From the Guidelines
Suboxone (buprenorphine/naloxone) is appropriate for patients diagnosed with moderate to severe opioid use disorder who are motivated for treatment and can adhere to the medication regimen. This recommendation is based on the most recent and highest quality evidence, including the CDC guideline for prescribing opioids for chronic pain, which emphasizes the importance of evidence-based treatment for opioid use disorder, such as medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies 1.
The initiation of Suboxone should be considered when a patient is in mild to moderate withdrawal, typically 12-24 hours after last short-acting opioid use or 36-48 hours after long-acting opioid use. The standard induction begins with 2-4mg sublingually, with additional 2-4mg doses as needed for withdrawal symptoms, up to 8-16mg on day one. The maintenance dose typically ranges from 8-24mg daily, with most patients stabilizing at 16mg daily.
Some key points to consider when prescribing Suboxone include:
- Patients should be monitored regularly for adherence, continued substance use, and side effects.
- Suboxone works by partially activating opioid receptors (through buprenorphine) to reduce cravings and withdrawal symptoms while the naloxone component deters misuse.
- Treatment duration is individualized but often continues long-term, as longer treatment is associated with better outcomes.
- Before prescribing, clinicians need appropriate DEA authorization (X-waiver or recent elimination depending on jurisdiction) and should ensure patients don't have contraindications such as hypersensitivity to the medication or severe hepatic impairment.
It's also important to note that the CDC guideline recommends that clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone, for patients with opioid use disorder 1. Additionally, the guideline emphasizes the importance of nonopioid therapy as the preferred treatment for chronic pain, and opioids should be used only when benefits for pain and function are expected to outweigh risks.
Overall, the use of Suboxone for opioid use disorder is supported by strong evidence and should be considered as part of a comprehensive treatment plan that includes behavioral therapies and regular monitoring.
From the FDA Drug Label
INDICATIONS AND USAGE Buprenorphine hydrochloride injection is indicated for the management of pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate The FDA drug label does not answer the question.
From the Research
Appropriate Prescription of Suboxone
Suboxone, which contains buprenorphine, is a medication used to treat opioid use disorder. The decision to prescribe Suboxone should be based on the individual's specific needs and medical history.
- Diagnosis of Opioid Use Disorder: Suboxone is appropriate for individuals who meet the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for opioid use disorder 2.
- Treatment Goals: The pharmacotherapy of opioid use disorder has three overarching goals: to manage withdrawal, to reduce cravings, and to block the effects of nonmedical opioid use. Suboxone can help achieve these goals 2.
- Comparison with Other Treatments: Suboxone is one of three FDA-approved medications for the treatment of opioid use disorder, along with methadone and naltrexone. The choice of medication depends on the individual's specific needs and medical history 3, 4, 5, 6.
- Pregnant Women: Suboxone (buprenorphine) may be prescribed to pregnant women with opioid use disorder, although methadone is also an option 2.
- Barriers to Treatment: Despite the effectiveness of Suboxone, barriers to treatment include poor adherence to treatment recommendations, high rates of relapse, and limited access to treatment 3, 5.
- New Formulations: New depot and implant formulations of buprenorphine have been developed to address issues of safety and problems of poor treatment adherence 3, 5.