Hernando County Community Paramedics

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MAT involves a combined approach to treating substance use disorder, involving FDA approved medication and behavioral therapy tailored to a patients unique needs. Medications help to minimize cravings, and the discomfort associated with withdrawal. When the distraction of withdrawal has been removed, studies show that evidence-based therapies are much more successful and significantly increase patient survival rates.

Dependence and addiction are often used interchangeably, but they are not quite the same thing. Dependence is when your body physically adapts to the presence of a substance. For example, when a certain dose of opioids no longer has the desired effect of pain relief or euphoria, that signals dependence. You need to use the drug at that dose just to feel normal. Addiction, on the other hand, is more about your attitude toward a substance. It’s when you’re preoccupied with it. You need it. You are willing to do things you would normally consider unethical to get it. You would rather use that substance than go to work or talk to your friends. Dependence is often a powerful element of addiction, but people often become dependent on opioids without showing the classic signs of addiction. Someone on MAT is technically dependent on the medication, in that they would experience withdrawal if they quit, but the medication helps to forestall the addictive behavior. It’s only trading addiction for dependence, a trade many people can live with.

One of the unfortunate truths about addiction is that some of the changes it makes to your brain may be permanent. Certainly, they last a long time, especially for powerful drugs like opioids. Although the brain is adaptive and always changing, addiction cuts a deep groove and sometimes therapy and positive life changes aren’t enough to protect you from relapse. This is why addiction is typically considered a chronic condition. Like other chronic conditions such as diabetes or heart disease, addiction often requires ongoing treatment. In fact, studies have shown that relapse rates for addiction are comparable to those of diabetes and heart disease, reflecting the challenge of making any major life change.

Suboxone contains buprenorphine (a partial opioid agonist that reduces cravings/withdrawal without causing euphoric feelings or Respiratory depression) and naloxone (which prevents misuse, snorting, smoking, or injecting).

An essential part of starting Suboxone is being transparent about your opioid misuse and  history.  You need to disclose to your provider every drug you’re taking, the dose and the  duration you were taking it. This allows them to individualize your care and ensure your  safety and comfort. 

The initial phase, or "induction," involves fine-tuning the dose based on your symptoms. You can expect your Suboxone dose to begin working within about 30 to 45 minutes after taking it,

which means it will begin to alleviate your withdrawal symptoms and cravings. If you don’t feel a  improvement, your provider may adjust your dose. Some people may feel mild headaches, nausea, or anxiety as their body adjusts.

You must feel withdrawal symptoms (sweating, aches, diarrhea, anxiety) before taking your first dose. Taking it too soon, especially after long-acting opioids, can cause intense, rapid withdrawal. There is no set time that you must wait before taking your first Suboxone dose—it’s contingent upon the severity of your opioid withdrawal symptoms. But there are a few factors that affect your opioid withdrawal timeline and severity, which in turn, affect how  long you have to wait before initiating Suboxone therapy. These factors include the type of  opioid, whether the drug is short-acting, immediate-acting, or long-acting. How much you were taking and for how long, previous withdrawal experiences, individual physiology and liver function.

Eat 15-30 minutes before you take your dose to minimize GI symptoms.

Make sure you don’t have food in your mouth before taking the Suboxone.

Take a sip of water.

Wash your hands.

Place the strip or tablet under your tongue.

Avoid talking, eating, drinking or moving the medication.

Wait until it dissolves.

Rinse your mouth with some water.

Wait at least 30 minutes to eat or drink something

NEVER mix Suboxone with alcohol, benzodiazepines (e.g., Xanax, Valium), or sedatives, as this combination can cause fatal respiratory failure.

Suboxone can make you feel better during withdrawal, but it’s not uncommon to experience some discomfort, both from transitioning off of opioids and also potentially from side effects from the new medication. Be patient – it gets easier. Be proud that you have completed your first day of MAT, and rest assured that it is putting you on a path to a better future. Once stabilized, you will move into a maintenance phase, allowing you to function normally while managing cravings. With your withdrawal symptoms and cravings under control, you can focus on the essential work you’re doing to discontinue your opioid use.