Suboxone treatment
A daily tablet that stops withdrawal, blocks other opioids, and allows take home doses sooner.
What it is
Buprenorphine with naloxone, dissolved under the tongue. It binds tightly but only partly activates, which gives it a ceiling effect on breathing.
How you take it
Once daily under the tongue, never swallowed. Or once a month as a Sublocade injection, which removes daily dosing entirely.
What to expect
You need to be in mild withdrawal before the first dose, or use a low dose start. Getting that timing right is the one thing worth planning carefully.
Nothing on this page is a substitute for an assessment by a clinician who knows your history.
How to get Suboxone in BC
Call us, walk into a clinic, or ask your pharmacy to send a request. You do not need a referral or a family doctor, and appointments are billed to MSP. A physician assesses you, agrees a plan with you, and sends the prescription to the pharmacy you already use. If getting to a clinic is difficult, the same assessment can happen by video anywhere in BC.
The one part that needs planning is timing. Starting buprenorphine too soon after a full opioid can cause precipitated withdrawal, so we either time the first dose to your last use or begin with a low dose start, which lets you build up while still using. Where that timing works out, treatment can begin the same day.
How Suboxone works
Buprenorphine, the active ingredient, is a partial opioid agonist. It binds to opioid receptors very tightly but activates them only partly. Two consequences follow, and both are clinically useful.
The first is a ceiling effect. Past a certain dose, buprenorphine stops suppressing breathing further. This is why overdose on buprenorphine alone is rare, and it is the main reason take home doses can be given earlier than with methadone.
The second is that its tight binding displaces other opioids from the receptor and blocks them from attaching. Using fentanyl on top of an established Suboxone dose generally produces little effect. Many patients describe this as the thing that finally broke the habit of trying.
The naloxone in the combination is there to deter injection. Taken as directed under the tongue, almost none of it is absorbed and it does nothing at all.
Starting Suboxone, and why timing matters
Suboxone has one genuine complication, and being warned about it in advance makes all the difference. Because buprenorphine pushes other opioids off the receptor, taking a first dose while other opioids are still active can trigger sudden, severe withdrawal. This is called precipitated withdrawal.
The way to avoid it is to already be in mild to moderate withdrawal before the first dose. We assess this with you using a standard symptom scale rather than guesswork, and we will tell you what to look for.
Fentanyl makes this harder than it used to be. Fentanyl stores in body fat and clears unpredictably, so the older waiting rules are unreliable. Two approaches are now common in British Columbia:
- Low dose initiation. Very small amounts of buprenorphine are introduced while you continue your usual opioid, then increased over several days. Precipitated withdrawal is largely avoided and you do not have to sit in withdrawal first.
- Standard initiation. You wait until clear withdrawal has set in, then take a first dose under guidance. Faster, but it requires an uncomfortable wait.
Which route suits you depends on what you have been using and how much structure your week allows. This is a conversation, not a rule we apply.
If you stop Suboxone, the blockade lifts while your tolerance is now much lower. This is the most dangerous moment in the whole course of treatment.
Sublocade, the monthly injection
Sublocade is an extended release buprenorphine injection given once a month into the abdomen. It releases medication steadily for four weeks, which removes daily dosing, pharmacy visits and the question of storing medication at home entirely.
It suits people who are stable on daily Suboxone and want their treatment to stop being a daily event, people whose work or travel makes daily dosing impractical, and people for whom keeping opioid medication at home is a risk. You normally need to be tolerating daily buprenorphine for about a week before the first injection.
Ask us about it if daily dosing is the part of treatment you find hardest. It is covered under BC PharmaCare special authority for eligible patients.
Take home doses and daily life
Because the safety margin is wider, carries with Suboxone often begin within the first week or two rather than after months. Many patients settle quickly into collecting a week or more at a time.
The tablet or film must dissolve fully under the tongue, which takes several minutes. Swallowing it wastes the dose, since buprenorphine is poorly absorbed from the stomach. Avoid eating or drinking for about fifteen minutes beforehand, and do not talk while it dissolves.
Most people take Suboxone in the morning. If it makes you drowsy, evening dosing works equally well. Because it is long acting, the exact hour matters less than it does with shorter acting medication.
What this treatment does well, and what to weigh up
Every option has trade offs. Here are both sides.
