Microdosing Buprenorphine/
Naloxone
What is Burprenorphine/
Naloxone?
Buprenorphine/naloxone (BUP/NX) is a medication used to treat opioid use disorder. It is commonly known as Suboxone, a brand name. BUP/NX comes as a pill or film taken once a day by dissolving under the tongue. Buprenorphine is a long acting opioid that reduces cravings and withdrawal.
Naloxone is included to prevent people from injecting this medication. Naloxone is not absorbed when you take the pill, but it is if injected and would cause withdrawal. BUP/NX works as well as methadone, but is safer and easier to get take-home doses (carries).
What is Microdosing?
Microdosing is a new way to start BUP/NX, commonly known as Suboxone. When using this method, you continue your current treatment or opioid use while taking very small (micro) doses of BUP/NX once or twice a day. BUP/NX levels slowly build up in your system and when they reach a certain level it is safe to stop your current opioids and stay on BUP/NX alone.
Who can start/switch to BUP/NX?
BUP/NX can be used as a treatment for anyone using illicit opioids, prescribed opioids or on methadone treatment. Traditionally, in order to start BUP/NX treatment, you must be in opioid withdrawal. Microdosing is a new way to start without having to stop other treatments or be in withdrawal.
What are the risks of microdosing?
Some people will experience withdrawal during the microdosing process. If this occurs, we may continue with the schedule, adjust it, or switch back to your previous medication.
On the final microdosing day, some people will experience withdrawal. This is because the 12 mg dose of BUP/NX is not high enough to replace your previous medication dose. This will get better as we can increase BUP/NX rapidly by 4 mg each day until your withdrawal stops.
What dose of methadone should I be on to microdose?
People on higher doses of methadone (above 80 mg) may have more difficulty when microdosing. Usually, I prefer patients to be on 80 mg or less before starting a microdosing BUP/NX switch. There are ways to microdose even on doses above 80 mg, usually involving a slower microdosing schedule. We would be happy to discuss this with you.
What if it doesn’t work for me?
We can switch you back to your previous medication (or try again)!
Further questions?
If you have any further questions, please call the office and book an appointment with me and we can discuss things.
Source: Written by Dr. Mike Gniewek (2024) for his patients