Microdosing Suboxone

Suboxone microdosing involves taking a smaller-than-average dose of medication for the first few days or weeks to avoid precipitated withdrawal from opioids.

Microdosing is often associated with psychedelic drugs like LSD, but some people use the technique to help them with starting Suboxone.[1] 

Never alter your Suboxone dose without talking to your doctor. But if you’re struggling with your medication or worried about starting Suboxone therapy, microdosing might be helpful for you.

What Is Microdosing?

Microdosing involves taking very frequent, small Suboxone doses for the first few days or weeks while your body gets used to the medicine without having to abstain from opioids.

In a traditional treatment program, you must quit opioids and enter mild withdrawal to avoid precipitated withdrawal.

Precipitated withdrawal is a severe form of opioid withdrawal that takes hold when people take therapeutic doses of drugs like Suboxone when active opioids are still in their bodies.[8]

Since microdosing involves a smaller dose of Suboxone, it could reduce the need for people to enter withdrawal before starting their medications.

Microdosing is a potential option for two types of patients:

1. Patients who cannot tolerate traditional doses of Suboxone, at least at first
2. Patients who are not able to tolerate the withdrawal symptoms during the period of stopping full opioid agonists and starting Suboxone

No universally accepted method of Suboxone microdosing exists. Some doctors use the Bernese method, which involves providing buprenorphine doses of 0.2 mg (whereas a traditional program involves doses of 2 mg or higher upon induction.) However, there is no accepted microdosing schedule approved by the FDA or medical officials.[10]

Key Facts About Microdosing Suboxone 

• Only one in five adults with opioid use disorder (OUD) gets medications like Suboxone to treat it.[2]
• Suboxone is designed as a single daily dose. Microdosing instructions aren’t included in patient documents approved by the U.S. Food and Drug Administration (FDA).[3]
• Doctors who suggest microdosing are using the drug off label, or in a way the FDA hasn’t studied or described. However, from the FDA’s perspective, doctors can use a medication in an unusual way as long as they deem it medically appropriate to do so.[4]
• Staying in treatment is critical, as people tend to relapse to opioid misuse when they stop taking Suboxone.[5]

How Does Microdosing Work?

In traditional treatment models, people must first withdraw from drugs like heroin before starting Suboxone. With microdosing, you can skip this step.[6]

In one case study, doctors worked with patients who had used methadone in the hospital to recover from early opioid misuse. They gave low doses of buprenorphine along with methadone, gradually increasing the buprenorphine and lowering the methadone over seven days. On day eight, methadone stopped abruptly. All three patients transitioned successfully.[6]

In a separate study, researchers used intravenous buprenorphine to transfer patients using methadone or other opioids. All were moved to the new medication without experiencing precipitated withdrawal.[9]

In a third study, doctors used at-home microdosing regimens with Suboxone to help people who entered the hospital with opioid use disorders. Of their patients using microdosing, 32% remained in treatment 30 days later.[10]

As these case studies make clear, microdosing routines are variable and can shift by patient need and provider preference. Typically, however, microdosing means taking small, frequent doses of Suboxone unlikely to precipitate withdrawal to help people transition into care. 

Which Patients Should Choose Microdosing?

Microdosing is a relatively new way of using Suboxone and may only be necessary for certain patients who cannot take standard doses of Suboxone.

These people might fit the following criteria:

• Struggle with side effects: This might be a patient who cannot tolerate the side effects of normal doses of Suboxone but is still highly motivated to use the medication for MAT.‍
• Feel unable to tolerate withdrawal: Microdosing means there is no need to wait for withdrawal and drug cravings to start. It’s appealing for patients who, for whatever reason, cannot tolerate the washout period usually required before taking the first dose of Suboxone.

Is Microdosing Effective?

Microdosing is a relatively new way to use Suboxone, and researchers say few studies have been published about its efficacy.[6] Small case studies suggest that it’s helpful for some people who can’t handle a traditional treatment program.[7] However, more research should be done to determine how well it works, how it compares to standard treatment and how ideal programs should be structured.

Seek Medical Guidance to Determine if Microdosing Is Right for You

Suboxone microdosing must be done carefully and requires very specific adherence to the dosing schedule. Since microdosing is a highly specialized form of therapy, your Suboxone provider may not be comfortable trying it.

If you’re interested in microdosing, talk with your provider first. Together, you can create the right plan for your health and sobriety. Never adjust your medication routines without checking with your doctor.