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What Is Suboxone Microdosing?

Suboxone microdosing involves taking a lower dose of the medication than usually prescribed. This should only be attempted under physician supervision.

How Suboxone Works

Suboxone is a prescription medication containing buprenorphine and naloxone. It is used to treat opioid use disorder (OUD)[1]. The Buprenorphine component of Suboxone is a partial opioid agonist that works by reducing cravings and withdrawal symptoms from opioids.

Suboxone has a “ceiling effect,” which means that at high doses, it does not create the same “high” that full agonist opioid drugs like oxycodone, fentanyl and heroin do. The naloxone component is a further abuse deterrent as it can act to make a user sick if the drug is injected inappropriately.

Suboxone is approved for MAT and is a safe and effective treatment for OUD.[2]

What Is Microdosing?

In general, the term “microdosing” refers to taking very frequent, low doses of a medication  in an effort to get the physiological actions of the medication while minimizing potential side effects. Generally, microdosing means taking about one-tenth of a traditional dose of a medication at more frequent intervals.

In the case of a drug like Suboxone, microdosing would involve taking enough of the drug to keep the opioid receptors activated but not enough to cause the “high” or precipitate withdrawal symptoms if the patient is also concurrently using opioids. Microdosing is a relatively new way of using Suboxone and may only be necessary in certain patients who cannot take standard doses of Suboxone (reasons for which are discussed further below). However, it is a potential option for patients interested in Suboxone therapy who cannot tolerate traditional doses of Suboxone.

Which Patients Should Use Microdosing Instead of Normal Doses of Suboxone?

Suboxone microdosing needs to be done carefully and requires very specific adherence which is why it is not necessary and may be overly complicated for most patients. It might be offered to a patient in very specific circumstances. 

For example, it might be used in a patient who cannot tolerate the side effects of normal doses of Suboxone but is still highly motivated to use the medication for MAT. 

It might also be used for a patient who is highly motivated to quit opioid use but is unable to abstain from opioids long enough to avoid precipitated withdrawal that would occur with standard doses of Suboxone. 

Microdosing is a highly specialized form of therapy, and your suboxone provider may or may not be comfortable trying it. If you are a person who might warrant microdosing, your Suboxone provider may even refer you to a specialist who has a lot of familiarity with Suboxone and specifically with the practice of microdosing. 

How Does Suboxone Microdosing Work?

Typically, when starting Suboxone after taking a full opioid agonist like fentanyl, morphine, oxycodone, or heroin for a prolonged period of time, you will need to wait until the full agonist drug is completely out of the system. In other words, waiting until early withdrawal begins in order for Suboxone to be most effective.

With Suboxone microdosing, you can take a small dose of the medication right away. You do not need to wait for the other opioid drugs to clear your body first. The doses are so small that they will be unlikely to precipitate withdrawal. However, they can still bind up receptors in the brain and exert their “ceiling effect”, slowly limiting the euphoria or “high” of opioid use and simultaneously minimizing the risk of overdose.

With microdosing, you can successfully transition from a full opioid agonist to the partial opioid agonist buprenorphine right away without the need for a taper first.[3]

Is Microdosing Effective?

Suboxone works to keep brain chemicals stabilized and help to minimize drug cravings and withdrawal symptoms. Microdosing with Suboxone can be started immediately. There is no need to wait for withdrawal and drug cravings to start, making it an appealing way to initiate Suboxone for patients who, for whatever reason, cannot tolerate the washout period usually required prior to taking the first dose of Suboxone. It is therefore an effective method for minimizing opioid withdrawal symptoms and helping to treat opioid use disorder.[4]

How to Know if Microdosing Is Right for You

Suboxone microdosing can be a great option for treating OUD for appropriate candidates. Microdosing can be particularly helpful for patients who, for various reasons, cannot abstain from opioids long enough to enter withdrawal organically in order to begin traditional doses of Suboxone.

With Suboxone microdosing, you can transition from full opioid agonists to a MAT protocol right away. But you should only do this under a doctor’s supervision. Microdosing can improve the safety and outcome of treatment and help to prevent the precipitation of withdrawal.[5]

Suboxone can be prescribed by a qualified medical provider to be picked up at your local pharmacy. Suboxone microdosing then can be useful in telemedicine and a highly effective tool for OUD treatment.[6] Talk to your doctor if you think a microdosing strategy might be right for you. 

SOURCES

  1. Suboxone. Indivior. https://www.suboxone.com/ 2021. Accessed January 2022.
  2. MAT Medications, Counseling, and Related Conditions. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions#medications-used-in-mat. November 2021. Accessed January 2022.
  3. Transitioning Hospitalized Patients With Opioid Use Disorder From Methadone to Buprenorphine Without a Period of Opioid Abstinence Using a Microdosing Protocol. Pharmacotherapy. https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/phar.2313. July 2019. Accessed January 2022.
  4. Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings: A Case Study. Frontiers in Pharmacology. https://www.frontiersin.org/articles/10.3389/fphar.2021.631784/full. Accessed January 2022.
  5. Rapid Buprenorphine Microdosing for Opioid Use Disorder in a Hospitalized Patient Receiving Very High Doses of Full Agonist Opioids for Acute Pain Management: Titration, Implementation Barriers, and Strategies to Overcome. Substance Abuse. https://pubmed.ncbi.nlm.nih.gov/33945452/. May 2021. Accessed January 2022.
  6. Buprenorphine Microdose Induction for the Management of Prescription Opioid Dependence. Journal of the American Board of Family Medicine (JABFM). https://pubmed.ncbi.nlm.nih.gov/33945452/. February 2021. Accessed January 2022.

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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