Withdrawal from Suboxone

I often receive e-mails asking for advice on tapering Suboxone, or asking how long Suboxone withdrawal should last.  People who read my blog know my approach to stopping Suboxone; I see it as an exercise in futility even in the rare cases where the person is successful, because of a relapse rate that verges on 100%.

A couple myths to get out of the way… there is NO evidence that withdrawal becomes more difficult the longer a person is on buprenorphine.  In fact, from my experience the opposite is true.  The feelings and emotions during withdrawal are aggravated by the guilt and shame of active using, and the further from active using a person gets, the less the suffering during withdrawal—and the better able the person is to keep some perspective on what is happening, rather than drowning in despair.  I believe that the severity of withdrawal is subject to a ‘kindling effect’, a phenomenon that affects seizure disorders and other neural activity as well.  In other words, the pathways of the brain that are used the most frequently are the pathways that are most likely to fire again.  So a person who has been through very severe withdrawal is likely to experience withdrawal as very severe, no matter what agent the person is stopping.  It would make sense that the more time that goes by in between episodes of withdrawal, the less powerful would be the kindling effect—sort of like ruts in a muddy road being erased by repeated cycles of weather over time.

Many people write on blogs or forums that Suboxone withdrawal is worse than coming off opioid agonists.  This is simply ‘poppycock!’  I have seen many, many people go through opioid withdrawal, and have experienced it myself (gratefully, many years ago!).  People going through withdrawal from agonists are very miserable; they tend to stay in bed, getting up only to race to the bathroom because of severe diarrhea.  Their legs shake involuntarily—a very uncomfortable experience that is similar to severe ‘restless legs.’  The mental effects are perhaps the worst; most people have severe depression and thoughts of suicide.  Eventually, when the person attempts to get out of bed, he/she faces weeks of profound fatigue and weakness.  During my own detox ten years ago I remember my family visiting after a week or two, and being able to walk about half a block before needing to sit and catch my breath.  Appetite is gone for weeks as well, and most people lose significant weight during detox.

Withdrawal from buprenorphine, on the other hand, rarely forces addicts into bed for more than a day or two.  I’m not saying that they don’t FEEL like staying in bed, but they will still usually get to work and engage in the activities of daily living—eating, showering, getting dressed, etc.  A simple look at the forums shows a profound difference between Suboxone and agonist withdrawal; people coming off Suboxone write about how bad they are feeling, whereas people coming off agonists are nowhere to be found— and are certainly not able to sit at the computer and type!

There are two basic approaches to stopping Suboxone.  One is to taper slowly, and the other is to just ‘jump’ and handle the withdrawal as best as possible, sometimes with the help of clonidine, benzos, or other substances.  Some people find that THC helps, but I can’t really recommend that approach—at least not in states where there are no laws allowing the use of ‘medical marijuana.’  There are a couple taper methods described here and there on the web; I described something called the ‘liquid taper method’ on the forum that uses tiny doses of dissolved buprenorphine, administered by an eye dropper.  As I mentioned in an earlier post there is a new transdermal buprenorphine system hitting the market soon, and that should make things considerably easier.  The main problem with any taper is that the person usually gets to a certain point and then realizes that a full dose would cause a ‘buzz’—and that buzz is almost impossible to say ‘no’ to, especially after being in minor withdrawal for several days or weeks!  The transdermal approach is appealing because it would allow the person to get rid of all tablets that could be used to bail out of the taper.  I can’t imagine that there is much chance of success if the person has 8 mg of tablets stashed away in the house somewhere!

Because of the tendency to bail out of a taper, most people who start out tapering end up ‘jumping’ at some point—raising the question of whether people should just jump from the start, planning to be miserable for a good few weeks, and then just tolerating it.  For those taking that approach, the main thing is to STICK WITH IT.  In order for your receptors to return to normal, you MUST be miserable— that misery is what causes the neurons to manufacture new receptors.  If you take a break from the misery by using for a day, you turn off the forces that are moving you toward feeling better, delaying the process by days to weeks.  To be direct, the quickest way to stop Suboxone and get back to zero opioid tolerance is to avoid opioids completely until you feel better.

Again, in my opinion, all of this is folly because the chance of staying clean is low. At minimum, a person must be completely free of any contacts who are using or who have access to opioids.  The person should be actively involved in some time of recovery program.  The person should have someone in his or her life who can act as a ‘reality check’ to speak up if the person starts to harbor resentments, or if the ego begins to grow out of control.  If you don’t have these things at a minimum, consider just sticking on buprenorphine.  You will save yourself a great deal of money, time, embarrassment, and who knows what else.

