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Methadone Detoxification
It is generally not recommended that stable methadone patients transfer to Suboxone or Subutex. However, patients may request to transfer from methadone to Suboxone or Subutex for many different reasons.
For example, individual responses to methadone are variable, including the occurrence of side effects and drug interactions. Some patients are reluctant to be on effective methadone doses and may prefer to be maintained on Suboxone in a private office setting. A limiting factor for many patients considering maintenance treatment is the problem of dependence of the maintenance opioid. The pharmacological properties of Suboxone or Subutex, including slow dissociation from mu-opioid receptors and apparent mild withdrawal syndrome, may be perceived as a benefit by the patient. It is recommended that the physician review the risks/benefits of transferring from methadone to Suboxone or Subutex with the patient well in advance of the transition and provide the patient with realistic expectations during the transition.
Normal Transfer (from methadone-equivalent dose <= 30 mg):
At least 48 - 60 hours should elapse after the last long-acting opioid dose. The initial dose of Suboxone or Subutex should be administered when moderate signs of withdrawal are evident.
High-Dose Transfer (from methadone-equivalent doses ranging from 30 - 60 mg):
- No Suboxone or Subutex should be given after the last methadone or long-acting opioid dose until the patient experiences maximal withdrawal discomfort (at least 48 - 96 hours after the last dose). Earlier dosing with Suboxone or Subutex is highly likely to precipitate withdrawal.
- Be prepared to administer limited amounts of withdrawal medication (eg, clonidine, loperamide, sleep aid, NSAID, etc) for symptomatic relief.
- High-dose transfer patients need careful monitoring and dose titration according to the response of the patient. If withdrawal symptoms have not worsened or have improved within 2 - 4 hours after the first dose of Suboxone or Subutex, an additional 4-my dose of Suboxone or Subutex is recommended. Clinicians have reported prescribing a third dose (2 - 4 mg) to be taken later in the evening if needed for withdrawal symptoms.
Dose Reduction Schedule
| Days |
Dose Schedule |
| 1 - 7 days |
8 mg buprenorphine |
| 8 - 14 days |
4 mg buprenorphine |
| 15 - 21 days |
2 mg buprenorphine |
| 22 - 30 days |
1 mg buprenorphine |
| 31 - 37 days |
Non-narcotic medication |
| ~ 38 - 44 days |
Start Naltrexone |
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