Outpatient Buprenorphine Microdosing Protocol for Short-Acting Opioids
For patients on opioids with short-acting duration, including oxycodone,
morphine, heroin (although beware of contamination with fentanyl which has
prolonged clearance)
Day Full Opioid Dosing
Total Daily Dose Comments
Agonist
Instructions for of
Dose
Buprenorphine Buprenorphine
(Suboxone)
(Suboxone)
1
Full dose
0.5 mg QD
0.5 mg
Start with 2mg film and cut
into 4 pieces. ¼ film is
0.5mg.
2
Full dose
0.5 mg BID
1 mg
Cut each film into 4
pieces. ¼ film is 0.5mg.
3
Full dose
1 mg BID
2 mg
Cut each film into 2
pieces. ½ film is 1mg.
4
Full dose
2 mg BID
4 mg
Don’t cut films. Each film
is already 2mg.
5
Full dose
4 mg Qam
6 mg
Cut each film into 2
2 mg Qpm
pieces. ½ film is 1mg.
6
Full dose
4 mg BID or 8 8 mg
Don’t cut films. Each film
mg QD
is already 2mg.
7
STOP
8 mg QD or
8 mg or uptitrate Switch to 8mg film. Can
uptitrate as
as needed
cut into 2 pieces. ½ film is
needed
4mg.
Provider Instructions:
Rx buprenorphine/naloxone 2-0.5 mg films #11 for days 1-6. Schedule follow up visit for
day 8. Consider Rx buprenorphine/naloxone 8-2 mg films for days 7 onward.
Important Tips:
1. Arrange for daily telephone check-in for close monitoring
2. Provide phone number to patient to call with questions or concerns
3. Monitor patient for withdrawal using SOWS criteria if over the phone and COWS
if in person
4. If patient has co-existing pain, monitor pain via PEG scale.
5. If patient encounters withdrawal symptoms, please prescribe clonidine,
loperamide or ibuprofen if no other contraindications. In addition, slow the
transition (e.g. return to the prior day’s dosing and hold it for 2 days).
6. If patient continues to have withdrawal symptoms, assess patient in person.
Montefiore 12/7/20
Patient Instructions (smartphrase for EMR):
You are being prescribed 2mg films of buprenorphine (suboxone). You will start by
cutting each film into 4 pieces.
Day 1: You will only take 1 piece of film in the morning. Continue to take your ***
Day 2: You will take 1 piece of film in the morning and 1 piece of film in the evening.
Continue to take your ***
Day 3: You will take 2 pieces of film in the morning and 2 pieces of film in the evening.
Continue to take your ***
Day 4: DO NOT CUT FILM. Take 1 whole film in the morning and 1 whole film in the
evening. Continue to take your ***
Day 5: DO NOT CUT FILM. Take 2 whole films in the morning, 1 whole film in the
evening. Continue to take your ***
Day 6: DO NOT CUT FILM. Take 2 whole films in the morning and 2 whole films in the
evening. Continue to take your ***.
Day 7: STOP YOUR ***. You will now be prescribed 8mg films of buprenorphine
(naloxone). Take 1 whole film in the morning. If you have increased cravings or pain,
you can take an additional HALF of a film in the evening.
Montefiore 12/7/20
Patient Instructions:
You are being prescribed 2 mg films of buprenorphine (suboxone). You will start by cutting each
film into 4 pieces.
Date
Day
Opioid
dose
__/__ /__
Day 1
Full
dose
Buprenorphine/naloxone (suboxone) dose
Morning
You will only take 1 piece of film in the
morning.
Evening
__/__ /__
__/__ /__
__/__ /__
__/__ /__
__/__ /__
__/__ /__
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Full
dose
Full
dose
Full
dose
Full
dose
Full
dose
STOP
opioid
Morning
You will take 1 piece of film in the
morning
Evening
You will take 1 piece of film in the
evening
Morning
You will take 2 pieces of film in the
morning
Evening
You will take 2 pieces of film in the
evening
Morning
DO NOT CUT FILM You will take the
whole film in the morning
Evening
DO NOT CUT FILM You will take the
whole film in the evening
Morning
DO NOT CUT FILM You will take 2
whole films in the morning
Evening
DO NOT CUT FILM You will take 1
whole film in the evening
Morning
DO NOT CUT FILM You will take 2
whole films in the morning
Evening
DO NOT CUT FILM You will take 2
whole films in the evening
Morning
You will now be prescribed 8mg films.
Take 1 whole film in the morning. If you
have increased cravings or pain, you
can take an additional HALF of a film in
the evening
Your provider will call to check in during the week. If you have any questions, please call:
__________________________________ at __________________________________.
Montefiore 12/7/20