomfortable periods of time in between using, rather than using it to help them through recovery.6
- Suboxone has the potential for opioid-type physical dependence.6 It is worth noting, however, that the abuse potential is still lower than that of methadone.4
- Suboxone can pose potential risks for recovering heroin users who drive or operate heavy machinery.6
- Suboxone may be risky for elderly recovering users and users under the age of 16.6
- Suboxone has some serious potential side effects:5
- Respiratory problems
- Sleepiness, dizziness, or problems with coordination
- Potential for dependency
- Liver problems
- Allergic reaction
- Opioid withdrawal (shaking, sweating, fever, runny nose, watery eyes, goosebumps, diarrhea, vomiting, and muscle aches)
- Decrease in blood pressure
Who Should Consider Suboxone Detox?
Suboxone detox is recommended for treatment-seeking heroin users. The drug helps reduce cravings while at the same time blocking the euphoric, addictive effects of heroin use.1 In decreasing doses over time, Suboxone is an effective abstinence maintenance medicine.6
The maximum potential benefit of Suboxone therapy occurs in combination with counseling or therapy. Namely, persons with addiction to heroin who follow detoxification without the medication-assisted therapy have higher chances of relapsing and lower chances of overcoming addiction.11However, Suboxone treatment may not be right for everyone.
Treatment plans should be individualized, as each person can react differently to medications. The best way to find out if Suboxone is right for a treatment-seeking individual is by speaking with professionals who will assess their unique set of circumstances and needs. The professionals should also optimize treatment outcomes by devising more intensive and structured treatment.
Suboxone should be considered if:5
- At-home self-administration treatment is preferred to staying at an inpatient clinic.
- There is a concern the person may abuse other opioid replacement medications (such as methadone).
- A person has a history of relapse.
- A person’s current prescription regimen (e.g., some HIV medications) may be contraindicated for use with another type of opioid replacement medication.
- A person is open to attending counseling or therapy sessions to supplement the medication.
Suboxone should be avoided if:5
- The assessment found the person to be unwilling to bear the responsibility of dosing their own medication treatment.
- A person is allergic to buprenorphine or naloxone.
- A person is taking medicines that may have a reaction with Suboxone (their doctor must be consulted).
- A person is pregnant or plans on becoming pregnant.
- A person has breathing or lung problems.
- There is a concern that a person might use it to simply stave off withdrawal until they can get more heroin.
- A person is also struggling with alcoholism or plans to drink alcohol while taking Suboxone.
- A person has liver or kidney problems.
How Much Does It Cost?
The price of Suboxone depends on the quantity of Suboxone you buy, where you buy it, and what the dose is. Most insurance plans and Medicare will cover the drug. Price info is below. Keep in mind that Suboxone purchased on the street will probably be more expensive.
Note: Subutex, a branded form of Suboxone, is no longer available.
Generic buprenorphine/naloxone, 2mg/0.5mg15
- 10 sublingual tablets = $26-$38
- 30 sublingual tablets = $61-$86
- 90 sublingual tablets = $166-$233
Generic buprenorphine/naloxone, 8mg/2mg15
- 4 sublingual tablets = $14-$21
- 14 sublingual tablets = $43-$54
- 60 sublingual tablets = $154-$196
Frequently Asked Questions
What Is Suboxone Used For?
Suboxone is a brand name for buprenorphine/naloxone sublingual films/tablets.1 Suboxone is intended for persons dependent on opioids who have already started and are continuing medication therapy.12 Because it contains buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist, it is indicated for the maintenance treatment of opioid dependence.6
Is It OK to Cut Suboxone Film in Half?
Although suboxone film is originally not intended to be cut, physicians often prescribe film fractions for treatment and tapering.13 In fact, the cuttability and the option to cut the film into smaller dosage sizes for easier dosage titration is considered to be one of the key advantages of suboxone, as long as the decision to alter dosage was reached upon consulting with a medical professional.14
How Many Suboxone Can You Take a Day?
