Establishing a Maintenance Dose of Buprenorphine

Clinicians can determine their patients' ideal daily dose within the first few days of induction. The next few weeks are a stabilization period, during which time patients should be maintained at their daily dose with close monitoring and adjustments as needed. Regular and frequent clinic visits (recommended: weekly) should continue until the patient stabilizes medically and psychosocially.

At an ideal daily dose, the patient should experience no withdrawal symptoms and no cravings. Most patients' daily maintenance dose is between 12 to 16mg, but may be up to 32/mg.

The maintenance phase will continue indefinitely for most patients. Patients can be maintained at a 12-16 mg daily dose indefinitely, as long as the patient is comfortable and happy with treatment (McNicholas 2011). Clinic visits can be decreased but patients should still be seen regularly. Clinicians should monitor the patient's cravings for opioids and adherence to psychosocial therapies. Additionally, conduct periodic lab testing:

• Monthly urine toxicology screens
• Monthly pregnancy tests for women of childbearing age
• Liver function tests every 6 months

Opioid abuse during maintenance should not be grounds for terminating buprenorphine treatment. Alternative responses include checking on proper use of buprenorphine and dose, increased office visits, and making continued treatment contingent on increased psychosocial support.