Suboxone

6. We Do Everything We Can to Help You Through Withdrawals

Opioid withdrawal symptoms are uncomfortable, but there are withdrawal treatments your Bicycle Health provider can prescribe to help relieve these symptoms:‍

• ‍Clonidine helps reduce anxiety, irritability, muscle aches, sweating, and runny nose;
• Hydroxyzine (Atarax) helps relieve anxiety and insomnia;
• Tizanidine (Zanaflex) helps reduce muscle spasms;
• Ondansetron (Zofran) relieves symptoms of nausea and vomiting;
• Loperamide (Imodium) helps relieve diarrhea; and
• Bentyl helps relieve gastrointestinal (GI) symptoms, especially abdominal cramping.

And lastly, once you start buprenorphine/naloxone (Suboxone), you will experience significant relief from opioid withdrawal symptoms.

Induction may take up to 3 days, after which you’ll feel well with no further withdrawal symptoms… and finally yourself again!

How Is Suboxone Dosed?

Suboxone comes as a sublingual film, meaning it is placed under the tongue when administered. It also comes in pill form.

The filmstrips come in varying dosage levels, with buprenorphine listed as the first ingredient and naloxone as the second. Here are the various strengths available:[1]

• 2 mg buprenorphine and 0.5 mg naloxone
• 4 mg buprenorphine and 1 mg naloxone
• 8 mg buprenorphine and 2 mg naloxone
• 12 mg buprenorphine and 3 mg naloxone

What Starting Dose Is Recommended for Suboxone?

The initial recommended dose is up to 8 mg/2 mg of Suboxone in divided doses on the first day. This means you won’t take your Suboxone in a single dose as you will with maintenance treatment. On this first day, you’ll split up the dose throughout the day.

Medical providers will often begin your Suboxone treatment by giving you low-dose variations and assessing their effects. You will most likely be given a 2 mg/0.5 mg or a 4 mg/1 initial test dose followed by a 2 mg/0.5 or a 4 mg/1 mg dose at least an hour later. You may be assessed after that on the same day to determine if you need a third dose. You’ll continue to be monitored during this initial period.

The recommended doses will depend on the severity of your use, your past history with Suboxone, and your symptoms after the initial test dose.

The timing of the first dose of Suboxone administration relative to your last use of an opioid will depend on what kinds of opioids you were most recently using. Short-acting opioids, such as heroin, codeine, and hydrocodone, process out of the body more quickly. You’ll begin taking Suboxone 6–12 hours after your last dose of opioids, provided that withdrawal symptoms are present.

Long-acting opioids, such as methadone, fentanyl, and oxycodone, take longer to process out of the body. As a result, you’ll need to wait longer after your last dose to begin Suboxone. Usually, it’s recommended to wait at least 24 hours after your last dose of a long-acting opioid before taking Suboxone.