Establishing a Maintenance Dose of Buprenorphine
Clinicians can determine their patients' ideal daily dose within the first few days of induction. The next few weeks are a stabilization period, during which time patients should be maintained at their daily dose with close monitoring and adjustments as needed. Regular and frequent clinic visits (recommended: weekly) should continue until the patient stabilizes medically and psychosocially.
At an ideal daily dose, the patient should experience no withdrawal symptoms and no cravings. Most patients' daily maintenance dose is between 12 to 16mg, but may be up to 32/mg.
The maintenance phase will continue indefinitely for most patients (SAMHSA 2004). Long-term maintenance is recommended due to high relapse rates. For example, in one study of 255 individuals, approximately 87% relapsed at 3 months (Ling 2009).
Patients can be maintained at a 12-16 mg daily dose indefinitely, as long as the patient is comfortable and happy with treatment (McNicholas 2011). Clinic visits can be decreased but patients should still be seen regularly. Clinicians should monitor the patient's cravings for opioids and adherence to psychosocial therapies. Additionally, conduct periodic lab testing:
- Monthly urine toxicology screens
- Conduct initial pregnancy tests for all women of childbearing age, and ask each month, thereafter, if the patient thinks they may be pregnant, or test the patient as seems indicated. Request to be notified if they think they are pregnant.
- Liver function tests every 6 months, if the initial test was abnormal, or with liver disease
Opioid abuse during maintenance should not be grounds for terminating buprenorphine treatment. Alternative responses include checking on proper use of buprenorphine and dose, increased office visits, and making continued treatment contingent on increased psychosocial support.