If you’re taking Suboxone for pain, discomfort is a clear sign of a too-small dose. If you’re taking Suboxone for opioid use disorder (OUD), cravings and withdrawal symptoms may indicate that your buprenorphine/naloxone dose is too low.
Your Suboxone dose may be too low if you experience opioid withdrawal symptoms, such as:
- Nausea and vomiting
- Abdominal pain
How Do I Know If My Suboxone Dose for OUD Is Too Low?
Doctors use a clinical opiate withdrawal scale (COWS) to monitor general withdrawal symptoms when you quit using opioids. If you’re using Suboxone and are experiencing opioid withdrawal symptoms and cravings, your dose is likely too low.
These are common signs and symptoms that indicate you may need to talk to your doctor about increasing your Suboxone dose:
You may feel irritable and upset. Your mind can’t focus, and your thoughts seem to skip. Others may notice the following:
- Jitteriness: You may pace, tap your toes or grind your teeth.
- Distractibility: You may pick up a task and abandon it moments later.
- Irritability: You may be unable to participate in a clear, focused conversation.
- Panic attacks: You may feel acute bouts of panic in which your heart races and you feel like you can’t breathe.
When you hold your hands out straight, your fingertips may shake. In severe cases, large muscle groups (like those in your thighs) may jerk and twitch.
You may experience waves of chills and flushing and you may feel feverish. Your face may turn red, and you may have sweat on your brow. In severe cases, your face and body may sweat profusely.
Your intestines also contain opioid receptors, and when your Suboxone dose is too low, you can have GI-related symptoms, including the following:
- Stomach cramps
- Loose stool or diarrhea
- Nausea and vomiting
Opioid cravings aren’t a core feature in COWS, but they’re important to assess. If you find yourself thinking about using opioids like heroin, fentanyl or Vicodin, or even planning how to get drugs to misuse, your Suboxone dose could be too low.
The chart below shows different symptoms of opioid withdrawal. If you have high measurements for multiple symptoms, your Suboxone dose may not be appropriate. Ask your doctor whether your dose should be modified.
|Resting pulse rate||Low: 80 or belowHigh: Faster than 120|
|Sweating||Low: AbsentHigh: Sweat streaming off face|
|Restlessness||Low: Able to sit stillHigh: Unable to stay still for more than several seconds|
|Pupil size||Low: NormalHigh: Only the rim of the iris is visible|
|Bone/joint aches||Low: NoneHigh: Unable to sit still or stop rubbing sore spots|
|Runny nose or watery eyes||Low: NoneHigh: Nose constantly running or tears streaming down face|
|GI upset||Low: NoneHigh: Multiple episodes of diarrhea or vomiting|
|Tremor||Low: NoneHigh: Visible shaking|
|Yawning||Low: NoneHigh: Several times per minute|
|Anxiety or irritability||Low: NoneHigh: So irritable or anxious that conversation is difficult|
|Goosebumps||Low: NoneHigh: Visible|
How Do You Know If Your Suboxone Pain Dose Is Too Low?
Suboxone is an effective pain medication. At least one study found that 86% of people experienced moderate to substantial relief while taking Suboxone for chronic pain. If your pain is poorly controlled on Suboxone, you could need a higher dose.
Suboxone is administered in different doses for pain control, often between 2 to 20mg per day.
Suboxone and pain control often go hand in hand, but you might need to work closely with your doctor to find the right daily amount. A dose adjustment could involve taking more each time or taking the same dose more frequently.
Learn more: Suboxone & Chronic Pain
What Is Considered a Low Suboxone Dose?
Suboxone contains buprenorphine (an active ingredient that lessens pain and treats OUD) and naloxone (an ingredient that is only activated if the medication is misused). Several Suboxone doses and strengths exist.
Suboxone films come in the following strengths:
- 2 mg buprenorphine to 0.5 mg naloxone
- 4 mg buprenorphine to 1 mg naloxone
- 8 mg buprenorphine to 2 mg naloxone
- 12 mg buprenorphine to 3 mg naloxone
Suboxone tablets come in the following strengths:
- 2 mg buprenorphine to 0.5 mg naloxone
- 8 mg buprenorphine to 2 mg naloxone
Suboxone’s manufacturer says most people take 4 mg to 24 mg of buprenorphine in one dose per day. However, the organization doesn’t offer any other specifics about a high dose versus a low one. In general, if you’re using medications at the small end of this spectrum, you’re taking a low dose.
People who take a low dose typically have mild pain or OUD caused by low-potency opioids. Those who need high Suboxone doses often have significant pain or OUD caused by very strong drugs like heroin and fentanyl.
Your doctor will choose a dose depending on how severe your OUD symptoms are and what dose effectively manages those symptoms while limiting side effects.Pete Manza, PhD
What is the max dose of Suboxone per day?
Generally, any buprenorphine/naloxone above 16 mg/4 mg is considered a high dose, but it’s not necessarily the maximum. Sometimes, people may be prescribed 24 mg/6 mg, which tends to be the highest dose doctors recommend. Never try taking the highest dose of Suboxone without talking to your doctor first.
