Is Suboxone (buprenorphine/naloxone) prescribed on a weekly basis?

Suboxone Prescribing Schedule

Suboxone (buprenorphine/naloxone) is typically not prescribed on a weekly basis but rather with longer prescription intervals, usually 2-4 weeks at a time for stable patients, though the medication is taken daily by patients.

Standard Prescribing Practice

Suboxone is a medication used for opioid use disorder (OUD) treatment that combines buprenorphine (a partial opioid agonist) with naloxone (an opioid antagonist). The prescribing schedule follows these general guidelines:

• Initial Phase: During the induction and early stabilization phase, prescriptions may be written for shorter durations (1-2 weeks) with more frequent follow-up visits 1
• Maintenance Phase: Once stabilized, patients typically receive prescriptions for 2-4 weeks at a time 1
• Daily Administration: Regardless of prescription interval, patients take Suboxone daily, typically as a sublingual film or tablet 2

Monitoring Requirements

The American Academy of Pediatrics and other medical organizations recommend:

• Regular visits for clinical assessment
• Urine drug testing
• Prescription monitoring program checks 1

These monitoring requirements influence the prescription schedule but do not mandate weekly prescribing for most stable patients.

Factors Affecting Prescription Duration

Several factors may influence how frequently Suboxone is prescribed:

• Patient stability: Newly initiated patients or those with recent relapse may require more frequent visits and shorter prescription durations
• Insurance requirements: Some insurance plans may limit the quantity dispensed
• Provider preference: Individual prescribers may have different protocols based on their clinical judgment
• Treatment setting: Office-based practices vs. specialized treatment programs may follow different protocols

Special Considerations

Treatment Agreements

Treatment agreements typically include:

• Regular appointment attendance
• Compliance with consultations
• Engagement in counseling
• Regular urine toxicology and prescription monitoring 1

Dosing

• Initial dosing typically starts at 4-8mg sublingually on the first day
• Target maintenance dose typically ranges from 16-24mg daily 1
• Medication is taken daily by the patient regardless of how frequently it is prescribed

Common Pitfalls to Avoid

1. Confusing prescribing frequency with administration frequency: While prescriptions may be written for 2-4 weeks, patients take the medication daily

2. Inadequate monitoring: Even with less frequent prescribing, regular monitoring through urine drug screens and clinical assessment remains essential

3. Misunderstanding the difference between Suboxone and methadone: Unlike methadone, which in some jurisdictions requires daily observed dosing at specialized clinics, Suboxone can be prescribed for take-home use in office-based settings 3

4. Assuming all patients need the same prescription schedule: Treatment should be tailored based on stability, compliance, and risk factors

In conclusion, while some patients may initially receive weekly prescriptions during the induction phase or periods of instability, the standard practice for stable patients on Suboxone maintenance therapy is to prescribe the medication for longer intervals (2-4 weeks) while maintaining appropriate monitoring.