If you do stop buprenorphine, expect withdrawal to peak at about 4-7 days after you finally discontinue taking Suboxone, followed by slow recovery that accelerates each week.  By four weeks, you will be done with the creepy crawly legs, and your energy will be starting to return.  By two months, your sleep should be coming back—unless you are also stuck on benzos, which make sleep a big problem if you use them for more than very short-term.

By three months, you should be back to normal—assuming that you did not use opioids at all.  And you will recover fastest if you get some exercise, eat right, and stay as active as possible, even when you don’t feel like it!

18 thoughts on “Withdrawal from Suboxone”

  1. At this time, I don’t understand anyone encouraging getting off Suboxone. My son has recently tapered down to 8mg to relieve some side effects of the higher dose (constipation was a terrible problem), but I think he will stay at this dose indefinitely. What is the big rush, and why take such a dangerous chance? The doctors who are insisting that patients taper need to read up on the latest Suboxone news and get with the program (I have had several tell me that my son needs to get off “that drug”). Perhaps in a few years there will be something new that will help addicts w/ the cravings, but for now “better safe than sorry”.

  2. This is in reference to Thankful Mom stating that she is at ease with her son staying on Suboxen indefinitly. It is a addictive drug that will not go away. He may be fine on that dose at this time but you do not know what tomorrow brings. He may need more for whatever reason it is and it just does not stop. It will not go away until he completely goes off the drug. It is a horrible subsitute for Opiates. My daughter got on Suboxen as a relief for the withdrawls from Opiates. It was just the same and now needs to be dealt with. She kept trying to taper down but never could do it. She found them when she needed them. It is a addiction that needs to be dealt with with anyone on Suboxen.
    She daily dealt with the guilt of not being able to deal with her day with out her fix. Taking Suboxen is not going to go away or get better on any size dose. It is living a addictive life or not. It needs to be dealt with.

  3. There are so many inaccuracies in this message that I don’t know if I should even allow it. I encourage ‘choices’ to keep learning about addiction– which is an obsession to take a substance, not physical dependence on a substance. People who need medication to keep their coronary arteries free of plaque are just as dependent on THEIR medications– even more so. And people who stop antihypertensive medication are subject to rebound hypertension, and must taper off slowly– although they are generally smart enough to stay on medication that is helping them survive, and probably don’t have an annoying person called ‘choices’ trying to tell them to stop taking it!

    Your daughter should not be ‘tapering down’, for the reasons I’ve written about numerous times– the same reasons quoted in the numerous studies that show that opioid dependence is a lifelong illness. I feel bad for her, that her mom wants her to go through life untreated for her illness, placing her at risk of relapse and death. All I can say about your daugher, ‘Choices’, is that I hope that she discovers sooner rather than later that her mother is useless in her fight against dying from opioid dependence; the sooner she cuts her mother out of her medical decisions the better– even if that means cutting mom out of her life completely. I’ve seen mothers like ‘choices’ literally destroy their children, and that is a shame.

    By the way– it is spelled ‘Suboxone’.

  4. Dear Choices, I believe that Suboxone was sent from God to save my son and others like him. I not only have my son back, he is a better person than he was before. Be patient, let go of your desire for her to be off of all medication, and be thankful for your daughter and each day you have with her.

  5. SuboxDoc,
    I do not agree with you in stating that I am guiding my daughter down a path of destruction. To cut me out of her life is quite serious to advise.
    She has been on Suboxen for 8 months now and her doctor has cut her off because it is time to be off of it.
    It is her decision by the way to want off of it. She hates the stuff and what it has been doing to her life. She just is going thru hell now to get off it. I understand what she has is a lifelong problem. It is very serious.
    You may be a advocate for Suboxon of some sort and that is why you were so cruel at my statement of it being a terrible drug. It is just as addictive as pain killers and it should be not the answer for therapy for drug addiction cases.
    Thankfulmom..
    Thankyou for your kindness. When my daughter was put on Suboxon she was also like you described, my daughter again but it lasted only for about 4 months. When she tried to cut and taper off it was not working. She was working and going to college and it was just not working. Now she is here at home and taking medical leave from job and going thru withdraw. It is not as bad as it was with pain killers but it is still very bad. She can’t sleep, she has diarrhea, her legs twitch all the time, she is cold. She had tapered down to 8 mg cut in four taking 1 a day, 2mgs. But she did have some days when she had taken the full 8 mg a day.
    I hate to know that this is going to be a life long disease. I do acknowledge that, but thru the grace of God she will beat it. She will live a life not looking back but yet knowing what can happen if she slips up just once.
    She is going to outpatient therapy. Which is seeing a counselor 3 times a week. She is going to meetings twice a week.
    I wish you well with your son.
    I pray on my knees as she sleeps (when she sleeps) for her recovery. Now that I have her here with me. That is her real only answer.

