The Benefits of Long-Term Suboxone Maintenance Treatment

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 preferred 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 healthcare 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 separate 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.

Why Should Therapy Be a Part of Suboxone Treatment?

Many patients taking medication for opioid use disorder (OUD) may benefit from counseling as part of their treatment. In fact, the Food and Drug Administration (FDA) label for Suboxone states, “Suboxone sublingual film should be used as part of a complete treatment plan that includes counseling and psychosocial support.” 

Counseling helps people with OUD change how they think, cope, react, and acquire the skills and confidence needed for recovery. 

Counseling for OUD gives patients tools to manage their illness, achieve and sustain better health, and improve their quality of life. 

While medication for OUD like Suboxone will improve quality of life, many patients in treatment for OUD have complex issues that may complicate recovery. Some of these issues include:

• Other substance use disorders
• Major depressive disorder
• Anxiety
• Posttraumatic stress disorder (PTSD)
• Medical issues like hepatitis and diabetes
• A history of trauma
• Poor diet
• Lack of physical activity
• Lack of social support

The behavioral health team at Bicycle Health can help patients with OUD address these concerns by helping them learn to manage the symptoms of their mental health conditions and provide strategies and behavioral activation for increasing physical activity, healthy habits and social support. The behavioral health team can also provide assistance with linking patients to additional forms of care including psychiatric care, primary care, or a higher level of care if needed.