Author: Diary of a Quitter
Posted: Sun Oct 02, 2011 3:17 pm
There are valid reasons why some Suboxone maintainence patients take doses of >4mgs per day. Some of those reasons are:
1. They are also taking Suboxone for pain management.
2. Maintaining a consistent blood level of buprenorphine. This is an important factor in breaking the addictive cycle of dosing in response to feeling withdrawal. If you’re on such a low dose of bupe that you’re feeling the drop of medication in your blood as withdrawal symptoms either in the late afternoon or upon waking in the morning, and then you feel relief after you dose, then you are reinforcing the stimulus-response-reward circuit in your brain. Studies show that this cycle can become as addictive as the actual drug itself, and breaking this cycle is an important step in healing from addiction. The ability to dose once per day and not really "feel" your dose is conducive to breaking this cycle and unlearning the addictive behavior.
3. Maintaining a blood level of buprenorphine high enough to discourage or prevent relapse. Enough buprenorphine in the blood will block the euphoric effects of short-acting opioids. Some patients find that they need this extra insurance against relapse. Even though a dose of 4mgs may block some or even all effects of other opiates, it would be easier to plan for a relapse on this relatively low dose. Where a person on 16mgs/day would have to abstain from Suboxone for several days and then still might not be able to get high, a person on 4mgs a day would have a much higher chance of a "successful" relapse.
4. Subjective experience. Some patients just feel better on a higher dose. My best friend and I started Suboxone at the same time. I quickly decreased my dose from 16mgs to 8mgs, while she always felt better at 16mgs. I consistently tapered my dose throughout my treatment and my longest maintainence dose was 4mgs. She had to be forced down to 8mgs by her doctor and she really struggled with that dose. Her depression was much worse and she experienced cravings. I was able to complete a long, slow taper down to micrograms and she wasn’t and basically quit cold-turkey when her eligibility for the low-income Suboxone program ran out. She and I are similar in many ways – our history of drug abuse, history of mental illness, age, socio-economic status. So I don’t know what explains the difference, but I think her experience is as vaild as mine. She really did try for a lower dose and it just didn’t work for her.
5. Compliance with treatment. This may not be a factor in a patients conscious decision to stay at a higher dose of Suboxone, but it is something that was considered when dosing recommendations for Suboxone were formulated. A higher dose means it is more difficult to discontinue the medication, which makes it more likely that patients will continue treatment. Since length of treatment strongly correlates to success (as measured by frequency of relapse) this makes sense.
