Buprenorphine Dosing and Suboxone Dosing Update

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Buprenorphine Dosing and Suboxone Dosing : Latest Update

Buprenorphine Dosing and Suboxone Dosing Update

Buprenorphine Dosing and Suboxone Dosing Update

I just finished watching an update on buprenorphine dosing and Suboxone Dosing.  It covers the most recent  information for opioid dependency with the use of Suboxone (buprenorphine).  The information is mainly helpful for doctors who are treating their patients who have an opioid dependency, however, some patients and family members may be interested.  I have summarized some of the main points below.

You can find specifics on what exactly is suboxone treatment by going here.  Go to the next link if you are looking for more posts and answers to frequently asked questions about Suboxone treatment.  This treatment for opioid addiction has helped thousands of individuals and it is an alternative to methadone treatment.

Not New With Buprenorphine Dosing and Suboxone Dosing

Doctors are still expected to carefully select appropriate patients before starting buprenorphine dosing or suboxone dosing.  Not all patients should take this medication.  It depends on the same factors that have been important in the past.  Is the patient willing and able to follow the precautions with this medication? Are they willing to go to counseling and not simply take the medication?  Are they willing to seek treatment for other addictions that are common such as alcoholism, cocaine dependence, methamphetamine use, and such.

Is the patient even interested in Suboxone treatment?  I’ve seen patients that have been encouraged by family and friends to seek help with buprenorphine dosing and suboxone treatment.  It can be helpful to discuss the benefits of treatment, but when a patient starts the medication to only please someone else, there is a good chance of failure. The patient needs to understand buprenorphine dosing and suboxone dosing and be willing to follow doctor’s orders with this highly regulated medication.

Prior to starting buprenorphine dosing, the patient should still received the proper consent to treatment. These forms will cover the benefits and dangers of buprenorphine or suboxone treatment.  The information will usually contain a treatment contract covering the expectations of the patient with regard to urine drug screens, clinic attendance, and others involved with treatment.  This consent process has not changed much.

 Buprenorphine Dosing an Suboxone Dosing: What Has Changed

Some doctors are offering buprenorphine dosing at home and the same for suboxone dosing for the suboxone induction (start).  This is a huge benefit for those patients that are reliable enough to start the medication at home rather than at their doctor’s clinic.  The doctor may also follow up over the next few days with phone calls rather than the patient having to come in to the office to change the buprenorphine dosing.  Some doctors will start the patient on 4mg of buprenorphine dose and then increase every hour to 12mg or mor the first day.  Other doctors will give the patient written instruction on how to increase the suboxone dosing on their own within certain parameters and to call if there are any problems.  Most patients can be stabilized within three days.  There is, however, a risk that of opioid withdrawl with this method, but this should not happen if the patient makes sure they are in true opioid withdrawal before starting the suboxone.

When switching from methadone to suboxone, some are saying to reduce the dose of methadone (or other narcotic equivalent) down to 30mg per day before attempting to start induction.  It is also becoming know the large difference people having in how long it takes for them to have withdrawals after stopping the methadone. This can range from 24 to 100 hours.  It is thought a good time to make the switch will be during moderate withdrawals (Clinical Opioid Withdrawal Scale of 12 or 13) with will happen for most coming up on 70 hours or so generally. Trying to switch from methadone to buprenorphine at higher doses of methadone has been found to caused too many side effects.

Buprenorphine Dosing and Suboxone Dosing : Other Considerations

Here is a list of some guidelines for buprenorphine dosing and treatment:

  • Avoid doses over 24mg to 32 mg.  This is likely only for the rare patient. Almost everyone is stabilized on 16mg or less.
  • Consider monthly pregnancy tests for women of child bearing age on buprenorphine and suboxone
  • Consider initial liver function tests and again at 6 months
  • Initial drug screen should include for buprenorphine.
  • Try to get on once per day dosing.  More frequent dosing is unnecessary
  • If induction causes opioid withdrawal, consider continuing treatment and increasing to 16mg. Increasing the dose should not worsen the withdrawals.
  • Buprenorphine patch is NOT for opioid addiction
  • Only good use for buprenorphine alone (as opposed to buprenorphine/naloxone) is during pregnancy for is a patient has a proven naloxone allergy.  Buprenorphine alone has a higher diversion risk.

You can watch the full presentation of is video on buprenorphine dosing and suboxone dosing here.

Find Professional Help With Opioid Addiction

Use our FREE services to find help. We have several directories: a Suboxone Doctor Directory, Methadone Treatment Clinics Directory, a Drug Treatment Directory, and an Alcohol Treatment Directory. These list will help you find drug addiction treatment in your area. Dr. Rich has more articles on drug addiction including: The Real Suboxone Cost and and Understanding What Is Methadone?

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