Suboxone is a compound of buprenorphine and naloxone designated for the maintenance treatment of opioid addiction. It is a sublingual medication prescribed in the medically assisted treatment (MAT) of opioid use disorder (OUD).

Suboxone is a controlled Class III/Schedule III substance. This classification authorizes the use of the drug in a medical context; however, the presence of buprenorphine in the drug, which is a partial opioid agonist, poses certain risks including dependence and addiction. The effect of a partial opioid agonist at the brain’s receptor site is subdued in comparison to a full opioid agonist such as heroin or fentanyl. See Suboxone Ingredients: All You Need to Know to understand more about the difference between a partial opioid agonist and a full opioid agonist.

The medication retails in the form of a soluble film that is absorbed sublingually, meaning through the veins under the tongue. The properties of both naloxone and buprenorphine are regulated and controlled when ingested sublingually. However, if inhaled in any capacity or administered intravenously, both chemicals react at a much higher efficacy. If the buprenorphine is snorted or injected, it will surge the brain’s receptor site and initiate a full state of intoxication. This is why naloxone is present in Suboxone. The naloxone will trump the buprenorphine and block the partial opioid agonist from reaching the receptor site. When ingested sublingually as directed, the naloxone dissolves with zero effect. Naloxone should not be ingested by pregnant women or patients with a documented allergy to the chemical. In these instances, buprenorphine mono products such as Subutex could be prescribed or alternate medications like methadone or naltrexone.

Suboxone is formulated at a ratio of 4:1, 4 units of buprenorphine to 1 unit of naloxone. When administered sublingually, the drug becomes fully concentrated approximately 90 minutes after it has been ingested. This is, of course, dependent on the physiology of each individual patient and other variables such as variants in bioavailability. 2.5 to 3 hours following its absorption into the bloodstream, the drug reaches its half-life.

Suboxone Dosage Chart

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Suboxone Dosing Guidelines

The medication is sold in 2mg, 4mg, 8mg, and 12mg strips, and it can be prescribed in doses that range between 2mg and 32mg, although in rare cases higher doses may be needed as the brain’s opiate receptors become saturated at 32mg. At this point, you do not get much benefit from higher doses as the remedying effect of the buprenorphine has essentially reached its capacity. To effectively treat OUD and maintain sobriety, a normal dose of Suboxone usually sits between 12 mg and 24 mg per day. Dosages are printed on the orange Suboxone strip itself. If you are prescribed 16mg, you would place one 12mg strip and one 4mg strip under your tongue in the morning, or you would take four 4mg strips throughout the day. See How to Use a Suboxone Strip to read our top tips for using a Suboxone strip.

The max daily dosage or appropriate dosing of Suboxone is often caused for debate. Some physicians will argue that singular dosing is more effective than split dosing and vice versa. There is also debate around keeping the dose as low as possible. The goal is not necessarily to keep the dose as low as possible; the dose should be determined at the point where the clinical effect is achieved. The clinical effect refers to the total dose in a 24-hour period that keeps all symptoms and effects in place, i.e., withdrawal, cravings, and pain. The purpose of Suboxone is to obliterate pain, withdrawal, and craving. Clinical effect means that you should not be feeling cravings, withdrawal, or pain at any point within a 24-hour period. If you begin to feel symptoms, your dosage should be increased to counteract these feelings.

Suboxone Maximum Dosage

There are risks to overdosing and underdosing the medication. Overdosing can result in death, while underdosing may mean the individual remains in withdrawal. Usually, patients will have reached mild to moderate withdrawal or a score of 17 on the Subjective Opioid Withdrawal or SOWS, a validated opioid withdrawal scale designed for self-administration, and begin Suboxone treatment with a 4mg dose repeated every few hours until the dose reaches 12-16mg on day 1 of treatment.

A target score of 17 on the SOW scale translates to approximately 24 hours with respect to time since last use, but this depends on the drug. More time is required if transitioning from methadone as the possibility of precipitated withdrawal is much higher in this case because the drug is long-acting. If a patient is on methadone, the transition process is more challenging than transition from oxycodone or heroin. This can be managed with your prescriber.

Buprenorphine is approved up to doses of 32 mg. The majority of insurance providers will cover up to 24mg; however, many people do not need more than 16 mg. 

Studies also show that patients who have been using fentanyl need higher doses of Suboxone (between 24mg and 32mg) than patients using heroin and oxycodone. Illicitly manufactured fentanyl and its analogues are high potency synthetic opioids. Fentanyl builds up in the body and causes reduced renal clearance. It is lipophilic, which means it is stored in tissue. This is one of the reasons why precipitated withdrawal can activate when transitioning between fentanyl and Suboxone. Again, it’s important to discuss your options and past use with your prescriber.

No matter the dose, side effects including but not limited to blurred vision, stomach pain, shallow breathing, lethargy, and confusion have been recorded in Suboxone patients. Other side effects like excessive perspiring and slurred speech have also been documented. Your provider may be able to relieve symptoms during your transition onto Suboxone with other medications, called comfort medications. The team at Confidant will establish a treatment plan and Suboxone dosage tailored exclusively to you and work with you through this process.