Opioid addiction is considered a chronic and progressive brain disease that is highly treatable. One of the methods used during opioid addiction treatment is medication-assisted therapy. It is never recommended to stop taking, or abusing, an opioid “cold turkey,” or suddenly, as this can lead to the onset of difficult withdrawal symptoms. Medications may be used to help curb cravings and manage these withdrawal symptoms.
Suboxone is an FDA approved sublingual filmstrip that treats opioid addiction. It is dissolved in the mouth, usually once or twice a day. Suboxone contains both buprenorphine, a partial opioid agonist, and naloxone, a partial opioid antagonist. The partial opioid agonist works by displacing full opioid agonists from the brain, and the antagonist then blocks the opioid receptors from receiving any more drugs. Partial agonists, like buprenorphine, are less likely to create a “high” or have other mind-altering effects. They may make you feel more energized and generally pleasant. Buprenorphine’s effects also plateau after a certain amount is ingested, so even if you take higher doses to try and increase the “happy” feelings, after a set amount you will not be able to. Suboxone also contains the antagonist naloxone, which serves to block opioid receptors from receiving more opioids, so even if you take another opioid while on Suboxone, you won’t get “high.” Naloxone is relatively dormant when Suboxone is taken as directed and only serves to precipitate withdrawal if abused and injected.
The use of Suboxone during medication-assisted therapy can speed up detox and promote long-term success with fewer instances of relapse. Precipitated withdrawal occurs when Suboxone replaces a full opioid agonist in the brain before the other opioid is out of your system.
Precipitated Withdrawal Symptoms
Precipitated withdrawal is similar to opioid withdrawal, although it can be more intense and start suddenly. Symptoms of opioid withdrawal and precipitated withdrawal include:
- Excessive yawning
- Muscle aches
- Runny nose
- Watery eyes
- Abdominal cramping
- Dilated pupils
The severity of these symptoms may depend on how long you abused opioids, which drug you abused and your method of abuse, the level of physical dependency, and certain genetic factors. Drug cravings may also occur during withdrawal, as withdrawal symptoms can be uncomfortable, and it may seem easier to relapse, or return to abusing opioids to stop those withdrawal symptoms.
Avoiding Precipitated Withdrawal
When starting medication-assisted therapy, it is vital that you are honest about what drugs you took and when the last time you took them was. Different drugs stay in your system for varying amounts of time depending on your metabolism, physiology, tolerance levels, and the half-life of the particular drug taken. Some drugs have short half-lives, for example, meaning that they may leave your bloodstream more quickly than others. Morphine, oxycodone, and hydrocodone immediate-release products such as OxyContin, Vicodin, and Percocet, are generally out of the bloodstream within 8-12 hours, for instance. Oxymorphone drugs like Opana and extended-release formats may stay in your bloodstream for up to 24-30 hours.
Methadone is a long-acting opioid with a long half-life, and it can take 36 hours to a few days to be fully flushed from your body. In order to avoid precipitated withdrawal, you should wait to begin taking Suboxone until all other opioids are completely out of your bloodstream. This may be indicated by the onset of early withdrawal symptoms, which include psychological side effects as well as some of the physical ones, such as the muscle aches, sweating, yawning, tearing, runny nose, sweating, and insomnia. Once these symptoms begin, it is likely safe to initiate medication-assisted therapy.
Physical dependence plays a role in the onset of precipitated withdrawal, and often, in order to safely detox from opioid drugs, a tapering schedule is implemented first. Someone who is heavily dependent on an opioid may need to gradually taper their dosage slowly, in a controlled manner and over a period of time, gradually reducing the dosage down to zero. This should be closely monitored by medical professionals in order to maintain safe levels of the drug and to ensure that the dosage continues to decrease. Once the drug is tapered off completely, Suboxone can be introduced to continue to keep withdrawal symptoms and cravings to a minimum.
Suboxone is generally started within 12-24 hours of your last dose of an opioid and during the induction phase of opioid addiction treatment. The amount of time you take Suboxone for will depend largely on your level of dependency and addiction, and medical professionals should determine its use. In order to avoid precipitated withdrawal when taking Suboxone, you also need to take the medication exactly as directed. Taking higher doses, abusing, or diverting Suboxone may lead to precipitated withdrawal. In addition, mixing other drugs or alcohol with Suboxone can be dangerous and also precipitate withdrawal symptoms.
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In addition to a Suboxone regiment, psychotherapy, including behavioral therapies to address psychological dependence, is an important part of opioid addiction treatment. Support groups and therapy sessions are tools used in conjunction with medications for successful treatment and recovery.
At Futures, we employ the latest evidence-based treatment methods to assist with your recovery. Contact us today for a free and confidential assessment.
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