Suboxone "Microdosing"
An alternative gentle induction approach for the treatment of opioid use disorder
Suboxone (buprenorphine–naloxone) “microdosing”: a fresh alternative to getting started with treatment for opioid use disorder https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970598/
Microdosing schedule for Suboxone
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Day 1: 0.5 mg once a day
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Day 2: 0.5 mg twice a day
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Day 3: 1 mg twice a day
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Day 4: 2 mg twice a day
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Day 5: 3 mg twice a day
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Day 6: 4 mg twice a day
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Day 7: 12 mg (stop other opioids)
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Day 8: 16 mg (stop other opioids)
Typically to get started on Suboxone patients have to stop using for a day or two. This “opioid washout” is painful and challenging.
To address this, the “microdosing” strategy was developed. It starts with small doses and small dose increases over a week or more while patients can continue to use other opioids (either prescribed or illicit) until a therapeutic dose of Suboxone has been achieved.
Suboxone has a strong opioid receptor binding affinity meaning that it will replace other opioids from the brain and hold its position. By day 7 most receptors will be occupied by suboxone and NOT by the other opioid(s); these will be floating as extras and are no longer needed. That's why they can be stopped without having withdrawal.
Opioid replacement therapy is essential, at least for a while, to prevent going back to problematic opioid use. Suboxone can be gently lowered to allow the brain to heal over time.