ReviewJournal of addiction medicine
Evidence on Buprenorphine Dose Limits: A Review.
Review in Journal of addiction medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it, 66 citations in OpenAlex.
- Multi-ancestry genome-wide association meta-analysis of buprenorphine treatment response.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2025Pooled it
- A Systematic Review of State Office-Based Buprenorphine Treatment Laws Effective During 2022: Counseling, Dosage, and Visit Frequency Requirements.Substance use & addiction journal · 2024Pooled it
- Randomized, placebo-controlled trial of gabapentin during outpatient buprenorphine-assisted taper and transition to injectable naltrexone.The American journal of drug and alcohol abuse · 2025Trial
- A Single-Dose Study to Evaluate the Relative Bioavailability, Safety, and Tolerability of Monthly Extended-Release Buprenorphine at Alternative Injection Locations in Adult Participants with Opioid Use Disorder.Clinical drug investigation · 2024Trial
- Can Buprenorphine Be Overdosed? The Ceiling Effect and Its Clinical Implications.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Emergency Department-initiated standard versus high-dose buprenorphine induction (ENVISION): a randomised clinical trial protocol.BMJ open · 2026Article
- Feasibility, Acceptability, and Preliminary Efficacy of a Pilot Study To Integrate Buprenorphine into a Harm-reduction Drop-in-Center in Kampala, Uganda.AIDS and behavior · 2026Article
- Risk of opioid overdose during buprenorphine treatment for opioid use disorder in the fentanyl era.Addictive behaviors · 2026Article
- Perioperative Management of Patients on Buprenorphine.Current pain and headache reports · 2026Review
- Pain Management in the Older Adult with Opioid Use Disorder.Clinics in geriatric medicine · 2026Review
- Article
- Identifying Optimal Thresholds for Early Opioid Use Frequency in Predicting Buprenorphine Outcomes.The Journal of clinical psychiatry · 2026Article
- Cost-Effectiveness of Treatment for Opioid Use Disorder in Pregnancy and Its Impact on Birth Outcomes.JAMA pediatrics · 2025Article
- Implementation opportunities for optimizing retention on buprenorphine treatment for people with opioid use disorder in West Virginia.Drug and alcohol dependence · 2025Article
- Impact of hepatitis C serostatus on health service utilization for opioid-related harms among individuals prescribed opioid agonist therapy: A longitudinal prospective cohort study.Drug and alcohol dependence reports · 2025Article
- Article
- [Clinical pharmacology of opioid analgesics].Schmerz (Berlin, Germany) · 2025Review
- Emergency Department-Based Medication for Opioid Use Disorder: A 5-Year Experience.Journal of the American College of Emergency Physicians open · 2025Article
- Escalated Oxycodone Self-Administration Is Associated with Activation of Specific Gene Networks in the Rat Dorsal Striatum.International journal of molecular sciences · 2025Article
- Buprenorphine adherence among a prospective cohort of homeless-experienced adults with opioid use disorder.Drug and alcohol dependence · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAs overdose deaths from fentanyl continue to increase, optimizing use of medications for opioid use disorder has become increasingly important. Buprenorphine is a highly effective medication for reducing the risk of overdose death, but only if a patient remains in treatment. Shared decision making between prescribers and patients is important to establish a dose that meets each patient's treatment needs. However, patients frequently face a dose limit of 16 or 24 mg/d based on dosing guidelines on the Food and Drug Administration's package label.
methodsThis review discusses patient-centered goals and clinical criteria for determining dose adequacy, reviews the history of buprenorphine dose regulation in the United States, examines pharmacological and clinical research results with buprenorphine doses up to 32 mg/d, and evaluates whether diversion concerns justify maintaining a low buprenorphine dose limit.
resultsPharmacological and clinical research results consistently demonstrate buprenorphine's dose-dependent benefits up to at least 32 mg/d, including reductions in withdrawal symptoms, craving, opioid reward, and illicit use while improving retention in care. Diverted buprenorphine is most often used to treat withdrawal symptoms and reduce illicit opioid use when legal access to it is limited.
conclusionsIn light of established research and profound harms from fentanyl, the Food and Drug Administration's current recommendations on target dose and dose limit are outdated and causing harm. An update to the buprenorphine package label with recommended dosing up to 32 mg/d and elimination of the 16 mg/d target dose would improve treatment effectiveness and save lives.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.