From the Guidelines
When converting from sublingual Suboxone to oral oxycodone, it is essential to consider the complex potency ratio due to buprenorphine's unique pharmacology, and start with lower oxycodone doses, titrating carefully under medical supervision. Buprenorphine is approximately 30-40 times more potent than oral morphine, while oral oxycodone is about 1.5 times more potent than oral morphine, as noted in the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1. This means that 8 mg of sublingual buprenorphine (the active component in Suboxone) is roughly equivalent to 240-320 mg of oral oxycodone. However, this conversion is complicated by buprenorphine's ceiling effect and partial agonist properties. Due to buprenorphine's strong binding to opioid receptors, patients should wait at least 24 hours after their last Suboxone dose before starting oxycodone to avoid precipitated withdrawal, as suggested by the unique pharmacology of buprenorphine 1. Additionally, patients may experience reduced effectiveness of oxycodone initially as buprenorphine slowly clears from receptors.
When transitioning between these medications, it's crucial to consider the potential risks and benefits, including the risk of respiratory depression or overdose, and to follow established guidelines for opioid prescribing, such as those outlined in the clinical policy for critical issues in the prescribing of opioids for adult patients in the emergency department 1. The recommended initial doses and intervals for short-acting oral opioid formulations, including oxycodone, are provided in this policy, and can serve as a guide for clinicians when titrating oxycodone doses.
Some key points to consider when converting from sublingual Suboxone to oral oxycodone include:
- Starting with lower oxycodone doses and titrating carefully under medical supervision
- Waiting at least 24 hours after the last Suboxone dose before starting oxycodone
- Monitoring patients closely for signs of precipitated withdrawal or reduced effectiveness of oxycodone
- Following established guidelines for opioid prescribing to minimize the risk of respiratory depression or overdose.
From the Research
Suboxone Sublingual to PO Oxycodone Potency
- The potency of Suboxone (buprenorphine) compared to oxycodone is not directly stated in the provided studies, but we can look at the effectiveness of buprenorphine in treating chronic pain and opioid use disorder.
- A study from 2012 2 found that patients who were converted from full-opioid agonists to sublingual buprenorphine experienced significant decreases in pain, with a mean decrease of 2.3 points on a scale from 0-10.
- The same study found that patients who were previously taking oxycodone had a 2.5 point decrease in pain after conversion to buprenorphine.
- Another study from 2017 3 discussed the use of buprenorphine and methadone in the treatment of opioid use disorder, but did not provide direct comparisons of potency between buprenorphine and oxycodone.
- A review of buprenorphine treatment for opioid use disorder in 2019 4 noted that buprenorphine is a partial opioid agonist, which means it has a lower potential for abuse and overdose compared to full opioid agonists like oxycodone.
- A study from 2024 5 compared the effectiveness of buprenorphine/naloxone and methadone for the treatment of opioid use disorder, but did not provide information on the potency of buprenorphine compared to oxycodone.
- A study from 1976 6 is not relevant to the comparison of Suboxone and oxycodone potency, as it discusses immunologic induction of reticulum cell sarcoma in a graft-versus-host model.
Key Findings
- Buprenorphine is effective in treating chronic pain and opioid use disorder, with significant decreases in pain reported in patients who were converted from full-opioid agonists to sublingual buprenorphine 2.
- The potency of buprenorphine compared to oxycodone is not directly stated in the provided studies, but buprenorphine has a lower potential for abuse and overdose due to its partial opioid agonist properties 4.