Suboxone contains buprenorphine and naloxone. Buprenorphine is the active opiate in Suboxone. Buprenorphine is a partial opiate agonist. An agonist stimulates the opiate receptor in the brain. Because buprenorphine is a partial agonist, it only stimulates the opiate receptors about half as much as the other opiates. When all the opiate receptors are saturated with buprenorphine, maximum opiate stimulation is reached. Most patients reach this level on 16 to 24 mg of Suboxone per day.
The other unique quality of buprenorphine is that it has a stronger affinity or attraction for the opiate receptors than every other opiate. Therefore, if you have any other opiate in your brain when you take buprenorphine, buprenorphine knocks the other opiate off the brain receptors. This is the reason you don’t take your first Suboxone until you are in moderately severe withdrawal. If you take it too early and there is still significant saturation of receptors by another opiate such as heroin, OxyContin, or methadone, and you have a high tolerance, buprenorphine will knock off a stronger opiate and replace it with the weaker, partial agonist buprenorphine, and cause you to go into withdrawal. And you may have to wait for hours to days for your tolerance to decline to where buprenorphine can relieve your withdrawal.
This stronger attraction of buprenorphine to the receptor provides protection from overdose from all other opiates because they can’t get into the blocked receptor.
This stronger attraction of buprenorphine to the receptor also gives it a much longer duration of action than most other opiates. This causes a slower, more gradual onset of withdrawal if Suboxone is stopped abruptly. When patients want to detox off Suboxone, they need to wait for a week after a reduction to see if they are going to have withdrawal from that step down. If they are having any withdrawal, they should not make another reduction. Most successful successful withdrawals from maintenance Suboxone are achieved by small reductions of 15 to 25% of total daily doses with at least one week between reductions.
If you are on a usual maintenance dosage of Suboxone of 16 to 24 mg per day, taking another narcotic results in no effect either good or bad. The Suboxone is holding on to the opiate receptor in the brain so tightly that the other narcotic can’t get into the receptor at all.