On the issue of “treatment failures” with Suboxone…

Yes, they do happen, and are not uncommon.

Usually, the treatment fails the patient because of one of two issues:

1. The medication is not strong enough to effectively block cravings for some people with a history of heavy opiate use. Buprenorphine dosing includes a “ceiling effect” at which point increasing doses have no additional effect. If this happens, the patient should consider switching to methadone –which permits a larger range of dosing options.

2. The medication is provided without adequate supports to a person who is not stable enough in their recovery to successfully hold their own medication. In other words, the patient’s recovery is not stable enough for the patient to take the medication as prescribed and/or withstand the temptation to sell the medication (to pay rent, buy food, or buy other opiates).

In my experience with hundreds of people who have tried medication-assisted treatment, only a small percentage needed the stronger dosing options available with methadone.

What is much more common, is that the person needed additional supports early in treatment before they were able to successfully stabilize in treatment.

For this reason, we added a buprenorphine support program to the range of services we offer at the program for opiate-dependent people I supervise at my workplace.

The support program provides counseling, case management, medication management (pill counts etc.) and drug testing –all provided in a non-punitive, supportive context.

These are the kinds of services you might want to try to have in place, or add if the person seems to be struggling (of course also making sure they are not being under dosed). The closest thing to a standard dose is 16mg/day.

If the person does well, but has a relapse (especially early on), consider taking a wait and see approach. If the relapse continues and the person is unable to self-limit the relapse, the person should consider seeking residential treatment at a facility that will allow the person to continue to take their Suboxone while in residential treatment.

This period of residential treatment (where the medication will be held and administered), is often very effective in stabilizing recovery. In fact, a good way to begin Suboxone treatment is to be inducted (started) while in residential treatment.

This post is based on a comment I wrote at the parent blog A Mom’s Serious Blunder.  Read the original post I was responding to here.