Contrary to the belief that doctors and some patients hold, Suboxone can in fact be IV’ed/snorted/plugged without going into terrible withdrawals. The commonly held belief is that the naloxone in Suboxone will put you into withdrawals if the medication is snorted or intravenously injected. That isn’t true, plain and simply. However, if one uses a full agonist opioid such as Oxycodone, Hydrocodone, Codeine, Morphine, Methadone etc. and uses Suboxone before they are in withdrawal, or have let the medication leave their system (in the case of the opiate naive) they will be sent directly into what’s called precipitated withdrawal. This will happen no matter what route of administration is used. Precipitated withdrawals are not caused by the naloxone in the pill, but rather the buprenorphineitself. This is because buprenorphine (bupe) has a higher affinity for the opioid receptors in one’s brain than most full agonist opioids. What effectively happens is the bupe shoves it’s way into the receptors throwing the other opioid molecules out. This results in a fast, full-on withdrawal kicking in. I’ve never experienced it myself, but it is hellish, from what I hear. Instead of taking 1-3 days to peak in withdrawal it happens in minutes. Very unpleasant.
However, if you’re on a Suboxone maintenance program it doesn’t matter which ROA you use. The naloxone in the pill is essentially there as a psychological deterrent. I can attest personally that you can snort, shoot or plug and you will not go into any sort of withdrawal as long as you’re stabilized on Suboxone. Some of the other ROAs may be more favorable than because of the higher bioavailability (BA). Sublingually bupe has a BA of approximately 30%. While snorting and plugging have a BA of ~50% and ~70%, respectively.