The normal dosing regimen for sublingual film Suboxone or generic equivalent is once daily, although an alternative regimen may be prescribed.9 The recommended target dosage for maintenance is 16/4 mg.5 However, in the event a person has, for instance, been prescribed concomitant therapy which involves CNS depressants and Suboxone sublingual film, their physician may consider dose reduction.6
As far as Suboxone treatment goes, other important considerations include:
- Starting an adequate treatment dose should be achieved as rapidly as possible.5 Namely, according to some studies, a gradual induction spanning several days was counterproductive and led to a high drop-out rate during the induction period.5
- There must be no opioids left in the body before beginning this treatment: different rules apply when initiating treatment and during withdrawal on discontinuation.11
- Therapy must be supervised and discontinued as part of a comprehensive treatment plan to lower the risk of relapse to illicit drug use and improve the odds of lasting rehabilitation.6
- To diminish the risk of suboxone diversion and abuse, the prescription quantity for unsupervised administration must be strictly determined and controlled. This should be done in accordance with the patient’s current level of stability, the security of their living situation, and other factors that may have a negative effect on their ability to manage supplies of take-home medication.6
How Long After Heroin Can You Take Suboxone?
Persons with a physical dependence on heroin, a full opioid agonist, are at a high risk of experiencing intense opioid withdrawal symptoms in the following cases:6
- Parenteral misuse of Suboxone
- Sublingual administration before the agonist effects of other opioids have subsided
It is therefore important that treatment is initiated once objective signs of moderate opioid withdrawal appear. This typically happens no less than six hours after the person last used heroin or another opioid.5
What Happens If You Take Suboxone Too Soon After Quitting Heroin?
When misused by persons with heroin dependence or used too soon after the last use, suboxone sublingual film or tablet may produce opioid withdrawal signs and symptoms. This happens because it contains both naloxone and buprenorphine. Buprenorphine has partial agonist properties and may precipitate withdrawal signs and symptoms in such persons. This is why Suboxone should only be administered after the agonist effects of the opioid have subsided.5
- Substance Abuse and Mental Health Services Administration. (2020). MAT Medications, Counseling, and Related Conditions.
- Substance Abuse and Mental Health Services Administration. (2016). Naloxone.
- Substance Abuse and Mental Health Services Administration. (2016). Buprenorphine.
- Jennifer R. Velander Ochsner J. (2018). Suboxone: Rationale, Science, Misconceptions.
- Food and Drug Administration. (2018). Highlights of Prescribing Information for Suboxone Sublingual Film.
- Food and Drug Administration. (2017). Highlights of Prescribing Information for Suboxone Sublingual Tablets.
- National Institute on Drug Abuse. (2018). What are the treatments for heroin addiction.
- Walter Ling, Maureen Hillhouse, Catherine Domier, Geetha Doraimani, Jeremy Hunter, Christie Thomas, Jessica Jenkins, Albert Hasson, Jeffrey Annon, Andrew Saxon, Jeffrey Selzer, Joshua Boverman, and Richard Bilangi. (2009). Buprenorphine tapering schedule and illicit opioid use.
- Substance Abuse and Mental Health Services Administration. (2020). Tip 63: Medications for Opioid Use Disorder – Executive Summary.
- McCance-Katz EF, Sullivan, L, Nallani S. (2010). Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict.
- National Institute on Drug Abuse. (2017). Opioid treatment drugs have similar outcomes once patients initiate treatment.
- Substance Abuse and Mental Health Services Administration. (2015). Tip 45: Detoxification and Substance Abuse Treatment.
- Reindel KL, DeAngelis MJ, Ferrara AS, Conn KM, Phillips EM, Corigliano AT, Zhao F. Int J Pharm Compd. (2019). An Exploratory Study of Suboxone (Buprenorphine/Naloxone) Film Splitting: Cutting Methods, Content Uniformity, and Stability.
- PBM (2014). Buprenorphine / Naloxone Buccal Film (BUNAVAIL) C-III National PBM Abbreviated Drug Review.
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