How does suboxone work? One way to easily recall how Suboxone (Buprenorphine) works is to think of a sink faucet. Imagine opening the hot water only. The more one opens it, the hotter the water gets. Eventually you can burn you hand if left under the water. This is the way normal opioids work. Take too much and you get too high, along with stopping breathing. Now imagine starting to open the hot water faucet slowly. You get the warmth, but no burn. Now, as you open the hot water more, begin opening the cold water. Now think of both the hot and cold running full blast: no burn, but you get some warmth initially. Buprenorphine works this way. At lower doses, you will get an initial “buzz” or mild “high.” It feels good. As one takes more, it doesn’t get better an better of a high. It just levels off. In fact, my patients tell me they actually don’t feel well at all at higher doses (usually above 24mg to 32mg)
Suboxone binds tightly to the receptors in the brain, more so than the other narcotics. If you take Suboxone while already on another narcotic, you can go into severe withdrawals. The Suboxone will immediately kick the methadone, oxycontin, or hydrocodone off the receptor and cause immediate withdrawal. This is why I have to have a patient actually in withdrawal before I can start the Suboxone. The general rule has been to get someone down to the equivalent dose of 40mg of methadone and then start the withdrawl process. As long as patients are having some signs and symptoms of withdrawal, I can get them started. It has not been my experience that one needs to be in Severe withdrawal. I usually tell them to think how long it takes them to go moderate withdrawal with some cravings, goosebumps, and maybe sweating. This averages around 12 hours. It has been my experience that it is unnecessary to get to the point of misery (severe cramping and diarrhea) before starting the medication.
I will add that Suboxone for pain works well. This is usually accomplished by using lower doses of the the medication dosed through the day frequently. It used to be that a patient who broke an arm or was having severe pain would be taken off the Suboxone® and placed on morphine or oxycontin briefly; however, what is being tried now is increasing the dose of the buprenorpine per 24 hour period, but taking smaller, more frequent doses during the day. If this situation arises for you, discuss this option with your doctor.
In the above cartoon, if you are confused by the explanations, just think of the analogy. These were the best cartoons I could find on the web without having to resort to drawing pictures…and I cannot draw well.
Find Suboxone Doctors:
If you feel you need help and are looking for a doctor who prescribes Suboxone, click here for our buprenophine physician registry. If you think you may need more intensive treatment such a methadone detox, other opioid detox, or getting started on buprenorphine inpatient, click here for our state opioid treatment center registry.