What is the recommended treatment plan for a patient taking Suboxone (buprenorphine) for opioid use disorder who is now clean?

Patient Education for Suboxone (Buprenorphine) Maintenance Therapy

Continue taking your Suboxone as prescribed indefinitely—this is a long-term maintenance medication that protects you from relapse and overdose, not something you need to stop just because you're "clean." 1, 2

Understanding Your Medication

• Suboxone works by occupying opioid receptors in your brain, preventing cravings and withdrawal symptoms while blocking the effects of other opioids if you were to use them 1, 3
• Your medication contains buprenorphine (a partial opioid agonist) plus naloxone, which prevents misuse by injection 1
• The typical maintenance dose is 16 mg daily, though some patients benefit from doses up to 32 mg daily for better control of cravings and reduced opioid use 1, 4

Duration of Treatment

• Opioid use disorder is a chronic, relapsing brain disease—think of Suboxone like insulin for diabetes or blood pressure medication for hypertension 2, 3
• Longer treatment duration is associated with better outcomes, including restored social connections and lower risk of relapse 2
• Stopping Suboxone prematurely dramatically increases your risk of relapse and fatal overdose 2

What "Being Clean" Really Means

• Being stable on Suboxone IS being in recovery—you are not "using" when taking prescribed buprenorphine 1, 3
• Sporadic opioid use in the first few months is not uncommon and should be addressed with more frequent visits and behavioral therapy, not by stopping your medication 3
• Continue your medication even if you have occasional slips—the goal is harm reduction and long-term stability 3

Combining Medication with Behavioral Support

• Suboxone works best when combined with counseling and behavioral therapies in a "whole-patient" approach 1
• Consider contingency management programs where you can receive material incentives for maintaining abstinence from illicit substances—this has medium to large effect sizes for reducing stimulant use, improving therapy attendance, and maintaining medication adherence 5

Important Safety Information

If You Need Pain Management or Surgery

• Never stop your Suboxone without medical guidance, especially before surgery 6, 1
• For acute pain (injury, dental work, minor procedures): Continue your regular Suboxone dose and your doctor can add short-acting opioid pain medications on top of it 6, 1
• You may need higher doses of pain medication because buprenorphine occupies opioid receptors, but this is safe when properly monitored 6
• For major surgery: Your doctor will decide whether to continue, adjust, or temporarily switch your medication based on expected pain levels 6, 1

Critical Warnings

• Never suddenly stop Suboxone on your own—this can trigger severe withdrawal and dramatically increase overdose risk if you relapse 6
• Avoid QT-prolonging medications (certain antibiotics, antipsychotics, heart medications) as they can cause dangerous heart rhythm problems when combined with buprenorphine 1
• Keep naloxone (Narcan) available at home in case of accidental overdose from other substances 2

Ongoing Monitoring

• Expect regular urine drug testing—this helps your doctor assess for continued illicit opioid use and ensure treatment effectiveness 1, 3
• Attend follow-up appointments consistently for pill counts, prescription monitoring database checks, and assessment of cravings or withdrawal 3
• Get screened for hepatitis C and HIV as part of comprehensive addiction care 1

Common Pitfalls to Avoid

• Don't view being "clean" as a reason to stop Suboxone—premature discontinuation is the most common cause of relapse and overdose death 2
• Don't skip doses or try to taper on your own—work with your doctor if you ever want to discuss dose changes 1, 3
• Don't feel ashamed about being on long-term medication—this is evidence-based medical treatment for a chronic disease 2, 3

When to Seek Help

• If cravings return or intensify, contact your doctor immediately—you may benefit from a dose increase to 32 mg daily 4
• If you experience withdrawal symptoms, don't wait for your next appointment—call your prescriber 3
• If you relapse, continue your Suboxone and contact your treatment team for increased support rather than stopping medication 3