Buprenorphine Withdrawal: Symptoms, Timeline & Treatment

Buprenorphine can effectively treat opioid addiction and manage chronic pain, but the medication comes with inbuilt challenges. Withdrawal from buprenorphine can occur, even though it’s less likely to trigger dependence and withdrawal than methadone, also used to treat opioid use disorder.

This guide explores how buprenorphine works, how it’s used in opioid withdrawal treatment, the most common buprenorphine withdrawal symptoms, and how to ease them.

What is Buprenorphine

Buprenorphine is a prescription medication mainly used to manage opioid addiction. Introduced in the 1960s, this partial opioid agonist activates the brain’s opioid receptors, but not as powerfully as opioids like heroin, morphine, or fentanyl [1]. This makes it effective in reducing withdrawal symptoms and cravings without triggering the intense euphoria associated with more potent opioids.

Buprenorphine is often prescribed as part of MAT (medication-assisted treatment), a comprehensive approach that blends medications with counseling and behavioral therapies to treat substance use disorders. By stabilizing individuals and reducing their reliance on opioids, buprenorphine enables them to focus on recovery without cravings or severe withdrawal symptoms.

The drug works by binding to opioid receptors in the brain, reducing withdrawal symptoms, and blocking the effects of other opioids [2]. This makes it particularly effective in helping people transition from the use of heroin, fentanyl, or prescription painkillers.

Buprenorphine is available in several formulations, often combined with naloxone to deter misuse:

• Sublingual tablets: Subutex contains only buprenorphine, while Suboxone also contains naloxone (an opioid antagonist). These medications are dissolved under the tongue for quick absorption.
• Extended-release injections: Buprenex is an injection that provides long-lasting effects and is used to treat moderate or severe pain without the need for daily dosing. Sublocade, an injectable used monthly, is also FDA-approved to treat opioid addiction.
• Films: Belbuca and Bunavail are films containing buprenorphine and naloxone.

Buprenorphine has become a first-line treatment for treating opioid use disorder. It is often administered in an outpatient setting, avoiding the need for specialized clinics like those required to dispense methadone. It helps stabilize brain chemistry, reducing the risk of relapse and improving the overall quality of life in those tackling opioid addictions.

Like other opioids, buprenorphine can be addictive—it’s classified as a Schedule III controlled substance [3]. Misuse can lead to dependence and the presentation of buprenorphine withdrawal symptoms upon discontinuation.

Buprenorphine Withdrawal Symptoms

While buprenorphine is highly effective when used as directed, discontinuing its use can provoke withdrawal symptoms. These symptoms occur as the body adjusts to functioning without the medication. Buprenorphine withdrawal tends to be milder than withdrawal from full opioids but can be uncomfortable and challenging without medical oversight.

Physical symptoms of buprenorphine withdrawal include:

• Nausea and vomiting: Many individuals experience digestive upset, including nausea and vomiting, as their bodies adapt during buprenorphine withdrawal.
• Muscle aches: Muscle discomfort can range from mild stiffness to intense pain.
• Sweating and chills: Profuse sweating followed by cold chills is a typical sign of buprenorphine withdrawal.
• Insomnia: Difficulty sleeping often begins in the early stages of withdrawal and can persist.
• Headaches: Withdrawal frequently triggers tension or migraine-like headaches.

Emotional and psychological symptoms of buprenorphine withdrawal include:

• Anxiety and irritability: Withdrawal can heighten feelings of unease and lead to irritability or restlessness.
• Depression: As the brain adjusts to lower opioid levels, individuals may experience feelings of sadness or hopelessness.
• Mood swings: Sudden shifts in emotions are common during withdrawal.
• Cravings for opioids:  One of the most challenging aspects of withdrawal is the intense craving for opioids. These urges can be physical, psychological, or both, making relapse a significant risk. 

The intensity and duration of withdrawal symptoms depend on several factors, including:

• Length of use: Individuals who have used buprenorphine for an extended period may experience more prolonged symptoms.
• Dosage: Higher doses of buprenorphine often lead to more intense withdrawal experiences.
• Individual factors: Genetics, overall health, and co-occurring conditions can influence the severity of symptoms.

Withdrawal symptoms result from the body’s dependence on buprenorphine to maintain equilibrium. Over time, the brain adapts to the presence of the drug, producing fewer natural opioids (endorphins). When the medication is discontinued, the brain struggles to restore balance, leading to the discomfort associated with withdrawal.

Buprenorphine Withdrawal Timeline

Withdrawal symptoms follow a predictable pattern, but the intensity and duration can differ slightly.

Phase 1: initial withdrawal (6- to 48 hours)

Withdrawal symptoms usually begin within 6 to 48 hours after the last dose of buprenorphine. This delayed onset occurs because buprenorphine has a long half-life, meaning it remains in the body longer than many other opioids [4]. During this phase, individuals may experience:

• Restlessness and irritability: A sense of unease is often one of the first signs of withdrawal.
• Mild physical symptoms: These can include sweating, chills, and muscle aches.
• Sleep disturbances: Many people find it difficult to fall asleep or stay asleep during this stage.

