How long does Suboxone take to work? Like all medications, it may work differently in different individuals, but in general terms, Suboxone crosses rapidly into the bloodstream from the oral tissues. Unlike some other opioids, the partial agonist narcotic in the drug, buprenorphine, is poorly absorbed when swallowed. That’s why it’s supplied as sublingual strips and tablets. To work correctly, these tablets and strips must be held under the tongue until they completely dissolve. Suboxone comes in individually wrapped, square orange strips consisting of 8 milligrams of buprenorphine and 2 milligrams of naloxone, which is an opioid overdose rescue drug. Although oral buprenorphine provides no euphoria for opioid addicts, the same cannot be said for intravenous use. If injected, buprenorphine might be able to cause euphoria and other desirable effects sought by opioid users.
That’s why the naloxone is there. At the 2 milligram dose level, naloxone doesn’t have much of an oral effect. However, if the strip is dissolved in water and injected, the naloxone will target the brain’s opioid receptors and remove all existing opioid molecules from them. It can do this because it has a higher preference for the receptors than opioids do, although naloxone has no narcotic effects of its own. It just acts as an opioid receptor blocker. This is also how it reverses an opioid overdose. This action also causes the person to go into instant, full-blown opioid withdrawal that is untreatable and will last until the naloxone wears off a couple of hours later.
The orange strips are opaque and have a peculiar chemical taste that is and isn’t like mint. If the manufacturer is trying to hide or improve the taste of the drug, they’re not doing a very good job of it.
Suboxone relieves withdrawal symptoms and quells drug cravings very well for most people. However, it has a major drawback. It cannot be taken unless and until the person is well into full opioid withdrawal. If taken too soon, the drug can prompt a full opioid withdrawal syndrome. However, this time it’s far worse than the one caused by naloxone because buprenorphine has a very long half-life. This means the drug can cling to the brain’s opioid receptors, especially the mu receptor, for as long as several days. All that time, the person will be in agonizing withdrawal that cannot be treated because the buprenorphine is sitting on the mu receptor. This reaction is called precipitated withdrawal or PW. It occurs in part because buprenorphine is only a partial narcotic. It activates the mu, but only partially.
PW is never seen in the full narcotic agonist methadone. It can be taken at any point in the withdrawal process or even before it starts with no risk of PW.
Once the opioid addict is well into withdrawal, it will be safe to begin Suboxone therapy. However, it must be no less than 36 hours since the last dose of any opioid other than buprenorphine. By then, the withdrawal process is well advanced, and the person is extremely uncomfortable. Because of the advanced state of withdrawal, it may take the Suboxone the better part of a day to have its full effect. So, the person must wait for additional hours, in some cases, in the utmost pain and discomfort. This waiting period will vary from person to person.
Suboxone will not work for everyone because it’s not a full agonist. It seems to fail most frequently in people with very high usages of very strong opioids like fentanyl or very high-dose oxycodone. Many people may not realize the actual power of oxycodone. Taken orally, it’s actually fifty percent stronger than morphine, and up to 88 percent of the dose reaches the brain’s mu receptor. Very high-dose heroin users may not get sufficient relief from Suboxone, either. However, some do. The only way to know is to try. When Suboxone fails, methadone is available, and it works for virtually everyone, stopping withdrawal symptoms in their tracks and wiping out drug cravings. It’s also a stellar painkiller for people who also require pain relief.
Methadone is unpredictable and dangerous outside of a medical setting. Taking this drug recreationally makes no sense because it’s too slow-acting to produce much euphoria. The risk of accidental overdose is high. Methadone has killed adults in doses as low as 20 milligrams, just four 5-milligram tablets. This is an extreme example, but it has happened. Leave methadone dosing to the professionals.
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