Buprenorphine Prescribing Guidelines

Non-Pregnant Adults and Adolescents

The American Academy of Family Physicians recommends Suboxone (buprenorphine/naloxone) as the first-line formulation for non-pregnant patients with opioid use disorder due to its reduced abuse and diversion potential 2, 3
The target maintenance dose is 16 mg daily for most patients, with an effective range of 4-24 mg daily, as recommended by the American College of Obstetricians and Gynecologists 1, 4
Patients must abstain from short-acting opioids 12-24 hours and long-acting opioids 36-48 hours before induction to prevent precipitated withdrawal, as advised by the American College of Obstetricians and Gynecologists 1, 4

The American College of Obstetricians and Gynecologists states that both Subutex (buprenorphine alone) and Suboxone (buprenorphine/naloxone) are safe options during pregnancy 1, 5, 6
For women already on Suboxone who become pregnant, continuation of the combination product is recommended by experts rather than switching formulations, as suggested by the American College of Obstetricians and Gynecologists 1, 6, 7
Higher and more frequent doses (2-4 times daily) may be required during pregnancy, increasing with gestational age due to altered pharmacokinetics, as recommended by the American College of Obstetricians and Gynecologists 1, 5

The American Academy of Pediatrics recommends that medication-assisted treatment must be combined with counseling and behavioral therapies, not used as monotherapy 9, 10, 4
Prescribers must hold appropriate waiver credentials to prescribe buprenorphine beyond 72 hours or arrange referral to addiction treatment programs, as required by the Centers for Disease Control and Prevention 11, 4
Regular assessment using DSM-5 opioid use disorder criteria is required for ongoing monitoring, as advised by the American Psychiatric Association 4

The American College of Obstetricians and Gynecologists advises against switching pregnant women from Suboxone to Subutex unnecessarily, as the theoretical risk of naloxone is not supported by evidence 1, 7
The American Academy of Family Physicians recommends confirming active opioid withdrawal before initiating buprenorphine to prevent precipitated withdrawal 1, 4
The American Academy of Family Physicians advises against prescribing buprenorphine monotherapy (Subutex) to non-pregnant patients when Suboxone is available, as this increases diversion and abuse potential without clinical benefit 2, 3