Tips and Information About Stopping Suboxone
What is tapering and how long should I be on Suboxone (Buprenorphine)?
Tapering refers to gradually reducing the buprenorphine dose in patients who have been stabilized on the medication for some time.
There is no ideal tapering protocol. Providers and patients should understand this before beginning a taper. Whether buprenorphine is ultimately discontinued, patients need additional psychosocial and recovery support during this time.
Generally, taper occurs over several months to permit patients to acclimate to the lower dose and to reduce potential discomfort from opioid withdrawal and craving.
The questions you need to ask before tapering?
How is your treatment going?
Are you in full remission, meaning clean drug screens and reduction in cravings? Do you have adequate mental and social supports to remain in remission and maintain recovery?
Why do you want to taper?
Are you motivated by inconvenience, expense, loss of insurance coverage, side effects, feelings of shame, pressure from family, and lack of recovery support. Many of these reasons are not predictive of a successful outcome.
What strategies do you have for engaging family members and recovery supports to reduce the risk of return to illicit substance use?
Successful dose reductions may be more likely when you have sustained abstinence from opioids and other drugs, psychosocial support, housing, effective coping strategies, stable mental health, employment,
and involvement in mutual-help programs or other meaningful activities.
What to expect when stopping suboxone?
withdrawal symptoms generally follow this pattern:
- First 72 hours: Physical symptoms (chills, fever, headaches, gastrointestinal problems, insomnia, muscle aches, nausea and vomiting, sweating)
- The first week: Muscle aches and pains, insomnia, mood swings.
- Two weeks: Depression and sluggish.
- One month: Depression and drug cravings.
- After 28- 35 days: Symptoms should subside, and you should start to feel normal again
When tapering off from Suboxone, most people experience withdrawal symptoms, such as low energy, low appetite, irritability, and insomnia. A good tapering schedule, however, will help reduce their severity.
If an individual decides to forgo a buprenorphine taper schedule and quit the medicine cold turkey, they can expect withdrawal symptoms to be at their worst approximately 72 hours after the final dose.Physical symptoms continue for up to two weeks and then will often be replaced by cravings or depression. These psychological side effects will carry forward for a month or longer this is when people are most likely to have a relapse.
For those patients that have the time to invest in a buprenorphine taper plan, they have less of a risk of experiencing withdrawal symptoms.
Buprenorphine Taper Schedule
General rule:
Pace the taper with the body’s ability to adapt to each decrease. Dose decreases of 25% separated by at least 10 days have been reported to be tolerable by many.
General Rule:
Pace the taper with the body’s ability to adapt to each decrease. Dose decreases of 25% separated by at least 10 days have been reported to be tolerable by many.
10 Tips for coming off suboxone
1. Working with the Ceiling Effect of Buprenorphine
When you’ve hit the ceiling with buprenorphine, almost all your opioid receptors become occupied with it. This is where it induces a very slight opioid effect.
If you do take more Suboxone than the amount to cause the ceiling effect, you’re not going to feel additional effects. If your dose is near or over your ceiling dose, you’ll experience the same opioid effect.
This is why tapering from buprenorphine can be aggressive. If you cut your current dose in half, it doesn’t mean that half of your opioid receptors have been affected. The ceiling effect means you wouldn’t experience a difference.
2. What Time of Day to Taper Suboxone Dose
There are a few opinions about when you should take buprenorphine for tapering purposes. Some say by taking it in the morning, and you get its full benefits during your waking hours. It’s believed there will be fewer withdrawal symptoms. You will experience fewer cravings because buprenorphine is at its strongest.
You also avoid anticipation of taking the dose all day. You may feel fidgety while waiting to get your ‘reward,’ your dose. This can reinforce behavioral patterns you are probably trying to eliminate. There is an exception. The decreased buprenorphine in your body may add to your inability to sleep. If you’re experiencing insomnia, you may want to take your dose at night.
3. Take Your Full Dose at Once
It may be tempting to split your Suboxone dose for the day, but taking it once a day is the most effective method. You will likely have a successful buprenorphine detox if you follow the guidelines. You will transition much more easily from taking Suboxone from once a day to zero than if you had to abstain after a double dose day. If you are suffering from insomnia, it’s understandable that you might split the dose taking half in the morning and half in the evening.
