What Are Signs That My Suboxone Dose Is Too Low?

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:[4]

• Anxiety
• Tremors
• Sweating
• Nausea and vomiting
• Abdominal pain
• Diarrhea

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.[4] 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:

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.
• Panic attacks: You may feel acute bouts of panic in which your heart races and you feel like you can’t breathe.

Tremors 

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. 

Sweating

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. 

GI Upset 

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

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. 

COWS Self-Assessment

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.

Quick COWS Assessment

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.[5] 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.[6]

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:[1]

• 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:[1]

• 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.[2] 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?

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.[7] 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.[9]

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.[9]

Talking to Your Doctor

Up to 80% of people aren’t forthcoming with their doctors about information that could be critical to their health.[8] 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.