Is 8mg too much? That's a bit high for a long-term maintenance dose IMHO. But it's easy to wean down on suboxone. At least, in the beginning. I wouldn't get used to 8 mg. 1 mg bupe = 40 mg morphine. It's those last few mg that are the killer.
Is there a risk to develop tolerance to Suboxone? I don't think so. I've been on 4 mg/ day for like 10 years.
Can I use this medication as a long-term solution? See above, yes. I'm actually just now deciding to finally start the final wean off of suboxone.
Before I get too into the weeds, I should mention I’m on Belbuca 150mcgs x2 a day (so 0.3mgs/300mcgs total) as a test for baseline pain control (at a dose my NP believes is semi-therapeutic). I am prescribed Oxycodone 5mgs up to 4x a day. At my next appointment, we will discuss reducing the Oxycodone 5mg for x2 daily as needed for spikes and breakthrough pain, and increasing the Belbuca to 300mcgs x2 a day (still a mere 0.6mgs/600mcgs total).
In response to your post, I must say that Bupe is stronger than people give it credit for! If it had better bioavailability, the MDEs would be higher too. For example, Suboxone/Subutex tablets have 30% bioavailability, but the *preferred Sub films have roughly 40% bioavailability, and some practitioners believe it has better program retention partially for this reason. The sublingual tablet is indeed roughly = 40MDEs, but the film would be closer to a 55MDE daily dose. With that being said, because of increasing receptor saturation at higher doses coupled with partial agonism, once you start going above 4mgs, some practitioners (not all) practitioners will say that “8mgs of Bupe is less than double the MDE of 4mgs”. Above 8mgs every 12 hours, the benefit is limited as 8mgs of the film will put you at about 95% receptor occupancy. However, this isn’t entirely a bad thing as it might explain why it’s somewhat easy to reduce your dose. On the flip side, from my research, it does seem like it’s notably harder to go from 8mg to 6mg to stabilize at 4mg (x2 dosing) than going from 2mg to zero subs. I think the MDE diminishing returns hypothesis plays into this.
To be honest, I’m 100% ok with that reality because my best friend has been clean from Opioids for 10 years, thanks to Subs! She’s been on 8mgs x2 films daily nearly all of that time, and it’s clear the long term maintenance for her is the way to go! She tried dropping her dose at one point to 2mgs, with the goal of coming off. However, 2mgs was uncomfortable and after 3 days on zero subs, she ended up back on them quite quickly, but do to uncomfortableness, her doctor upped her back to 8mgs x2 daily. She’s been there again for years, ZERO issues!
So I mentioned I’m on Belbuca for baseline pain at a semi-therapeutic dose. One thing they figured out is that increasing the bioavailability meant they could use microgram doses that were effectively delivered. Compared to the Sub films, the Belbuca bucal film formula has about 60% bioavailability, and a 21% Bupe increase versus the sub film. So my 300mcgs per day (150x2) is closer to about 450mcgs of the sub film and when I get jumped to 600 (300x2) daily, it’ll be closer to about 900mcgs in sub film, just shy of 1mg in subs daily. However, I can tell you, the 300 daily dosing did help my baseline pain, and I am taking less oxy (2-3 oxys daily), since as early in the day, it’s sufficient on its own! I’ve already decreased my oxy dosing. Once I jump to 600 daily, I intend to use the oxy between 0-2 times daily, depending on my pain, and yes, I think some days with no oxy would actually be a reality!!!
. I would imagine that Bupe in the 2-8mg range works probably better than a generous dose of antidepressants lol.
