Discontinuing Buprenorphine (Suboxone) Detox or Maintenance

Treatment using Buprenorphine (Suboxone) may be stopped or discontinued by a physician for many reasons.

Buprenorphine, and the brand name Suboxone, controls opiate and heroin withdrawal symptoms and is an excellent maintenance treatment for many patients. Comparable methadone, buprenorphine blocks the effects of heroin by binding to the same opiate receptors as heroin; so, opiate addicts who use buprenorphine are not able to get a high from heroin. Suboxone also has a ceiling effect- meaning that increased doses do not generate increased effects. Suboxone is estimated by the Substance Abuse and Mental Health Services Administration (SAMHSA) to be effectual for close to one-half to two-thirds of heroin and opiate abusers.

Even so some patients may require a stronger medication for opiate maintenance. If you continue to feel like using, or if you cannot stop abusing heroin or alternate opiates even when prescribed the highest doses of Suboxone, then your physician might transfer you to methadone or LAAN.

Both methadone or LAAN can exclusively be dispensed at clinics that are licensed to supply those medications.

Patients that are part of a Buprenorphine treatment protocol are frequently required make behavioral "contracts", or agreements, that they sign when they are admitted. Patients that break these contracts have consequences which can include discharge from the clinic.

Acting out, or behavior that is disruptive to the clinic or to other patients can result in discharge from Buprenorphine treatment as well. Unsafe or inappropriate behavior also includes showing up at the clinic intoxicated or loaded, and is another reason treatment may be stopped.

Generally, opiate and heroin detox with Suboxone ends by slowly decreasing the amount of Buprenorphine over a span of 2-3 weeks. The "tapering off" is closely monitored by your Doctor to insure that you do not display signs of acute withdrawal. Although friends and family may be seeing a "new you", (and you may feel great), it is the last days of detox that are often linked to relapse or dischage from treatment.

A primary reason for relapse near the end of detox is post-acute withdrawal. Post-Acute Withdrawal Syndrome (PAWS) is a result of damage to the nervous system caused by the opiates and the emotional and psychological stress that occurs when beginning to experience life without drugs. Although it can appear anytime, it generally occurs 1-2 weeks following phsical detox and stabilization.

As you can see, there are many reasons why Suboxone detox from opiates may be stopped.

What happens next though almost always depends on the patient; their actions and behavior. In some cases, a direct transfer to an inpatient or outpatient facility with another kind of maintenance treatment can be made, for example Methadone at a clinic that has a license to use Methadone as a detox protocol. Ultimately the physician, with input from the patient, will decide whether he/she is referred to another facility, given a 72 hour "cooling-off" period and then re-admitted, or simply discharged.