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A Guide to Suboxone Prescribing Requirements

September 24, 2021

Over the last few decades, medication for addiction treatment (MAT) has proven effective for treating individuals with opioid use disorder (OUD), specifically buprenorphine/naloxone (Suboxone). Suboxone greatly reduces a patient’s risk of relapse and helps maintain abstinence. Suboxone has also consistently been shown to work just as well as methadone, without the burden of going to a methadone clinic on a daily basis to get dosed. Learn more about long-term Suboxone treatment.

How Do You Obtain Suboxone?

Patients can get a prescription for Suboxone from a DEA-waivered physician in any treatment setting (like other prescriptions) and can take the medicine in their home. This is in contrast to methadone, for which patients must travel to a highly-regulated specialty clinic (opioid treatment program, aka “methadone clinic”) and have the medicine administered under supervision. Thus, Suboxone often represents an easier, more convenient and less stigmatizing solution for patients seeking access to treatment for OUD. 

Looking for a Suboxone provider? Learn more about finding the right one.

Who Is Eligible for Suboxone Treatment?

If you struggle with dependence or addiction to opioids or opiates (like oxycodone/Percocet, hydrocodone/Vicodin, hydromorphone/Dilaudid, methadone, heroin, or fentanyl), chances are buprenorphine/naloxone (Suboxone) will be a good medication choice to prevent cravings, withdrawals, and overdose. You can also take Suboxone while pregnant

Patients should be at least 16 years old and meet the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for opioid use disorder (OUD), determined via a comprehensive medical assessment:

  • At this initial exam, your provider will assess your eligibility for Suboxone by reviewing your history and current use of opioids, your symptoms of opioid withdrawal, and your prior experience with OUD treatments.
  • Because Suboxone is subject to diversion and abuse, providers will also make an assessment of a patient’s level of stability, the security of his or her home situation, and other factors likely to affect the ability to manage supplies of take-home medication.

Individuals Who Are Ineligible for Suboxone

  • If the patient has serious, severe and uncontrolled/untreated psychiatric problems (suicidality, active psychosis, etc.), it may not be appropriate to initiate Suboxone treatment. On the other hand, patients with milder psychiatric conditions may be started on Suboxone to get their addiction more stabilized and to get their brains thinking more clearly and then engage in more in-depth treatment around their mood (such as starting new medications and/or seeing a therapist). 
  • If the patient has a severe alcohol use disorder, Suboxone use may be contraindicated. Alcohol acts as a depressant, thereby depressing the body’s central nervous system. When buprenorphine/naloxone (Suboxone) and alcohol are mixed together, there is increased risk for sedation, difficulty breathing, overdose, and death.
  • If the patient misuses benzodiazepines, sedatives or hypnotics, Suboxone treatment may have to be postponed. Suboxone can cause some sedation at first, so taking it with other sedating drugs (benzodiazepines such as alprazolam/Xanax, clonazepam/Klonopin, diazepam/Valium, and lorazepam/Ativan; muscle relaxers; tranquilizers; sleeping agents; alcohol) is contraindicated. (Taking too many sedating medications can lead to respiratory depression and even overdose.)
  • Patients should not be prescribed Suboxone if they have a known allergy/hypersensitivity to buprenorphine. However, this is quite rare. 

What to Expect When Starting Suboxone Treatment

Treatment typically begins with supervised administration, progressing to unsupervised administration as the patient’s clinical stability permits.

You will need to be experiencing withdrawal symptoms when starting Suboxone, and your provider will walk you through that process so that you’re able to start successfully and with minimal discomfort. This phase of treatment is called the initiation phase; learn more about the initial withdrawal symptoms.

Ideally, patients should be seen at reasonable intervals (e.g., at least weekly during the first month of treatment) based upon the individual circumstances of the patient. Medication should be prescribed in consideration of the frequency of visits. Provision of multiple refills is not advised early in treatment or without appropriate patient follow-up visits. Periodic assessment is necessary to determine compliance with the dosing regimen, effectiveness of the treatment plan, and overall patient progress.

Once a stable dosage has been achieved and patient assessment (e.g., urine drug screening) does not indicate illicit drug use, less frequent follow-up visits may be appropriate. A once-monthly visit schedule may be reasonable for patients on a stable dosage of medication who are making progress toward their treatment objectives. 

Continuation or modification of pharmacotherapy should be based on the healthcare provider’s evaluation of treatment outcomes and objectives such as:

  • Absence of medication toxicity.
  • Absence of medical or behavioral adverse effects.
  • Responsible handling of medications by the patient.
  • Patient’s compliance with all elements of the treatment plan (including recovery-oriented activities, psychotherapy, and/or other psychosocial modalities).
  • Abstinence from illicit drug use (including problematic alcohol and/or benzodiazepine use).
  • If treatment goals are not being achieved, the healthcare provider should 
  • re-evaluate the appropriateness of continuing the current treatment.

Staying on Suboxone While Getting Back to Work and Daily Life

Generally speaking, it takes 1-3 days to titrate up to a “maintenance” dose (the dose that keeps the person stable without cravings or withdrawal symptoms), and patients often report it can take them 1-2 weeks to get used to this dose and start feeling normal. After a dose change, it usually takes 4-5 days to adjust. When taken appropriately, buprenorphine/naloxone (Suboxone) should NOT make people feel tired or groggy and they should be able to perform all their typical work duties without any restrictions or limitations.

How Long Will Suboxone Treatment Last?

Typically, Suboxone treatment duration should be at least 1-6 months. Addiction is a chronic condition, and research shows that patients who stay on Suboxone long-term are more likely to be opioid-free. Conversely, studies demonstrate that within one month of stopping treatment, more than 50% of patients relapse to illicit opioid use. Therefore, it is very safe to stay on Suboxone for many years, particularly if a patient feels it is helping them to sustain abstinence. However, if you desire to taper off Suboxone, consult with your medical provider in order to slowly taper your dose, as this will help prevent buprenorphine/naloxone (Suboxone) withdrawal symptoms.

All Your Suboxone Questions — Answered

If you have questions about opioids, opioid use disorders, treatments, or other Suboxone-related questions, be sure to browse through our Suboxone FAQs. To learn whether telemedicine Suboxone treatment is a good fit for you, call us at (844) 943-2514 or schedule an appointment here.

Photo by Karolina Grabowska from Pexels

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