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How long should you wait before taking Suboxone?

Medically reviewed by Sally Chao, MD. Last updated on April 16, 2021.

Official Answer

by Drugs.com

You typically have to wait 12-24 hours after last using opioids before you start taking Suboxone as a treatment for opioid use disorder. The exact length of time depends on the type of opioid used.

Short-acting opioids, like heroin, take effect more quickly and are eliminated from your bloodstream faster than long-acting opioids, like methadone. So, if you use short-acting opioids, you may only need to wait about 12-16 hours before starting Suboxone. You may need to wait 17-48 hours if you use intermediate or long-acting opioids.

This waiting period is necessary because it's important to start treatment with Suboxone when you are already having early symptoms of opioid withdrawal. That means the opioid drug is starting to leave your body, causing gradual symptoms. If you take Suboxone when you still have opioids in your system and are not beginning to experience withdrawal, it can trigger sudden and intense symptoms, called precipitated withdrawal.

Suboxone is a combination of the drugs buprenorphine and naloxone. Buprenorphine binds to opioid receptors in the brain, displacing the opioids that are currently attached to these receptors. So, taking buprenorphine after recently using opioids can cause precipitated withdrawal, instead of these opioids slowly losing their effect. (Naloxone is added to prevent drug misuse.)

Your doctor will need to know what type of opioid you used and when you last used it to decide when to start treatment to manage opioid withdrawal. The Clinical Opiate Withdrawal Scale (COWS) or another scale may be used to measure your withdrawal symptoms and determine when to begin treatment.

You may first take buprenorphine alone to manage opioid withdrawal symptoms, and then switch to Suboxone after a day or two. Sometimes treatment begins with taking Suboxone right away.

Suboxone comes as a film you put under your tongue (sublingual) to dissolve. You and your doctor will decide whether Suboxone is the right medication for you, based on factors like your medical history and personal preferences.

References
  1. Substance Abuse and Mental Health Services Administration (SAMHSA). Buprenorphine. Last updated March 12, 2021. Available at: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. [Accessed March 23, 2021].
  2. Providers' Clinical Support System. Models of buprenorphine induction. December 16, 2014. Available at: http://pcssnow.org/wp-content/uploads/2015/02/Buprenorphine-Induction-Online-Module.pdf. [Accessed March 23, 2021].
  3. University of Massachusetts Medical School Center for Integrated Primary Care. Fact sheet: Buprenorphine. Available at: https://www.umassmed.edu/globalassets/center-for-integrated-primary-care/amber/final-fact-sheet-on-buprenorphine-final.pdf. [Accessed March 23, 2021].
  4. U.S. National Library of Medicine. Buprenorphine sublingual and buccal (opioid dependence). Last updated December 15, 2020. Available at: https://medlineplus.gov/druginfo/meds/a605002.html. [Accessed March 23, 2021].
  5. American Society of Addiction Medicine. (ASAM) National practice guideline for the use of medications in the treatment of addiction involving opioid use. June 1, 2015. Available at: https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf?sfvrsn=24. [Accessed March 23, 2021].

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