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 Post subject: why such high dosages?
PostPosted: Fri Dec 04, 2009 3:11 pm 
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From what I’ve read (and experienced) the effects of suboxone reach a ceiling around 2-4mg and don’t increase at higher doses. So my question is – why do doctors prescribe doses of 16, or 24, or even 36mg? I understand that sublingual administration is imperfect/inconsistent and that you want to make sure you’re above the ceiling, but it seems that doses of 6-8 mg would accomplish that. My cynical self reckons that the marketing team from Reckitt-Benckiser (the maker of Suboxone) might have something to do with it. The standard 8mg tablet form that Suboxone comes in certainly doesn’t make it convenient to take smaller doses (and makes it especially difficult when you get down to sub-milligram doses needed when tapering off the stuff).

My personal experience (5 months on Suboxone, so admittedly not extensive) is that lower doses are perfectly sufficient. In addition, many of the side effects I’ve had (constipation, decreased libido, sleep disturbances, stiff/sore joints, etc.) have decreased as I’ve tapered down from 8 mg to 3mg. I’ve actually felt better as I’ve decreased my dosage and I have not experienced withdrawal symptoms or cravings for my drug of choice (and am also saving a significant amount of money).

So what’s up with the crazy high dosages???


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PostPosted: Fri Dec 04, 2009 4:09 pm 
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The reason for doses higher than 4mgs is to #1 make sure that steady state blood level never drops below 2-4mgs range and #2 the opiate antagonizing effects of buprenorphine are only somewhat effective at 8mgs and below meaning that if someone wanted to get high it would take alot more and would obviously be dangerous and dumb but still possible up around 16mgs and above buprenorphine's antangonist blockade is much stronger making it extremely difficult for someone to try and get high. Sometimes people start out at a little higher dose and then move down to around 8mgs later on if they're able to stay clean.

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PostPosted: Mon Dec 07, 2009 2:37 pm 
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Thanks for the explanation, Matt2 - I didn't realize that the antagonist/blockade effect wasn't effective at lower doses. It's a question that's always confused me. What's f**ed up though is that, for a minute, when I finally figured out that I still could theoretically get high on the dose of sub that I'm on, the junky in me immediately thought - 'alright, let's go get high then'! The thought only lasted a moment, though, and I was very quickly able to talk myself out of using. As I said, even the low dose of sub I'm on does seem to be effective for me in easing the craving for opiates, which is a blessing. The last five months that I've been on sub have been the only time in a decade that my life has felt halfway stable and under control, and I'm not willing to give that up.


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