4. Medications will help with tapering off buprenorphine.
- Clonidine helps reduce anxiety, irritability, muscle aches, sweating, and runny nose.
5. Exercise and Buprenorphine Detox
Again this simple solution to a big problem does work. For people that struggle with addiction, their brains have become deficient in endorphins. Happiness is hard to come by, and depression is prevalent. Physical stimulation helps build endorphins back up. It is a necessary part of detoxing from Suboxone. Vigorous exercise at least 5 days a week will combat the withdrawal symptoms you may experience. While doing a Suboxone taper, it’s good to start incorporating the exercise regime even if you’re not motivated.
6. Nutrition and Tapering Off Suboxone Successfully
How to get off Suboxone naturally can involve your nutrition. During buprenorphine tapering, you will want to feed your body extra nutrients and supplements to combat the negative effects. With the overuse of opioids, nutrients have been lost, contributing to how the brain functions. With the aid of nutrition, you may have more energy, be capable of sleeping more soundly, and experience an improvement in your mood. You may have never eaten healthy, but this lifestyle change will help the body heal.
7. Balancing Out Your Brain Chemistry
There are endorphin-deficient supplements to help balance out brain chemistry that has been compromised through substance abuse. They are holistic and non-addictive such as:
- DLPA– Supplementing with DL-phenylalanine has been shown to boost dopamine levels and function.
- L-theanine– L-theanine reduces levels of cortisol, a stress hormone, and has been found to reduce abrupt blood pressure spikes in people experiencing stress.
- L-Tyrosine– L-Tyrosine for opiate withdrawal can reduce depression and enhance your mood because of its ability to increase dopamine in the brain.
- NAD+– It has been determined that the excessive use of drugs and alcohol will deplete the body’s natural stores of NAD. Because of this, the brain cannot receive the same energy it usually would from breaking down food. NAD therapy floods the brain with the co-enzyme to replenish its stores.
8. Understand that Buprenorphine Detox can Cause Depression
Buprenorphine detox can sometimes lead to depression as it is recognized as an anti-depressant. Sometimes, when you stop using Suboxone, you’ll experience depression. This is especially true if you were depressed before you started using opioids. One of the main reasons people use any mood-altering drug is to get away from reality. Depression can have a major impact on your success from getting off buprenorphine. This is why the holistic aspects of buprenorphine detox are important. Also, if you have severe depression, you may have to use antidepressants while abstaining from Suboxone.
9. Pausing the Suboxone Tapering
Someone tapering off Suboxone may experience uncomfortable withdrawal feelings. When this occurs, you can return to your last dose. Maintaining the prior level is okay to do for a few days. You could also hold the dose longer than the buprenorphine taper calls for. Your mind and body are unique from the next person, so your process will be too. When the body does adjust, go back to the recommended dosing.
10. Mid-taper Breaks are Acceptable
There is no negative outcome from taking a break from Suboxone detox if you need to. The rule of thumb is that it should be minimal and not too often. Like any drug that causes dependency, the longer you stay on it, the harder it is to stop. For example, if you’re at 0.5 mg per day for seven days and experiencing withdrawal symptoms, try taking 1-2 mg one day. This will get rid of the symptoms for that day and probably the next day as well. Taking a break from tapering down is better than returning to your old opioid drug of choice. You need time and space to focus on managing your life without buprenorphine. When you incorporate a healthy lifestyle, you may find it easier to stay the course of the tapering. One day at a higher dose isn’t going to ruin the progress you’ve already made. You limit higher doses once or twice during your Suboxone taper process. To counteract the bigger dose, you can also try not to take any the next day. Half of the dose is still being metabolized in your body at that point.
Every patient is different. Some factors that might help taper may include the following:
- Employment, engagement in mutual-help programs, or involvement in other meaningful activities.
- Abstinence from opioids and other drugs during treatment.
- Positive changes in the patient’s environment.
- Good support system.
- Engagement in treatment after medication discontinuation.