A healthcare provider should prescribe a patient with opioid use disorder more Suboxone (buprenorphine) when the patient has how many days of medication left?

When to Prescribe More Suboxone

Healthcare providers should prescribe more Suboxone when patients have approximately 5-7 days of medication remaining, ensuring continuous treatment without gaps that could precipitate withdrawal or relapse.

Optimal Refill Timing

The evidence strongly supports prescribing opioid medications, including buprenorphine (Suboxone), with sufficient lead time to prevent treatment interruption:

• For acute opioid prescriptions, guidelines recommend 5-7 day supplies maximum 1, 2, which establishes a framework for medication supply duration
• Monthly prescriptions are standard for stable patients on Suboxone maintenance 3, meaning refills should be written when approximately one week of medication remains
• This timing prevents both medication gaps (which risk withdrawal and relapse) and excessive stockpiling (which increases diversion risk)

Clinical Rationale for 5-7 Day Buffer

Prescribing when 5-7 days remain provides a safety margin that accounts for:

• Pharmacy processing delays 1
• Patient scheduling conflicts
• Weekend or holiday closures
• Insurance authorization requirements
• Prevention of precipitated withdrawal, which can occur rapidly with buprenorphine's long half-life 1

Monitoring Requirements During Ongoing Treatment

For patients established on Suboxone maintenance:

• Monthly prescriptions should be provided after evidence of continued stability 3, including negative urine drug screens and compliance verification
• Follow-up visits should occur at least monthly 4 to assess treatment response, medication adherence, and emergence of concerning behaviors
• State Prescription Drug Monitoring Programs (PDMPs) should be checked before each prescription 2 to identify potential doctor shopping or multiple prescriptions

Common Pitfalls to Avoid

Never allow patients to completely run out of medication before providing refills, as this creates several serious risks:

• Precipitated withdrawal symptoms including tremor, diaphoresis, agitation, diffuse pain, and dysphoria 4
• Increased risk of relapse to illicit opioid use 4
• Treatment discontinuation and loss to follow-up 4
• Potential overdose if patients seek alternative opioid sources 4

Do not prescribe excessive quantities "just in case" 1, as this increases diversion risk and contradicts harm reduction principles 2.

Special Considerations for Unstable Patients

For patients showing signs of instability (positive drug screens, missed appointments, concerning behaviors):

• Consider more frequent visits with smaller prescription quantities (e.g., weekly supplies) 3
• Implement or reinforce treatment agreements 2 specifying prescribing policies and monitoring methods
• Increase monitoring intensity 4 rather than abruptly discontinuing treatment, which is associated with serious adverse outcomes