Phase 2: peak withdrawal (2 to 7 days)

The most intense symptoms occur during the first week of withdrawal, with a peak around days 3 to 5. This phase is often the most challenging and may include:

• Severe muscle and joint pain: Persistent aches can make everyday tasks difficult.
• Digestive issues: Nausea, vomiting, and diarrhea are common.
• Emotional symptoms: Anxiety, depression, and mood swings can intensify.
• Drug cravings: The urge to use buprenorphine or other opioids is strongest during this time.

Phase 3: post-acute withdrawal (1 to 4 weeks)

After the initial peak, physical symptoms begin to subside, but psychological and emotional challenges often persist. This phase can last for several weeks and is marked by:

• Lingering fatigue: Low energy levels are typical as the body works to regain equilibrium.
• Emotional instability: Mood swings, irritability, and sadness may linger.
• Insomnia: Sleep patterns can take time to return to normal.
• Cravings: While less intense, cravings may continue to surface unexpectedly.

For some individuals, mild withdrawal symptoms may persist for months. This condition, known as PAWS (post-acute withdrawal syndrome), can include:

• Difficulty concentrating: Cognitive fog may make it hard to focus on tasks.
• Emotional sensitivity: Anxiety or depression can re-emerge sporadically.
• Cravings: Urges can persist but typically lessen over time with proper treatment and support.

Understanding the withdrawal timeline can help individuals and their support networks prepare for the process, making managing symptoms and avoiding relapse easier.

Always speak with a healthcare provider before discontinuing buprenorphine. They can design a tapering plan tailored to your needs, minimizing withdrawal symptoms.

Surround yourself with supportive friends, family, or peers who understand your goals and can offer encouragement during challenging moments.

Stock up on essentials like nutritious food, hydration options, and over-the-counter remedies for minor symptoms to create a calming environment.

Understanding that withdrawal is temporary can help you focus on your long-term goals. By preparing physically and mentally, you can face withdrawal with greater confidence and resilience.

Withdrawal Treatment

Buprenorphine withdrawal can be challenging, but effective treatments are available to reduce symptoms and support recovery. The best approach combines medical intervention with emotional and behavioral support to address the physical and psychological aspects of withdrawal.

Medical detox

Medical detox is the safest and most effective way to manage buprenorphine withdrawal. This process occurs in a supervised setting, where healthcare professionals monitor symptoms and provide medications to ease discomfort. Medicines used in detox include:

• Clonidine: Reduces symptoms such as sweating, anxiety, and agitation.
• Anti-nausea medications: Help alleviate digestive distress, including nausea and vomiting.
• Sleep aids: Address insomnia and promote restorative rest.
• Non-opioid pain relievers: Manage muscle aches and headaches.

Abruptly stopping buprenorphine can intensify withdrawal symptoms. A tapering schedule, where the dosage is gradually reduced under medical supervision, allows the body to adjust more comfortably [5].

Behavioral therapies

Behavioral therapies help address the psychological challenges of withdrawal and build skills for long-term recovery.

• CBT (cognitive behavioral therapy): CBT helps individuals identify and change thought patterns that contribute to substance use. It teaches coping strategies for managing cravings and stress [6].
• Contingency management: This approach rewards individuals for achieving milestones, such as abstaining, to encourage positive behaviors.
• Motivational interviewing: Therapists help people explore their goals and motivations for recovery, strengthening their commitment to the process.

Support networks

Having a strong support system is highly beneficial during buprenorphine withdrawal.

• Peer support groups: Groups like NA (Narcotics Anonymous) provide a community of individuals who understand the challenges of addiction and recovery.
• Family and friends: Loved ones can offer emotional support and encouragement during challenging moments.

Lifestyle changes

Simple lifestyle adjustments can improve overall well-being and make the withdrawal process more manageable.

• Balanced nutrition: Eating a diet rich in fruits, vegetables, lean proteins, and whole grains can help the body recover faster.
• Exercise: Regular physical activity releases endorphins, improving mood and reducing stress.
• Mindfulness practices: Techniques like meditation and yoga can ease anxiety and promote relaxation.

Withdrawal is just the beginning of recovery. Long-term care helps people maintain progress and prevent relapse.

Regular counseling sessions and support group meetings provide ongoing guidance and accountability. Developing a plan to identify and avoid triggers helps individuals stay on track.

Some individuals benefit from continued use of medications in a controlled setting to manage cravings and support recovery.

With the right combination of medical care, therapy, and support, it’s possible to work through buprenorphine withdrawal successfully and begin building a healthier, substance-free life.

Get Treatment for Buprenorphine Withdrawal and Addiction

If you need help for yourself or a loved one addicted to opioids, reach out to Renaissance Recovery.

When you choose an outpatient program at one of our California or Florida rehabs, you can live at home, meet your everyday commitments, and get effective treatment for opioid addiction during the day.

The unique nature of all opioid use disorders means all treatment plans at Renaissance are personalized. Therapies might include:

• MAT (medication-assisted treatment)
• Psychotherapies
• Motivational therapies
• Counseling
• Family therapy
• Group therapy
• Holistic treatments
• Aftercare

When you’re ready to recalibrate your life and kickstart your recovery, call 866-330-9449.

Sources

[1] https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/buprenorphine

[2] https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work

[3] https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf

[4] https://www.sciencedirect.com/topics/medicine-and-dentistry/buprenorphine

[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC3150159/