Buprenorphine, also known as Suboxone or Subutex, is a medication for opioid use disorder that can help relieve opioid withdrawal symptoms and serve as a long-term maintenance treatment.
While buprenorphine can help with opioid withdrawal symptoms, it should not be started until at least eight to 24 hours after a person has last taken an opioid drug.
Common opioids include:
- oxycodone (OxyContin)
- hydrocodone (Vicodin)
- hydromorphone (Dilaudid)
- oxymorphone (Opana)
Starting buprenorphine too early could trigger severe, acute withdrawal symptoms. Following withdrawal, individuals may be prescribed buprenorphine for long-term maintenance.
Timeline For Taking Buprenorphine For Opioid Withdrawal
Buprenorphine is often administered to individuals undergoing opioid withdrawal after becoming physically dependent or addicted.
However, buprenorphine should not be taken if someone still has opioids in their bloodstream, or if they are not in the early stages of opioid withdrawal.
Timeline for when to start buprenorphine, based on opioid type:
- Short-acting opioids (e.g. oxycodone, heroin): 8‒18 hours after last opioid use
- Extended-release opioid formulations: 24‒36 hours after last opioid use
- Long-acting-opioids (i.e. methadone): 72 hours after last opioid use
The Substance Abuse and Mental Health Administration (SAMHSA) recommends waiting at least 12 to 24 hours after last opioid use to begin buprenorphine for opioid use disorder treatment.
Starting too soon could trigger severe symptoms of withdrawal.
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What To Know Before Beginning Buprenorphine For Withdrawal
Clinical researchers have developed a checklist of symptoms, known as the Clinical Opiate Withdrawal Scale (COWS), that can indicate when it’s safe to begin taking buprenorphine.
Before starting buprenorphine, a person should be experiencing at least three of the following symptoms:
- excessive yawning
- muscle tremors (shaking or twitching)
- nausea, vomiting, cramps, or diarrhea
- watery eyes/runny nose
- chills or sweating
- bone pain or joint aches
- enlarged pupils
The COWS checklist and scale for symptom severity is used to assess the severity of a person’s opioid dependence and the severity of withdrawal.
Within a detox program, a doctor will administer medication according to the COWS symptom assessment and other clinical markers.
Opioid withdrawal can feel like a bad case of the flu. This is normal. Once enough time has passed after a person’s last opioid use, buprenorphine can help with these symptoms.
What Happens If You Take Buprenorphine Too Soon?
Starting buprenorphine too soon after last opioid use could make a person physically sick by triggering severe symptoms of opiate withdrawal.
This phenomenon is known as precipitated withdrawal. By adhering to the SOWS checklist, precipitated withdrawal can be prevented.
According to the National Institute on Drug Abuse (NIDA), prevention is the best treatment for precipitated withdrawal, which could require medical treatment and observation.
Find Opioid Detox At A Rehab Center Near You
Buprenorphine can be used as a supportive treatment for opioid withdrawal symptoms. The safest way to begin taking buprenorphine is to seek help from a medical doctor.
If you or a loved one is addicted to opioids, beginning a medical detox program for opioid addiction will likely be recommended. If you’re looking for detox, we can help.
Call our helpline to find a detox center and begin the path towards opioid addiction recovery today.
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- American Society on Addiction Medicine—A Patient’s Guide to Starting Buprenorphine at Home
- Substance Abuse and Mental Health Services Administration (SAMHSA)—Buprenorphine: Quick Start Guide
- University of Rochester Medical Center (URMC)—‘Start Low & Delay Until in Withdrawal’ - Lessons Learned From Precipitated Withdrawal after Early Buprenorphine Initiation after Methadone
- U.S. National Institute on Drug Abuse (NIDA)—Frequently Asked Questions about ED-Initiated Buprenorphine