This is a subject with much debate. Many doctors feel that between 8-16 milligrams is a sufficient dose, while some feel that 24 milligrams is necessary when the individual had a severe opiate use pattern. Most of the literature says that the proper dose needed is the dose necessary to occupy approximately 85% or less of the opiate receptors in the brain. This level of occupancy will stop most symptoms of withdrawal, but almost never totally stops withdrawal.
Sadly most of the generic preparations of buprenorphine are substantially less efficient (up to 40%) in transferring the buprenorphine from the pill to the opiate receptors in the brain, which means that even if taken properly they produce up to 40% less buprenorphine molecules at the opiate receptors. Said another way, when using generic buprenorphine, one must compensate by increasing the dose compared to the Suboxone dose to obtain the same therapeutic effect.
Dr. Russ believes very strongly that it is essential to stop 100% of the withdrawal symptoms because the last symptoms to stop with Suboxone treatment is craving, which is the main cause of withdrawal-triggered relapse. Unfortunately, craving is also the first symptom to return if an individual is no longer taking a sufficient amount of Suboxone.
In order to totally stop withdrawal symptoms including craving, it is necessary to 100% saturate the opiate receptors. Therefore, it is Dr. Russ’ strong belief that if only 85% of the opiate receptors are occupied, as is recommend by Suboxone’s manufacturer, the patient’s chance of relapse with opiates is greatly increased compared to when 100% of their opiate receptors are occupied by buprenorphine.
Dr. Russ’ patients with moderate to severe opiate problems (more than 350 mg of oxycodone or its equivalent) consistently state that they need a total of four 8/2 films taken in two doses per day to 100% stop withdrawal symptoms including craving. Consequently, Dr. Russ’ guideline for Suboxone dosing is the least amount necessary to totally stop withdrawal symptoms 24/7, which for many people is 32 milligrams per day.