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The Benefits of Long-Term Suboxone Maintenance Treatment

May 10, 2022

Table of Contents

Suboxone (buprenorphine/naloxone) is a safe medication that reduces the likelihood of relapse to opioid use in people with opioid use disorder (OUD). Many stay on this medication for years.

Since Suboxone can promote sustained recovery, it prevents many of the negative effects of OUD, including mental health issues, physical health problems, financial difficulties, strained relationships, and career difficulties. 

Research shows that long-term treatment with Suboxone significantly improves outcomes compared to short-term treatment, and saves lives.[1] 

Benefits of long-term Suboxone maintenance treatment include the following:

  • Stability
  • Confidence
  • Healthier relationships
  • Better career prospects
  • Increased financial security
  • Better overall health
  • Improved mood
  • Reduced mortality risk due to a lower likelihood of overdose 

The Case for Long-Term Suboxone Maintenance Treatment

Extensive research supports the effectiveness of long-term Suboxone treatment in the treatment of OUD Numerous studies show that buprenorphine reduces the risk of relapse to opioid use and promotes a better overall quality of life.[2]

Medication for Addiction Treatment (MAT), one of which is Suboxone, helps patients remain abstinent from opioids, greatly increasing treatment success rates compared to those not on MAT.[3] 

Methadone has a longer history as an MAT, but studies show Suboxone works as well for OUD relapse prevention as methadone. Both medications eliminate withdrawal symptoms in the short-term, and in the long-term reduce cravings for opioids and reduce the chance that someone will return to use. Both medications can effectively promote long-term recovery when used as a maintenance treatment.[3,4,5] 

Since Suboxone can be prescribed by a doctor and picked up at a local pharmacy, it offers more flexibility than methadone, which must be received in a specialized clinic. Naloxone adds an abuse-deterrent aspect to this combination medication, helping to reduce the potential for misuse. Suboxone is also safer than methadone, as it is more difficult to overdose from taking too much of it.

Vivitrol, which contains naltrexone, is a third option for people looking for a medication to help them stay abstinent. Vivitrol blocks opioid receptors in the brain, and also reduces craving and the chance of overdose if someone uses opioids while on it. However, it can be difficult to initiate people on it, as many days of abstinence from opioids are needed before it can be administered safely.

These features often make Suboxone the prefered MAT option for many people with OUD..

What Is a Proper Suboxone Maintenance Plan?

A Suboxone maintenance plan involves a steady dose of Suboxone for months, years, or indefinitely. 

In the first few days of Suboxone treatment, your prescribing health-care provider will work with you to determine the best dose for you. The ideal dose will alleviate opioid withdrawal symptoms and manage opioid cravings without causing significant side effects. 

On the day of initiation, people will generally receive up to 8 mg/2 mg (buprenorphine/naloxone) in separated doses.[6] On the second day of Suboxone treatment, this dose increases, usually up to around 16 mg/4 mg.

Your doctor will monitor you closely during your first few days of treatment. You may experience initial side effects, such as fatigue. However, as your body adjusts to the medication, these symptoms should lessen within a few days. Some people don’t experience any negative side effects when they initiate Suboxone. 

If you experience opioid withdrawal symptoms or cravings, your doctor may increase your Suboxone dosage until those symptoms are better managed. For most people, the average dose of Suboxone in a long-term maintenance plan remains around 16 mg/4 mg per day.

The highest dose of Suboxone that may be prescribed is 24 mg/6 mg. This is usually only prescribed in the early days of MAT for someone who has a high tolerance to opioids. The accepted recommendation is to limit buprenorphine dosages to less than 24 mg daily.[7]

The goal of Suboxone treatment is to control withdrawal symptoms and reduce cravings. If your doctor lowers your maintenance dosage and you begin to experience withdrawal symptoms, higher cravings, or relapse to opioid use, you’ll likely be returned to your prior dosage.

How Long Can I Be on Suboxone?

Suboxone is a viable long-term maintenance treatment for OUD.[8] 

Studies show that long-term MAT lowers the chances of relapse, thereby reducing the risk of overdose and death. In addition, long-term Suboxone maintenance treatment is associated with reductions in criminal activity and transmission of infectious diseases.[9] 

Ultimately, MAT results in higher success rates in recovery, enabling sustained sobriety and better overall quality of life and preventing death by overdose

Many people remain on maintenance doses of Suboxone for decades. They continue to work, manage responsibilities at home, enjoy healthy relationships and satisfying careers, and function successfully with the help of ongoing Suboxone therapy.  

Does Everyone Need a Long-Term Maintenance Plan?

The specifics of an individual MAT plan will vary according to specific circumstances, but long-term maintenance treatment is associated with better treatment success rates and fewer instances of relapse.[1]

Studies show that long-term maintenance MAT results in improved social function, lower mortality rates, and better quality of life.[10] The longer someone adheres to buprenorphine (Suboxone) treatment, the lower the likelihood of relapse.[12]

While long-term Suboxone treatment is common and often necessary, this doesn’t mean that everyone who takes Suboxone is on it indefinitely. Many people work with their treatment team to gradually taper their dosage over time.

Talk to your doctor about your goals for MAT and how to best accomplish these together.

Medically Reviewed By Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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Citations

  1. Extended Suboxone Treatment Substantially Improves Outcomes for Opioid-Addicted Young Adults. National Institutes of Health. https://www.nih.gov/news-events/news-releases/extended-suboxone-treatment-substantially-improves-outcomes-opioid-addicted-young-adults. November 2008. Accessed April 2022.
  2. Buprenorphine Treatment for Opioid Use Disorder: An Overview. CNS Drugs. https://pubmed.ncbi.nlm.nih.gov/31062259/. June 2019. Accessed April 2022.
  3. Opioid Use Disorder: Medical Treatment Options. American Family Physician. https://www.aafp.org/afp/2019/1001/p416.html. October 2019. Accessed April 2022. 
  4. Buprenorphine vs. Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. Journal of Neurosciences in Rural Practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271614/. January–April 2012. Accessed April 2022.
  5. Buprenorphine Maintenance Versus Placebo or Methadone Maintenance for Opioid Dependence. Cochrane Library. https://www.cochrane.org/CD002207/ADDICTN_buprenorphine-maintenance-versus-placebo-or-methadone-maintenance-for-opioid-dependence. February 2014. Accessed April 2022. 
  6. Highlights of Suboxone Prescribing Information. Indivior. https://www.suboxone.com/pdfs/prescribing-information.pdf. March 2021. Accessed April 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 April 2022. 
  8. Long-Term Suboxone Maintenance Therapy for Opioid Use Disorder: 2 Case Reports. Open Journal of Psychiatry. https://www.scirp.org/journal/paperinformation.aspx?paperid=65510. April 2016. Accessed April 2022. 
  9. Medication-Assisted Treatment for Opioid Use Disorder in a Rural Family Medicine Practice. Journal of Primary Care & Community Health. https://journals.sagepub.com/doi/10.1177/2150132720931720. January 2020. Accessed April 2022. 
  10. Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of Addictive Diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411273/. July 2012. Accessed April 2022.
  11. Relationship Between Buprenorphine Adherence and Relapse, Health Care Utilization and Costs in Privately and Publicly Insured Patients With Opioid Use Disorder. Substance Abuse and Rehabilitation. https://icer.org/wp-content/uploads/2020/10/NECEPAC_MAT_Draft_Scope_042618.pdf. September 2018. Accessed April 2022.

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