Suboxone Withdrawal: Symptoms, Timeline, Tapering, and the Sublocade Tail

Does Suboxone cause withdrawal?

Yes. Suboxone is buprenorphine plus naloxone, and the FDA label says long-term buprenorphine produces physical dependence of the opioid type, with withdrawal after an abrupt stop or a rapid taper. The same passage carries the two facts that shape everything below: the withdrawal is typically milder than with full agonists such as heroin, oxycodone or methadone, and it may be delayed in onset.

Physical dependence on a medication is not the same as addiction. Someone who takes buprenorphine exactly as prescribed can still have withdrawal if they stop suddenly, and that alone does not mean addiction. It does mean the way off should be planned.

Suboxone withdrawal symptoms

The labels describe buprenorphine withdrawal as opioid-type withdrawal, so the list is the familiar one. MedlinePlus splits opioid withdrawal into early and later symptoms:

Craving runs under all of it. Vomiting and diarrhea can dehydrate someone. A person who cannot keep fluids down needs medical care the same day, and vomiting that will not stop is a reason to call 911.

Withdrawal on a steady dose

Symptoms like these while still taking Suboxone every day are a different problem. The label tells prescribers to adjust the maintenance dose to a level that holds the patient in treatment and suppresses withdrawal signs and symptoms. Withdrawal between doses is information for the prescriber, not a reason to take extra film or to add something else.

Suboxone withdrawal timeline

Milder and delayed is not the same as short or easy. A slower drug can mean a withdrawal that arrives after the person has stopped expecting it. The practical rule is to stop on a plan, with the prescriber, and to keep the appointment that follows.

How to taper off Suboxone

When discontinuing, the label says, gradually taper the dose. It adds that the decision to stop after a period of maintenance should be part of a comprehensive treatment plan, and that patients should be told about the potential to relapse after stopping. ASAM’s 2020 guideline goes further on pace: a buprenorphine taper and discontinuation is a slow process, generally accomplished over several months, with close monitoring, and patients should be encouraged to stay in treatment for monitoring past the last dose.

Two trials show what happens when the taper is treated as the end of treatment.

• In a 2009 multisite trial of 516 people tapered off Suboxone after about a month of stabilization, a 28-day taper did no better than a 7-day taper. One and three months later, only 12 to 18 percent of either group gave urine samples negative for illicit opioids.
• In a 2011 trial of people dependent on prescription opioids, 360 who had not done well after a first, 2-week taper went on to a 12-week course of buprenorphine-naloxone. At week 12, while still on it, 49 percent had a successful outcome. Eight weeks after a 4-week taper, 8.6 percent did. Extra counseling did not change that.

Both trials tapered quickly by ASAM’s current standard, and both studied people early in treatment. They do not show that no one can come off. They show that coming off early, and fast, did not hold for most people in them.

What helps during a buprenorphine taper

The prescriber sets the steps with you, and a step that goes badly can be paused or reversed. For the symptoms themselves, there is non-opioid comfort medicine. Lofexidine (Lucemyra) is FDA-approved to ease opioid withdrawal symptoms for up to 14 days; its label warns about low blood pressure and slow heart rate and says it is not a treatment for opioid use disorder.

Sleep and stomach trouble belong with the prescriber too. Benzodiazepines bought elsewhere are the wrong fix: the Suboxone label warns about combining it with benzodiazepines and other sedatives.

Sublocade and Brixadi withdrawal: the long tail

Injectable buprenorphine stops differently, because the depot keeps releasing drug after the last shot.

The trap is timing. Symptoms that show up weeks or months after the last shot can be easy to blame on something else. Tell the prescriber before the last injection, not after, so the plan covers those months. Our Suboxone, Subutex and Sublocade guide covers how long each form stays in the system and how the injections compare.

The risk after the last dose

Opioid withdrawal is rarely fatal by itself, but tolerance falls within days, so a return to a former dose can be fatal. For someone coming off buprenorphine, the first day of using again can be more dangerous than the worst day of withdrawal.

Pooled cohort studies in the BMJ (Sordo, 2017) and JAMA Psychiatry (Santo, 2021) found all-cause death rates about half as high or lower during time on methadone or buprenorphine than during time off them. The Sordo review also found sharply higher death rates in the weeks right after people leave opioid agonist treatment. A 2020 study of Medicaid patients who had taken buprenorphine for at least six months found that about 5 percent had one or more medically treated overdoses in the six months after stopping, and about 42 to 50 percent went to an emergency department at least once. Staying on longer helped on some measures, but the risks stayed high in every group.

ASAM says anyone stopping buprenorphine should be told about the higher risk of overdose death if they return to illicit opioids, and should hear about methadone, naltrexone, and naloxone. Have naloxone at home and make sure someone else knows where it is. Do not use alone. Our naloxone guide for families explains where New Jersey residents can get it.

Is it safe to stop Suboxone cold turkey?

It is the approach the label and ASAM both steer away from. ASAM recommends withdrawal management over abrupt cessation, and its reason is specific: a sudden stop can bring strong cravings and acute withdrawal, and with them a risk of relapse and overdose. If a prescription runs out or a pharmacy cannot fill it, call the prescriber that day; do not stretch the supply on your own. If you are pregnant, do not stop on your own: ASAM recommends treatment with methadone or buprenorphine rather than withdrawal for pregnant people who are physically dependent on opioids.

If someone is using fentanyl again after stopping and wants back on buprenorphine, the restart carries a risk of precipitated withdrawal. Our fentanyl withdrawal guide explains why, and our methadone withdrawal page covers the other main medication.

In New Jersey

Under New Jersey law P.L.2017, c.28, fully insured New Jersey plans and the State Health Benefits and School Employees’ plans cannot require prior authorization for the first 180 days per plan year of in-network treatment your own physician, psychologist or psychiatrist finds medically necessary, or, during those same 180 days, for outpatient prescription drugs that treat substance use disorder, such as buprenorphine and naltrexone, when that clinician finds them medically necessary. Self-funded employer plans, Medicare and Medicaid are not covered by that rule, so verify with the plan.

NJ FamilyCare covers buprenorphine, methadone, and naltrexone. Residential detox is authorized through the IME for most members, and residential care and opioid treatment programs are scheduled to move into the NJ FamilyCare health plans in January 2027. The opioid detox guide lists New Jersey’s licensed opioid-capable programs, and our outpatient detox guide covers care that does not need a bed.

For help independent of us, the state’s IME Addictions Access Center at 1-844-276-2777 screens NJ FamilyCare and uninsured residents and refers them to treatment, and ReachNJ, the state treatment line, is at 1-844-732-2465. Periscope Behavioral Health, which publishes this site, is opening a medical detox in Hammonton, Atlantic County, expected Summer 2027. Until it opens, Periscope Behavioral Health at (888) 313-3583, our publisher’s admissions line, can talk through options in New Jersey and Florida, including facilities Periscope operates. What a plan covers depends on the plan and the facility’s network status.

What to settle with the prescriber first

Start with why now, and be honest about it. The reason is part of what the prescriber needs to set the pace. Then agree on the size of each step, the time between steps, and what would make you both slow down or stop.

Book the first visit after the last dose before the taper starts, and leave with naloxone. On Sublocade or Brixadi, also settle who is watching for withdrawal in the months after the last shot, because that is when the labels say to look for it.