What Are Signs That My Suboxone Dose Is Too Low?

Most people need a few days to adjust to Suboxone. Particularly when first starting, it can require some trial and error to figure out what dose you will need. If you're taking Suboxone for chronic pain, ongoing pain is the clearest sign of a dose that is too small. If you're taking Suboxone for opioid use disorder (OUD), the presence of withdrawal symptoms and cravings may mean you need more. 

How Do I Know If My Suboxone Dose for OUD Is Too Low?

In 2018, about 2 million people had an OUD.[1] Suboxone can help soothe withdrawal symptoms acutely after discontinuing opioids as well as ease cravings to maintain recovery.  

Suboxone contains buprenorphine (an active ingredient that eases pain and OUD) and naloxone (an inert ingredient that is only activated if the medication is inappropriately injected). 

Doctors use a clinical opiate withdrawal scale (COWS) to monitor withdrawal symptoms when you quit using opioids.[2] If you're using Suboxone and have the same symptoms listed in COWS, your dose could be too low. 

These are common signs and symptoms to watch for:

Anxiety

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.

Tremors 

When you hold your hands out straight, your fingertips may wave and wiggle. In severe cases, large muscle groups (like those in your thighs) may jerk and twitch. 

Sweating

You may experience waves of chills and flushing. Your face may turn red, and you may have sweat on your brow. In severe cases, sweat seems to pour off your face in large sheets. 

GI Upset 

Your intestines also contain opioid receptors, and when the drug isn't available, you can have GI related symptoms, include the following:

• Stomach cramps 
• Loose stool or diarrhea 
• Nausea and vomiting 

Opioid Cravings

“Cravings” involve the psychological or mental urge to use opioids. Cravings are complicated to assess because they involve psychological and behavioral components as well as physical symptoms. However, if you notice that you are having strong urges to use opioids or persistent thoughts about using, this may be a sign that you are having cravings and could benefit from an increased Suboxone dose. 

How Do You Know if Your Suboxone Pain Dose Is Too Low?

Suboxone is an effective pain medication. Researchers say 86% of people experience moderate to substantial relief while using Suboxone for chronic pain.[4] If your pain is poorly controlled on Suboxone, you could need a bigger dose. 

Suboxone is administered in different doses for pain control:[5]

• Minimum: 2 mg three times per day 
• Maximum: Up to 36 mg on a schedule your doctor sets

A dose adjustment could involve taking more each time or more frequently.

Talk to Your Doctor 

Never adjust how much Suboxone you take without talking with your doctor first. Tell your doctor right away about how you're feeling and explain that you think your dose is too low. Keep detailed records of how you feel right after taking your dose and when your symptoms worsen. Listen to your doctor's instructions and follow them carefully. At the same time, if you feel your dose is too low, make sure you advocate for yourself and don’t be afraid to ask your doctor for further help in controlling your cravings. They’ll be able to work with you to ensure you get on the right dose.

Sources

1. Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment. July 2022. Accessed October 2022.
2. Clinical Opiate Withdrawal Scale. National Institute on Drug Abuse. https://nida.nih.gov/sites/default/files/ClinicalOpiateWithdrawalScale.pdf. Accessed October 2022.
3. Overdose Deaths Reached Record High as the Pandemic Spread. The New York Times. https://www.nytimes.com/2021/11/17/health/drug-overdoses-fentanyl-deaths.html. November 2021. Accessed October 2022.
4. 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 October 2022. 
5. 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 October 2022.