  6. Dear Choices, Please address these problems with a doctor who is an addiction specialist. I think your daughter is having problems because she is not taking enough Suboxone. She is withdrawing. She needs to be on a dose that makes her comfortable (remember that she will not get high from this). Suboxone is for a chronic disease that needs to be treated indefinitely. I don’t believe arbitrary stop dates or time limits on therapy are appropriate. I have talked to many doctors over the past 2 years and I can tell you many of them know nothing about Suboxone. I think they equate it w/ methadone and just stopped reading about it. IT IS DIFFERENT. The doctor here has the best understanding of anyone I have read about or talked to. It is a whole new way of thinking. It is a miracle.

  7. I am 49 years old and have been on 16 mgs total per day, 4 times a day, for about 2 years now. I quit cigarette smoking 13 days ago and it seems that the suboxone is not working anymore. I am craving like crazy. Do you know of any connection between nicotine and suboxone? Wierd. I would ask my doctor, but every single month she wants to taper me down. So far, I have been successful in staying at 16 mgs per day. I want to tell her that 16 mgs isn’t working anymore and I need an increase. Do you have ANY ammo I can use? Please help. Thank you.

  8. what if you believe that after you die god wont let you enjoy opioids if you die still addicted to them and not having died sober or tasting withdrawal?

  9. Hello everyone. I recently started following Dr. Junig’s blog and forum and it is refreshing to read his posts (and others’) regarding his past with addiction in his life as well as his opinions on Suboxone. I started using opiates after a major surgery for cancer in 2005-2006. It started as taking the remainder of my Percocet prescription leftover from surgery (when I no longer needed it for pain), and then soon morphed into daily use of Oxycontin for a few years.

    Anyhow, I started on Suboxone about 3 years ago, and I have not looked back since. I have no desire to take full agonist opiates ever again, as I much prefer the stability in my life that Suboxone provides. I have thought of getting off of it numerous times, but have never attempted to do it. I very much would like to quit, because I don’t like the concept of being dependent on taking a substance daily that I need to function in my personal and professional life. However, I am afraid of the opiate cravings that will likely come back.

    Choices–my advice to you and your daughter is that she stay on Suboxone indefinitely until SHE feels that she is ready to attempt to taper or jump off of it. Please don’t think of Suboxone as “just another opiate”, because it is not. It doesn’t get me high. It makes me “normal”.

  10. Hey guys, just signed up and figured i would chime in. I have been on Suboxone for just over 1 year now and I can honestly say it was the best decision I ever made in my approach to kicking my addiction to opiate painkillers. As with any medicine it has its side effects and should be used under the care of a Doctor. I actually trolled this very site the days up to and following my induction and it with out a doubt helped me along my journey to get clean so I figure I owe at least this one comment if not many more pertaining to my experience with Suboxone and it putting me on track to get my life back. I will get off it because I want too. If I relapse then so be it but I dont think a total relapse will ever be possible due to the life experiences I had as an addict. I believe a good Doctor that is educated and cares about his patients is also key to success, which I have been fortunate enough to have. Suboxone is alot stronger than many people are led to believe and It is my belief that many people are over medicated but this is all just my opinion. Good luck to all and use your time on Suboxone to clean up the rest of your lives while you dont have to worry about your next fix or going through withdrawal.

