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Suboxone Dosage: Standards, Adjustments, and Side Effects

What's it like to attend an opiate treatment program?
What’s it like to attend an opiate treatment program?

The Commission on Accreditation of Rehabilitation Facilities (CARF) has much to say about the dosage of methadone for clients in medication-assisted treatment (MAT) programs, but it offers little instruction about Suboxone dosage. That’s because methadone is actually administered on site at the MAT facility, while Suboxone prescriptions are provided to the clients to be filled at their local pharmacy of choice. Whether people take methadone or a Suboxone, however, they should be carefully monitored to ensure that they are adjusting physically to the medication.

The CARF Standards provide guidelines for facilities that offer methadone treatment. According to these standards, the initial daily dosage of methadone should be determined for each patient individually by the examining physician. Additionally, if the initial daily dose exceeds 40mg, documentation must be provided to show that lower dosages up to 40mg failed in alleviating the patient’s withdrawal or abstinence symptoms. However, the standards do not specify any particular dosage for Suboxone, the only other medication approved for use in MAT programs.

Who Sets Suboxone Dosage Guidelines?

Suboxone dosage guidelines can be found on the website of the Substance Abuse and Mental Health Services Administration (SAMHSA). While companies that produce buprenorphine in different forms may have information on their websites about Suboxone dosage, SAMHSA is the ultimate authority on determining Suboxone dosage for MAT programs.

In the past, documentation of a year-long treatment for opiate addiction was necessary to obtain dosages of buprenorphine or Suboxone. However, in recent years, this requirement has been waived, allowing doctors who are certified according to the DATA 2000 requirements to prescribe Suboxone dosages immediately after a patient’s admission to an MAT program.

In 2012, legislation further expanded Suboxone prescribing guidelines so that treatment programs that have met licensure and certification standards would be the official prescriber and eliminate the need for physicians to obtain DATA 2000 waivers. However, just about all physicians who work in MAT programs and write for Suboxone dosages have taken the recommended training. Those who have not may have become Board certified by the American Board of Addiction Medicine.

Your Initial Suboxone Dosage

Even if you tell the assessment counselor at the MAT program that you want to be on the Suboxone program, in most cases, it will be up to the MAT program physician to make the final decision whether you can take Suboxone versus methadone. While the doctor will consider your preferences, their decision regarding your treatment plan will be primarily based on your past history of opiate use and previous treatment attempts, as well as your insurance coverage. If you enroll in the Suboxone program and fail to comply with program guidelines, the doctor may switch you to the methadone program

The initial Suboxone dose for most people is 4mg or 8mg, and you will have to return to the MAT program clinic within a couple days for re-evaluation. If you continue to experience withdrawal symptoms, it is unlikely that the doctor will immediately increase your Suboxone dosage. This is because the effects of Suboxone tend to improve gradually as your body adapts to it. Once you reach a moderate dosage range of 8mg to 20mg, the effectiveness of the medication should level off. It is uncommon for individuals to require a Suboxone dosage greater than 24mg.

When Suboxone Causes Danger

Nausea, vomiting, muscle aches and cramps, restlessness, irritability, constipation, and cravings are among the potential side effects of buprenorphine formulations, including Suboxone. It is important to note that Suboxone can also potentially depress the respiratory system, which can be particularly risky for individuals with asthma or COPD.

Individuals who struggle with opiate addiction often neglect their overall health, as their primary focus is obtaining their drug of choice. They may fail to recognize the detrimental effects of poor nutritional habits and unhealthy lifestyle choices, such as smoking cigarettes.

A physician in Boston was intrigued by the data concerning individuals who experienced nonfatal overdoses and whether they continued on the medication that caused the overdose. Specifically, the doctor looked back over a dozen years at nonfatal overdoses and what happened to the patients afterward. Surprisingly, 91 percent of those who overdosed on pain medication resumed using the same medication after they were treated for their overdose. Moreover, 70 percent of these patients continued to get their medication from the same doctor.

The critical issue that everyone overlooked is that the individual was either consuming a pain medication dosage that exceeded the recommended limit or taking more than what was prescribed by the doctor. Furthermore, in 70 percent of cases, the physician did not modify the medication regimen or consider alternative therapies like physical therapy or acupuncture.

It is crucial to consider the potential risks for individuals whose respiratory system is depressed due to their Suboxone dosage. For instance, if they visit a hospital emergency room, receive a few respiratory treatments, and are discharged without any modification to their Suboxone dosage, it could be a potentially dangerous situation. These cases were included in the doctor’s research.

In some cases, the patient failed to communicate that they were on Suboxone therapy. Even when the patient shared their medical history of participation in an MAT program, the doctor failed to recognize that the Suboxone dosage could be the cause of the respiratory depression. In fact, the hospital and emergency department doctor often failed to notify the MAT program that the person had been in the emergency department. The restrictions that govern communication about MAT treatment worked against those patients, increasing the odds of a repeat episode of respiratory depression.

The biggest risk is that the next episode of respiratory depression could be fatal. Adjusting the Suboxone dosage can alleviate respiratory depression and other side effects. This highlights the importance of regular communication with your doctor.

Communication Is Key

Suboxone therapy is all about communication. SAMHSA and other professional and regulatory agencies all agree that medication-assisted treatment works best when it is accompanied by individual and even group counseling sessions. Participation in 12-step meetings or guidance with a peer specialist or mentor contribute to overall success in MAT programs.

Effective communication with your team of substance abuse specialists is vital to your success. Don’t hesitate to speak up and let your counselor, nurse, or doctor know if you experience any discomfort or concerns. A simple adjustment to your Suboxone dosage may be all that’s needed to avoid a trip to the emergency department. By doing so, you can regain your quality of life and fully participate in the world with happiness and pride. Make the decision to participate in a Suboxone therapy program, and make your first phone call today.

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