Should You Use Suboxone Calculators?

January 2, 2023

Table of Contents

Currently, Suboxone calculators aren’t really a reliable way for a layperson to determine appropriate dose. Your Suboxone dosage should be determined by a doctor who is taking into account your overall health and past opioid use.

While Suboxone and other drug calculators may give patients a rough idea of dosing estimates, they don’t account for various personal factors that are key in determining your Suboxone dose.

What Are Suboxone Calculators?

Suboxone calculators are tools that allow physicians to calculate the equivalent dose of buprenorphine or Suboxone compared to other opioid medications and estimate the initial dose of Suboxone a patient might need in starting therapy.

Generally, these calculators are known as opioid conversion calculators.[1] They are primarily used by physicians when prescribing pain medication to patients to help them convert between equivalent doses of different opioids.

However, because buprenorphine (Suboxone) is considered a “partial opioid agonist”, it doesn’t have a clear, set conversion rate the way that full opioid agonists due, and therefore buprenorphine calculators are not always as accurate or helpful in determining the dose a patient will need.[3] It is more helpful to receive a personalized, individual assessment from a Suboxone prescriber to help determine the appropriate dose for you.

Are Buprenorphine Calculators Accurate?

Suboxone calculators are not generally used as they have not been studied or proved to correlate well to what dose patients end up needing in practice. There are baseline doses that physicians generally prescribe to patients, and adjustments are made from there as needed.

The prescribing physician conducts an overall assessment of the patient, considering their history of opioid misuse, including the average dosages used and the frequency of use.

The recommended average dose of Suboxone is 8 mg buprenorphine / 2 mg naloxone given in divided doses.[2] However, some patients are on doses as low as 2 mg buprenorphine/0.5 mg naloxone and sometimes as high as 16 mg buprenorphine/ 4 mg naloxone.

Some opioid conversion calculators have attempted to include buprenorphine, but many have now removed buprenorphine from these calculators due to the reasons described above [3].

If we don’t use calculators, how do physicians determine the best dose of Suboxone for a Patient?

All opioid calculators, including Suboxone calculators, have limitations.[4,5] They should never serve as a substitute for an assessment and general oversight from a physician.

Instead of Suboxone calculators, physicians generally start patients at the recommended low dose to minimize other risks and side effects. The physician and patient will then assess the patient’s symptoms. If withdrawal symptoms are controlled, they remain at that dose. If the patient still experiences withdrawal symptoms, they may be given additional doses up to a maximum of 16 mg/4 mg daily.[6]

Some patients may be prescribed higher doses initially, particularly if they have a history of high-dose opioid misuse, but they may later taper back to this recommended maintenance dose.[7]

It generally takes a few days to determine the best dose for a patient. Physicians and patients are in close contact during this initial induction period to ensure that the best dosing level is achieved and maintained.

Your physician will monitor any potential withdrawal symptoms and cravings, so make sure to be honest about anything you experience. This will help them to prescribe the appropriate dosage of Suboxone for your situation, so you have the best foundation for ongoing recovery.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

Sources

  1. Opioid Conversion Calculator Morphine Equivalents — Advanced. GlobalRxPh. https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/. Accessed July 2022. 
  2. Prescribing Information: Suboxone (Buprenorphine and Naloxone) Sublingual Film. Suboxone.com. https://www.suboxone.com/pdfs/prescribing-information.pdf. June 2022. Accessed July 2022. 
  3. Buprenorphine Conversions. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/pharmacological/buprenorphine-conversions. December 2018. Accessed July 2022.
  4. Drug Calculations: Are They Safer With or Without a Calculator? British Journal of Nursing. https://pubmed.ncbi.nlm.nih.gov/16936619/. July–August 2006. Accessed July 2022.
  5. Evaluating the Effectiveness of Calculator Use in Drug Dosage Calculation Among Italian Nursing Students: A Comparative Study. International Journal of Clinical Skills. https://www.ijocs.org/clinical-journal/evaluating-the-effectiveness-of-calculator-use-in-drug-dosage-calculation-among-italian-nursing-students-a-comparative-study.html. July 2017. Accessed July 2022. 
  6. Buprenorphine: Quick Start Guide. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf. Accessed July 2022.  
  7. Participant Characteristics and Buprenorphine Dose. American Journal of Drug and Alcohol Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272773/. September 2011. Accessed July 2022.

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