Microdosing Suboxone

Suboxone microdosing involves taking a smaller-than-average dose of medication for the first few days or weeks in order 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 at first. [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 week while your body gets used to the medicine without having to abstain from opioids. 

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. 

People using microdosing typically take about one-tenth of a traditional dose of Suboxone at more frequent intervals. They take enough of the drug to keep the opioid receptors activated and prevent going into withdrawal but not enough to cause precipitated withdrawal or other side effects.

Key Facts About Microdosing Suboxone 

Less than 20% of people with opioid use disorders (OUDs) in the United States get treatment with medications like Suboxone.[2]

Suboxone is designed to take anywhere from one to three times a day. However, microdosing is an off label way of taking Suboxone that may be appropriate for some patients. [3]

Close to 30% of people with prescriptions stop taking their medications due to side effects.[4]

Staying in treatment is critical, as people tend to relapse to opioid use 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, one can skip this step.[6]

Microdosing means taking such small doses of Suboxone that they will be unlikely to precipitate withdrawal. 

People typically take Suboxone once daily in a larger dose of anywhere from 2 to 24 mg. However someone doing a microdosing regimen might take just 1 mg at a time every 4 hours or so while the body slowly builds up tolerance. 

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?

Suboxone works to keep brain chemicals stabilized, minimize drug cravings, and ease withdrawal symptoms. Microdosing with Suboxone can be started immediately, without having to withdraw from other opioids. It is, therefore, an effective method for reducing opioid withdrawal symptoms and helping to treat opioid use disorder.[7]

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, which is why it is unnecessary and may be overly complicated for most patients. It might be offered to a patient in very specific circumstances. Suboxone can be prescribed online by a qualified medical provider to be picked up at your local pharmacy.

Microdosing is a highly specialized form of therapy, and your Suboxone provider may or may not be comfortable trying it. If you are a person who might warrant microdosing, your Suboxone provider may even refer you to a specialist who has a lot of familiarity with Suboxone and specifically with the practice of microdosing. For most people, standard doses of Suboxone work best. But if you think you might need to start with microdosing of Suboxone, talk to your provider. It may be an option that would allow you to get starting on MAT long term, which can be a lifesaving treatment for OUD.

Sources

1. Psychedelic Microdosing Hits a Rough Patch in Clinical Trials. Nature. https://www.nature.com/articles/d41586-022-02876-5. September 2022. Accessed December 2022.
2. Policies Should Promote Access to Buprenorphine for Opioid Use Disorder. Pew. https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/05/policies-should-promote-access-to-buprenorphine-for-opioid-use-disorder. May 2021. Accessed December 2022.
3. Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed December 2022.
4. Why Do People Stop Taking Their Meds? Cost Is Just One Reason. NPR. https://www.npr.org/sections/health-shots/2017/09/08/549414152/why-do-people-stop-taking-their-meds-cost-is-just-one-reason. September 2017. Accessed December 2022.
5. Discontinuing Buprenorphine Treatment of Opioid Use Disorder: What Do We (Not) Know? The American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19121245. February 2020. Accessed December 2022.
6. Transitioning Hospitalized Patients with Opioid Use Disorder from Methadone to Buprenorphine Without Period of Opioid Abstinence Using a Microdosing Protocol. Pharmacotherapy. https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/phar.2313. July 2019. Accessed December 2022. 
7. Using Microdosing to Induct Patients Into a Long-Acting Injectable Buprenorphine Depot Medication in Low Threshold Community Settings. Frontiers in Pharmacology. https://www.frontiersin.org/articles/10.3389/fphar.2021.631784/full. March 2021. Accessed December 2022.