Doctor's Note – What is Being on Suboxone Like?

Suboxone is the popular brand-name of the FDA-approved prescription medication used to treat people addicted to opioids. It is a combination of two major component ingredients: buprenorphine and naloxone. Buprenorphine acts an opioid antagonist by partially inhibiting the opiate receptors and curbing addictive cravings, while naloxone acts to discourage misusage and decrease diversion and possible misuse. This combination of both agents helps those suffering from addiction cope with and manage the withdrawal symptoms of the treatment. Suboxone can be prescribed by any doctor at the beginning of the treatment plan and can continue through full recovery.

When it comes to this kind of treatment, patients generally face a myriad of concerns as to the scope of the treatment, how to begin the treatment, the type of dosage, the side effects, and what to expect of the full medication process.

This article means to address these concerns, endeavoring to make the patients as informed and comfortable as possible for the procedure.

Key Points to Consider Before Beginning Suboxone Treatment

Before beginning any form of Suboxone treatment, it is important that the patient be provided with vital information which the doctor will consider while preparing a comprehensive treatment plan. This information will include:

1. The last time the patient used the substance.
2. The type and degree of opioid used (long- or short-term prevalent). Long term opioids like methadone will need a slower tapering before any kind of treatment in comparison to short term opioids. Treatment can often begin 12 hours after the last use of short-term drugs by the addict, and when the patient starts to feel symptoms of withdrawal.
3. The level of dependence on the opioid.

All this information will play a key role in preparing for effective opioid withdrawal and recovery.

What the Patient Should Expect Upon Starting the Suboxone Treatment

Patients who consider enrolling in the program are often curious about what to expect upon starting this treatment, namely the routines involved and the basic requirements for each milestone during the medication process.

The Suboxone treatment is typically divided into three consecutive phases: the beginning phase, the maintenance phase, and the conclusion phase.

The Beginning Phase:

Upon starting treatment, the first two days are dedicated to an induction into the program. During this time, patients are required not to involve themselves in outside activity to avoid distracting from the program’s course of action.

Ideally, patients will need to check into the medical facility for this short period to complete mental and psychological immersion in the program. They will then be administered with a 2–4 mg dose of Suboxone in a tablet or film form, receiving medical supervision to monitor for side effects. Following the dose, patients can be released to go home for continuing outpatient treatment. After the first day of induction, additional doses of up to 8 mg can be administered, depending on how each patient reacts to the first dose.

The Maintenance Phase:

The maintenance phase follows the induction phase, beginning by the third day after treatment has begun. By this time, it is expected that the patients will have gradually weaned off their opioid dependence. Subsequent doses can be added or reduced depending on the response of each patient. There is not one strict rule of thumb concerning the administration of the Suboxone medication. After the patient has achieved optimal stability upon a few more doses, a daily dose of 4–24 mg (typically an average dose of 16 mg) will then be required under continued supervision from the medical team.

Patients are strictly required to take their prescription each day and to keep appointments with their doctors and support team.

Counseling and Therapy:

Counseling is the last phase of the Suboxone treatment plan. By this time, it is expected that the main hurdle has been cleared, which sets the tone for a swift recovery process. This phase arranges therapy and support sessions to help unravel what caused the patient to become opioid dependent in the first place. Counseling comes with its challenges. Upon stoppage of the medication, patients will experience withdrawal symptoms, though not as serious as those of opioid withdrawal. These times of crisis require therapy sessions to help patients manage themselves, to help them grow, and to improve their self-awareness. These personal steps forward put patients on the fast track toward the emotional stability which best avoids relapses.

Some Side Effects of Suboxone:

This is another concern for an average patient, as withdrawal from any kind of opioid can be an excruciating experience. Fortunately, Suboxone can minimize the treatment’s numerous side effects. Patients shouldn’t worry too much, because the combination of the buprenorphine and naloxone agents helps keep the side effects of the treatment to a bearable minimum.

Some side effects typically associated with Suboxone are:

• Vomiting
• Headache
• Sweating
• Stomachaches
• Fatigue
• Low motivation

These side effects, should they grow unbearable, might cause the patient to want to withdraw from treatment. But abrupt withdrawal can have its own serious consequences, such as:

• Insomnia
• Joint pain
• Painful muscle spasms
• Anxiety attacks
• Diarrhea

Should a patient wish to discontinue treatment, he or she should first contact the doctor to devise the best plan to guide the withdrawal process.

Battling addiction can feel like the end of the world at first, but patients can learn to defeat it through consistency, an excellent treatment plan by a good healthcare provider, and a solid support group. It is also vital to the treatment process that the patient keeps a personal record of recovery and can discuss any worries concerning the treatment with the doctor.

Frequently Asked Questions (FAQs)

What happens at my first visit?

After the necessary patient history is documented, a urine sample is taken. The patient is then set up with medical personnel. Within minutes, a comprehensive course of treatment is decided upon by both parties, and induction begins on the following day.

How often do I need to have appointments with the doctor?

The induction phase would typically require a strict supervision by the doctor in charge. Subsequent treatment will require regular appointments with the doctor, ranging from once or twice a week to once every two weeks depending on the patient. Once a stable dose is set, appointments can typically be set up monthly. 

How long does the Suboxone treatment last?

There is not one agreed-upon time frame for a Suboxone treatment, but the greatest successes of the program have occurred with about a year of treatment. A year of gradual treatment will help the patient regain the motor skills and personality which were lost. Weaning off the medication will also require some time for the patient to recover from the subsequent withdrawal.

Isn’t the treatment just swapping one addiction for another?

No. There are no tradeoffs. The buprenorphine acts an opioid antagonist that partly inhibits the opiate receptors and curbs the addict’s urges. Buprenorphine helps patients put their lives back together, and with constant therapy and counseling, they can then stop using Suboxone completely.

Why do I need to go to counseling?

Counseling helps patients manage themselves in times of crisis, helps them grow increasingly self-aware, and helps them learn to deal maturely with life’s problems, without having to be dependent on any form of medication. This growth can equip patients with the necessary emotional stability to avoid future relapses.

About Dr. Nepa

Dr. Justin Nepa is a board-certified psychiatrist located in Boca Raton, Florida. He specializes in medication management and psycho-therapeutic approaches for adults and adolescents suffering from depression, anxiety, PTSD, ADHD, and addiction. He is excited to provide psychopharmacology alongside the wonderful mental health providers at MorMindful Therapy & Psychiatry of Boca Raton. This cooperation helps his patients meet their needs met in one place and benefit from continued care.

MorMindful is a mindfulness-based practice that provides affordable therapy and psychiatric services in Boca Raton.