Day 1: 8 mg B/2 mg N
Day 2: add’l 4 mg/1 mg up to 16 mg/4 mg
Days 3–7: increase in units of 4 mg/1 mg until withdrawal symptoms cease;
maximum 32 mg/8 mgAt least 2 hours observation with initial dose, then
1–2 visits in first weekAchieve lowest dose that eliminates withdrawal symptoms and illicit opioid useStabilization (up to 2 months)Generally range from
8 mg/2 mg up to
24 mg/6 mg1/weekEliminate withdrawal symptoms, side effects, and illicit drug useMaintenance (based on patient needs)Dose as determined during stabilizationBiweekly or monthlyAddress lifestyle changes and social and psychological needs; if desired plan for medically supervised withdrawal

References

Dodrill CL, Helmer DA, Kosten TR. Prescription pain medication dependence. Am J Psychiatry 2011;168(5):466–71.

Stahl SM, Grady MM. Stahl’s illustrated substance use and impulsive disorders. New York, NY: Cambridge University Press; 2012. (Chapter 4)

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