  11. I just wanted to add my own 2 cents here, which is that if you are going to the doctor and being prescribed a medication to help a problem it is not getting a ‘fix’ it is receiving treatment. It is not a terrible drug, when used correctly it gives people their lives back. With minimal horrible side effects. Much less then using of course, I can’t understand why someone would push themselves off medicine they need especially if they so obviously are not ready for it?
    I am so thankful for this treatment option, and if one of my children were ever in this same situation I would support their staying clean. Of course if they truelly decided for themselves they want off it I would support and help them in that too, and I would also be prepared for the fact that the risk of them beginning to use again is high. And on top of that they will probably go about it in such a way that they won’t let anyone know, and therefore will not ask for help, seeing themselves as an even bigger failure then before and the guilt of it all. They will think it didn’t work the first time nothing will work. This site has helped to inform me as far as getting help and my family, who also thought addiction was a weakness and loved to say well if you dont like it then just stop. Now they know that is not how it works. No matter how much you want it. While you were using you were reprogramming your brain basically, without even knowing it. Good luck to all who are receiving or seeking help. Stay strong and do what you feel is the right path for you. If it’s suboxone or not, long-term or not. A lot of people don’t or can’t understand and only see things their one way which is right despite all the evidence, don’t let them make you think you are still doing something wrong. Some did that to me then I realized that treatment for something is not wrong. Feeling human again is not wrong. As for myself, I’d rather not risk losing myself again and becoming the person I did not like at all, so I’ll stick with them!

  12. I just started researching withdrawal from suboxone yesterday as I took my final little sliver of a piece yesterday morning. I had been taking the tiniest pieces since last Thurs. Each of those days I was experiencing the withdrawal symptoms. I have my name as confused because in the little research I did I had seen on other sights that a person should be on suboxone for about a year. I know everyone is different. I had been on it for four years, I decided to taper down and stop because my Dr. told me a two years ago he would have me off in 6 months. He started me with 4 8mg pills a day and now for the past two years he has had me on 1 and a half when he told me he would slowly lower my dose to get me off. I’m not quite sure why I questioned him about keeping me on it maybe for fear of withdrawal. I also suspect he kept me on it without changing my dose to get his “kickback” (I’m not sure if Dr.’s actually do get a kickback I’ve just always heard they did) I also recently discovered that he has been charging me a considerable amount every month I had to go see him when my insurance has been paying for my visits. So I think he thinks why the hell am I gonna get this teacher (yes I am a 2nd grade teacher, my school has been very supportive, I am currently on a 30 FMLA ) off of suboxone when I am making this extra money off her insurance. My main concern is since I was taking little slivers has that set me back since I read that in the above article and as much as I want to be done with suboxone should I find another Dr. and get back on or at least talk to the Dr. to get his input. I know it said that almost 100% of people relapse but I honestly know I will be the exception. Even with today being terrible I have no desire to seek any narcotics, I just want to be the person I was before pain pills ruined my life. I’d appreciate any input no matter how minor. Thanks everyone and good luck.

  13. dear confused, it sounds to me like you aren’t really ready to be totally off of Suboxone. one thing i have had to do is accept the fact that my son will be on medication indefinitely and that it is OK. i think i just had to let go of that and be thankful that Suboxone is available for him. another thing that i had to let go of was wishing that he would have his life back like it was before addiction. he will never be the same and neither will i, we have been through too much and learned so much about ourselves. i now see our lives as 2 parts, the part before addiction and the part in recovery. the good news is that we are both better people than we were before. we have become extremely close, which i don’t think would have happened otherwise. he may not be the same, but he is more mature, more patient, more understanding and most importantly, he has learned that he is not invincible. i think maybe this is the way it is supposed to be.

    good luck to you. don’t put too much pressure on yourself and remember that you can be a good person with a fulfilling life on suboxone.

  14. i am a strange case: vegetarian, healthy, pilates instructor, goodlooking– NEVER A DRUG ADDICT — but i had a secret- i was badly depressed for years- treatment resistant to over 30 meds, only some helped to a point
    …i did extensive research into the brain and opiate systems and i wondered if it was possible my endorphin system may be the culprit ( check this primer: http://www.prohibitionkills.blogspot.com/)

    I was desperate enought to try out opiates as a final solution ( and i monitored myself- i have brakes yet i was always scared of tolerance– and forever afraid to keep on that track) then i found my holy grail… i learned about subxone’s other use- ( and it is now being studied for depression)
    I was forced to lie to get on suboxone, i pretended i was an oxycontin addict etc.. i know that is wrong, but i was trying to save my life ( i was already at the point of suicide attempts)…not only did i get better, i brought my mother in who was also treatment resistant and she was made better also within a week when even ECT failed her and messed up her brain for a good year…..she still takes what i took- 1mg in morning, 1mg in afternoon ( we both sensed that was when we needed a second dose not uncommon believe it or not for other depression sufferers that noticed a drop in the afternoone that suboxone was again needed)

