How long does it take for Suboxone to kick in? Approximately 30 to 60 minutes in most cases, although it may take several repeated doses over time for the full effect to become apparent. The narcotic component in Suboxone, buprenorphine, is rapidly absorbed by the oral tissues but only poorly absorbed when swallowed. That’s why buprenorphine is always supplied as a sublingual film or tablet intended to be held under the tongue until dissolved. After absorption, buprenorphine enters the bloodstream, where it then crosses the BBB or blood brain barrier. The BBB is a permeable, selective membrane that lines the blood vessels of the brain and spinal cord and prevents most drugs and pathogens from entering. Sublingual administration also avoids the first-pass effect through the liver. Most drugs taken orally must pass through the liver before going to the brain. The liver will detoxify the drug the best it can, usually resulting in less of the substance ever reaching the brain, reducing the effect.
Once in the brain, the buprenorphine binds to all three opioid receptors, which are the mu, the delta and the kappa. All three are involved in pain relief, but it’s the mu that is most significantly involved in addiction, tolerance, euphoria, sedation, overdose and reduced gastrointestinal function. Buprenorphine only partially activates the mu receptor, usually enough to relieve withdrawal and reduce drug cravings, but very rarely enough to induce euphoria. The drug has an extremely long half-life, averaging about 36 hours. This means that it takes the body a day and a half just to metabolize half of the ingested dose. Most other opioids, such as oxycodone, hydrocodone and hydromorphone, have half-lives of just a few hours. It’s this long half-life that allows buprenorphine to be dosed only once a day while still remaining effective round the clock.
A typical Suboxone dose is between 8 and 16 milligrams a day, but it can be as much as 24 to 32 milligrams daily. It can also be much less, sometimes as little as 2 to 4 milligrams. The legal limit in most areas is 32 milligrams. Beyond that, being that buprenorphine is only a partial narcotic agonist and not a full one, further therapeutic effect is unlikely. This is referred to as the ceiling effect.
When you begin your first day of Suboxone therapy, you must be in a rather advanced state of opioid withdrawal. In other words, you will feel pretty bad before it’s safe to start buprenorphine. Again, this is due to its partial agonist properties. If taken too soon, the drug can worsen withdrawal symptoms, a condition called PW or precipitated withdrawal. You want to avoid this at all costs. It’s a miserable and untreatable experience. Your doctor will evaluate your withdrawal progress and decide when it’s safe to begin Suboxone. It may take the better part of a day or even longer before you begin to feel better and like you’re out of opioid withdrawal.
Your doctor will likely start you at 4 to 8 milligrams and then wait a couple of hours. If this dose is insufficient, he or she will begin to titrate the dose upwards until a a total dose of up to 24 milligrams has been given. All buprenorphine doses given in the same day will be cumulative in effect due to the long half-life of each one. You will need to be patient and give the buprenorphine a chance to work. Most people will feel much better after anywhere from an hour to six hours after beginning Suboxone therapy as their dose is adjusted and individualized for them. Everyone is different. The worst part is waiting out the withdrawal symptoms until they’re severe enough to begin buprenorphine. For sure, it’s a temporary but major drawback to starting Suboxone therapy.
The only legal alternative at the current time is methadone. Because it’s a full narcotic agonist, there is no waiting period. Therapy can begin anytime.
If you’d like to know more about Suboxone therapy in your area, call us anytime at 833-846-5669. We can refer you to a Suboxone physician near you and also answer any other questions you may have about opioid maintenance treatment. Our counselors are compassionate and knowledgeable. We’re here to help, not to judge. We look forward to your call.