The Importance of Getting the Right Suboxone Dose
The amount of Suboxone you need depends on many factors, such as:
- Your physiology
- What opioid you were dependent on
- The opioid dose you were accustomed to
- The Suboxone side effects
- Your OUD symptoms
Most people need a few days to adjust to Suboxone. Particularly when first starting, it can require some trial and error to figure out which dose you need. But it’s critical to get the right Suboxone dose.
Reasons to increase your Suboxone dose include the following:
- Drug cravings
- Opioid withdrawal symptoms
- Drug relapse
- Uncontrolled pain
Learn more: Reasons to Increase Your Suboxone Dose
Without the right dose, you run the risk of OUD relapse and overdose. In a study of people released from prison in Washington state, overdose rates were 12-fold higher than what would normally be expected in the general population. During recovery, brain cells recover and reduce their tolerance for opioids. An opioid dose that you could once tolerate will now cost you your life.
For people in pain, a low dose leads to misery. They could experiment with other drugs to get relief, and that could also lead to an overdose.
Why Are My Suboxone Levels Low?
If your Suboxone or buprenorphine levels are low, you might be swallowing some of your sublingual Suboxone or not taking it correctly.
Suboxone needs to be taken sublingually by placing it under your tongue for between 5 and 10 minutes until it’s dissolved. You also need to avoid eating, drinking, or talking while taking your Suboxone.
Another explanation for low buprenorphine levels is if you miss one or several Suboxone doses. Make sure that you follow your doctor’s prescribing instructions, and if you have trouble remembering to take it, try to set an alarm or write a schedule down.
Talking to Your Doctor
Up to 80% of people aren’t forthcoming with their doctors about information that could be critical to their health. If you’re not telling your doctor the absolute truth about how you’re feeling, you can’t work together effectively to find the right Suboxone dose.
Questions your doctor might ask include the following:
- Are you experiencing withdrawal symptoms?
- Are you feeling drug cravings?
- Have you relapsed to drug misuse?
- How much pain are you feeling?
- Does anything help to ease the pain?
When you answer your questions, be honest. If you can, be specific. For example, if your doctor asks if you’re experiencing withdrawal symptoms, you could add the following level of detail:
- Symptoms you have
- When they start
- What makes them stop
- How severe they are
Never adjust your Suboxone dose without talking to your doctor first. A Suboxone ceiling effect exists, which means that after a certain point, higher doses aren’t always better. Use too much, and the drug stops working. The dangers of overcoming the Suboxone ceiling effect include intoxication and potential overdose.
Frequently Asked Questions About Suboxone
We have compiled some of the most frequently asked questions about Suboxone dosing and signs your dose could be too low.
No, it’s not safe. Never change any part of your Suboxone dose without talking to your doctor first.
Using more Suboxone than your doctor recommends can trigger other OUD symptoms. It’s also illegal. Still, an overdose is unlikely in people who take too much Suboxone.
Most people feel the impact of Suboxone for about 24 hours, which is why doctors typically ask their patients to take one dose per day. However, some people feel like the effects wear off more quickly than 24 hours. In those cases, doctors may choose to prescribe multiple smaller doses each day.
If you’re experiencing OUD symptoms or withdrawal, or your pain isn’t controlled, your Suboxone dose might need a bump.
Microdosing involves taking a small amount of drugs to check for impact and side effects. It’s not often required for prescription medications like Suboxone.
Reviewed By Peter Manza, PhD
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More
- Buprenorphine/Naloxone. Medscape. https://reference.medscape.com/drug/suboxone-zubsolv-buprenorphine-naloxone-343334. Accessed March 2023.
- Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.suboxone.com/pdfs/prescribing-information.pdf. June 2022. Accessed March 2023.
- Differences Between Opioids: Pharmacological, Experimental, Clinical, and Economical Perspectives. British Journal of Clinical Pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555047/. January 2023. Accessed March 2023.
- Clinical Opiate Withdrawal Scale. National Institute on Drug Abuse. https://nida.nih.gov/sites/default/files/ClinicalOpiateWithdrawalScale.pdf. Accessed March 2023.
- Sublingual Buprenorphine Is Effective in the Treatment of Chronic Pain Syndrome. American Journal of Therapeutics. https://pubmed.ncbi.nlm.nih.gov/16148422/. September 2005. Accessed March 2023.
- The Off-Label Use of Sublingual Buprenorphine and Buprenorphine/Naloxone for Pain. Providers Clinical Support System. https://pcssnow.org/wp-content/uploads/2014/02/PCSS-MATGuidanceOff-label-bup-for-pain.Gordon.pdf. May 2022. Accessed March 2023.
- Return to Drug Use and Overdose After Release from Prison: A Qualitative Study of Risk and Protective Factors. Addiction Science and Clinical Practice. https://ascpjournal.biomedcentral.com/articles/10.1186/1940-0640-7-3. March 2012. Accessed March 2023.
- Why Do Patients Often Lie to Their Doctors? Canadian Medical Association Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342698/. January 2019. Accessed March 2023.
- Furo H, Schwartz DG, Sullivan RW, Elkin PL. Buprenorphine Dosage and Urine Quantitative Buprenorphine, Norbuprenorphine, and Creatinine Levels in an Office-Based Opioid Treatment Program. Subst Abuse. 2021;15:11782218211061749. Published 2021 Dec 6. doi:10.1177/11782218211061749