First Dose of Suboxone - How Long Must You Wait After a Dose of Methadone, Oxycontin, Heroin, Oxycodone...?
Buprenorphine works great and it can help you overcome an addiction while avoiding the pains of withdrawal. But you have to listen to your doctor and you have to wait until you're feeeling a little bit sick before taking that first dose. Here's why...
Suboxone is a partial opiate type medication that can be used as a substitute for drugs of abuse, like heroin, oxycontin, Percocet or other opiate drugs. By substituting onto buprenorphine (the active ingredient in suboxone) a physically dependent (addicted) person can switch to Suboxone, and if it is taken correctly, they will feel little or no withdrawal pain.
Suboxone works very similarly to methadone (but has several advantages over methadone) unlike methadone though, if Suboxone is taken incorrectly, or if it is abused, it can cause strong and even immediate symptoms of opiate withdrawal and detox.
Before you take a first dosage of Suboxone, you will have to abstain for a while from all other opiates, and you will have to be feeling the beginnings of withdrawal pain. If you do not abstain, or if you take Suboxone too soon after taking another opiate, you can enter into precipitated withdrawal (an immediate symptom of detox pains).
Why does taking Suboxone too soon after another opiate cause withdrawal pains?
Suboxone is said to have high affinity but low activity on the opiate type receptors in the brain (mu receptors).
High affinity means that it is very able to fill and activate the opiate receptors in the brain, and since it has a higher affinity for these receptors than other opiates (like heroin or methadone) if you take suboxone and another opiate together - it will even bump these other drugs out and fill the receptors instead.
Suboxone has a low activity at these receptors though. Although it will bump out other drugs, it cannot activate these receptors in the brain as strongly.
If you take a drug like heroin, and then too soon after take suboxone, the suboxone will kick out the heroin, but it won’t be able to turn the opiate receptors on as well as the heroin. The brain (and body) experiences an immediate drop in the effects of the opiates. This drop in opiate levels of activation causes an immediate sensation of withdrawal.
When your doctor advises you to abstain from opiates for a certain period prior to taking a dose of Suboxone, it is very much in your best interest to listen and follow instructions. If you try to take another opiate drug too soon before your scheduled first dose of Suboxone, you will be making things much harder on yourself!
How long do you have to wait?
Your doctor will advise you on how long you will need to wait prior to taking a first dosage of Suboxone. In general, you will need to wait at least until you are feeling the initial sensations of withdrawal before you can safely take your first induction dosage.
The waiting times will vary depending on the drug of abuse. As a rough guideline, you can expect to have to abstain from:
- Heroin – 12- 24 hours
- Percocet, Vicodin, or Oxycodone – 12-24 hours
- Crushed Oxycontin – 12 – 24 hours
- Oxycontin 24 hours +
- Methadone (must be at low dose) 36 hours (at least)
Source *National Alliance of Advocates for Buprenorphine Treatment http://www.naabt.org/faq_answers.cfm#21
It is in your best interest to follow the advice and instructions of your doctor, and wait until you are truly in the early stages of withdrawal prior to taking a first dosage of Suboxone. After you take Suboxone under supervision in the doctor's office, you can expect to feel much better within a very short time.
Suboxone can also create this precipitated withdrawal if abused by injection, due to the naloxone contained within.
- Clinical Opiate Withdrawal Score (COWS Test)
Your doctor will most likely evaluate your symptoms and the severity of your withdrawal symptoms using this clinical test chart.
- How Long to Stay on Suboxone For
Four pieces of advice on how long you’ll need to use Suboxone from one of America’s leading experts on the use of the drug.