    anyway she is doing great on it to this day…saved her.
    me after intense meditation for one month- seriously no joke – i sensed i was ready to go off it.
    i do everything the hard way- so i went cold turkey off my 2mg a day after being on it for 5 years.
    lucky for me- no depression- although the withdrawal did a real number on me– i was so sick from flu and withdrawal , horrible coughing, sore throat,dizzy and weak i wound up at the ER – thought i had H1N1. lol !
    i was bed ridden for almost 2 weeks, i ate nothing for a whole week but soups.
    it was NO walk in the park, i was so weak i could not brush the tangles from my hair, even talk much to anyone. and the sweats were out of this world.

    i am now at one month and 2 weeks. i still feel kind of weak and sickly, swollen glands, and sometimes a sore throat a little, my face is pale and i have huge dark circles under my eyes… the sweats have almost stopped….but my pupils still dilate..
    when i exercise i tend to feel worse not better — why is that? \
    but my real question is this:
    why does it make me look so pale and dark circles- ??? is it the interrupted sleep?? or low blood pressure or vitamin defficiencies?? anemia – i take lots of vitamins and 3 iron pills a night ( always did as a veggetarian)
    i only wake up once or twice a night and i take a quarter of sleeping pill – unfortunately- every night still- otherwise i will be up forever..

    and is there any nutritional things i can do to make me look less ghastly?? i look like a heroin addict and feel like people will see me that way as i can’t keep saying i have a flu forever !! ! what puts color back in the face ??

    * before u lecture me about my terrible lie to the suboxone doctor ( i think he knows anyway as he had to fudge my notes to make me a worse addict than i claimed)

    but u know what?? when i was in ER , and could hardly walk straight from my flu + withdrawal–i told the doctor while i felt like i was dying – that even then…
    i was so happy i took suboxone – it cured me and my mom FROM A LIFETIME of DEPRESSION.

    there IS NO withdrawal that is worth depression, let alone years of it, so please don’t lecture me on what i did, i saved 2 peoples’ lives by lying and i would do it again in a heartbeat…( in fact i was so angry when i found they have a cure for treatment resistant depression i tried in vain to contact media sources to publish a story on it- but who would touch that??)

    edie

  15. Staj, Let me as lifer tell you this my friend. God is a loving god. And in what world were told that that kind of shit exists in any form or fashion. Are you insane or are u just on opoids at THIS VERY MOMENT. FREAK. You insult us that fight the good fight and keep your insignificant comments to your own delusional mind.

  16. I am new to this site and looking for some support for fellow sub users. For 5yra I was addicted to endone 5mg taking 15pd. I came off endone April last year with the support of a private dextox centre. They used sub to help take me off the more powerful full agtogonists! I was clean or 6mnths! However my mother died suddenly and I relapsed for 10days using codeine! The w/d symptoms came back so I went back onto suboxone. I chose to stay on a maintenance program of sub which was 18mg pd as I was facing alot of personal issues; grief, marriage issues etc. I can truely say sub saves my life! However, in conjunction with my dr I have started to ween off sub and r now down to 12mg, reducing every month by 3mg with the aim to go into clinic again to come off last 4mg under medical supervision. I am booked in for end of October! I am frightened about withdrawal I did not do too well last time! Very sick, tired and depressed! Any advise?

  17. For 5 years I was addicted to endone and oxycontin. I w/d from these under medical supervision and stayed clean for 6mnths. Unfortunately I relapsed for 2 weeks on codeine after my mother passed away. It was then I took my psychiatrists advise and started on a maintenance progrme of suboxone 18mg a day which I have been on now for 9mnths! Suboxone saved my life! I ha started to go into renal failure due to the ibrufen contained in codeine tablets!
    3 months ago my psychiatrist encouraged me to begin tapering off the suboxone. 3mg every month until Im down to 4mg and then I go into clinic again to cone off last 4mg.
    I’m frightened about withdrawal as I know what I went trough coming off the opiates! Any advise?? V

  18. My doctor put me on suboxome after I had a back injury. I was on Vicodin for 6 months. After that he put me on 16 mg a day of suboxome about 2 years ago. He has tapered me down from 16mg to 8 mg to 4 mg and now I have been on 2mg for the last month. I really want to stop taking this drug. Does anyone know how much longer I will have to be on suboxome so I dont have the withdrawel affects.