Where Suboxone is strongest
- Ceiling effect on breathing makes overdose on Suboxone alone far less likely
- Take home doses usually start within the first week or two
- Blocks the effect of other opioids, which removes the incentive to test it
- Fewer interactions with other medications than methadone
- Available as a monthly injection for people who want to stop daily dosing
What to weigh up
- Starting requires being in withdrawal first, unless a low dose start is used
- Precipitated withdrawal is a real risk if the timing is wrong
- Some people with very high fentanyl tolerance are not adequately held by it
- The tablet takes several minutes to dissolve and cannot be swallowed
- Starting from fentanyl needs more planning than it once did
Suboxone treatment: your questions answered
These are the questions our physicians are asked most often about this treatment. If yours is not here, call us and ask.
What is precipitated withdrawal, and how likely is it?
It is sudden, intense withdrawal that can begin within an hour of a first Suboxone dose, caused by buprenorphine displacing other opioids from the receptor faster than your body can adjust. It is deeply unpleasant, though not dangerous in itself, and it usually settles within a day.
It is also largely preventable. It happens when a first dose is taken too soon. With a properly timed start, or with a low dose initiation, the risk is low. This is the single most important reason not to start Suboxone from someone else supply without guidance.
How long do I have to wait after using fentanyl before my first dose?
There is no reliable fixed number any more, and anyone who gives you one is oversimplifying. Fentanyl accumulates in body fat and clears at very different rates depending on how long and how heavily it has been used. Waits that worked for heroin are frequently too short for fentanyl.
This is exactly why low dose initiation has become common in British Columbia. It lets you begin buprenorphine while still using your usual opioid, building up over several days, so the waiting problem largely disappears. Talk to us before you start rather than after a bad experience.
Should I choose Suboxone or methadone?
Both are first line treatments and both work. Broadly, Suboxone is often offered first because of its safety profile and earlier take home doses. Methadone tends to be more reliable at very high opioid tolerance, and it has no induction window, so it can be started without waiting for withdrawal.
The honest answer is that the better medication is whichever one keeps you in treatment. Switching between them is normal and is not a setback. What matters at the assessment is your history, your tolerance, your schedule and what you have already tried.
Can I switch from methadone to Suboxone, or the other way?
Yes, both directions are done regularly. Moving from methadone to Suboxone needs care, because methadone must be reduced to a lower dose first and then cleared enough to avoid precipitated withdrawal. It is planned over weeks, not days.
Moving from Suboxone to methadone is simpler and can usually be done quickly. If your current medication is not holding you, raise it with us. Switching is a normal clinical adjustment.
Will Suboxone block pain medication if I am injured or need surgery?
It complicates it, but pain can still be treated. Buprenorphine occupies receptors tightly, so standard doses of other opioids may have reduced effect. Non opioid pain control is often more effective than expected, and for severe pain there are established approaches your treating team can use.
Tell any hospital or surgical team that you are on Suboxone, and contact us as early as you can before planned surgery so we can coordinate. Do not stop your Suboxone on your own before a procedure.
Can I still feel the effect of other opioids while on Suboxone?
Generally very little, once you are on a full dose. That blocking effect is part of how Suboxone helps, because it removes the point of using on top.
There is an important safety consequence. If you stop Suboxone, the blockade lifts while your tolerance is now much lower than it was, and returning to a previous amount can be fatal. This is the most dangerous moment in the whole course of treatment. If you are thinking about stopping, talk to us first.
How soon can I get take home doses?
Often within the first week or two, which is considerably sooner than with methadone. Because buprenorphine has a ceiling effect, the risk that makes early carries unwise with methadone is much smaller here.
We still need to see that your dose is settled, that you have somewhere safe to store the medication, and that you are attending as arranged. Carries are reviewed continuously rather than granted once and forgotten.
Is Suboxone covered by PharmaCare in British Columbia?
Yes. Suboxone is covered for eligible British Columbia residents, and people on income assistance or disability assistance are generally covered in full including dispensing fees. Appointments with our physicians are billed to MSP.
Sublocade, the monthly injection, requires special authority approval, which we submit on your behalf. Bring your BC Services Card if you have one, and tell us early if you have no coverage so we can sort it out before it becomes a barrier.
If this is an emergency, call 911. Overdose symptoms, trouble breathing, chest pain, seizures or an immediate mental health crisis need emergency care, not a callback form. In British Columbia you can also reach the Suicide Crisis Helpline at 988 or call 811 for HealthLink BC nurse advice.
Ready to talk about suboxone treatment?
No referral needed. Assessment and, where appropriate, treatment the same day.