How long should you wait before taking Suboxone?

You typically have to wait 12-24 hours after last using short-acting opioids before you start taking Suboxone as a treatment for opioid use disorder. The exact length of time depends on the type of opioid use (long- or short-acting), the time since last opioid use, and the degree or level of opioid dependence. To avoid precipitating an opioid withdrawal syndrome, the first dose of Suboxone should only be started only when objective signs of moderate withdrawal appear.
Short-acting opioids, like heroin, take effect more quickly and are eliminated from your bloodstream faster than long-acting opioids, like methadone.

For patients dependent on methadone or long-acting opioid products, induction should not be with Suboxone, instead sublingual buprenorphine monotherapy is recommended on Days 1 and 2 of treatment, according to approved administration instructions. This is because patients who are dependent on long-acting opioid products such as methadone may be more susceptible to precipitated and prolonged withdrawal during induction than those on short-acting opioid products. Buprenorphine/naloxone combination products (Suboxone) have not been evaluated in adequate and well-controlled studies for induction in patients.

This waiting period is necessary because it's important to start treatment with Suboxone when you are already having early symptoms of opioid withdrawal. That means the opioid drug is starting to leave your body, causing gradual symptoms. If you take Suboxone when you still have opioids in your system and are not beginning to experience withdrawal, it can trigger sudden and intense symptoms, called precipitated withdrawal.

Suboxone is a combination of the drugs buprenorphine and naloxone. Buprenorphine binds to opioid receptors in the brain, displacing the opioids that are currently attached to these receptors. So, taking buprenorphine after recently using opioids can cause precipitated withdrawal, instead of these opioids slowly losing their effect. (Naloxone is added to prevent drug misuse.)

Your doctor will need to know what type of opioid you used and when you last used it to decide when to start treatment to manage opioid withdrawal. The Clinical Opiate Withdrawal Scale (COWS) or another scale may be used to measure your withdrawal symptoms and determine when to begin treatment.

You may first take buprenorphine alone to manage opioid withdrawal symptoms, and then switch to Suboxone after a day or two. Sometimes treatment begins with taking Suboxone right away.

Suboxone comes as a film you put under your tongue (sublingual) to dissolve. You and your doctor will decide whether Suboxone is the right medication for you, based on factors like your medical history and personal preferences.

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