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I have occassionally had a patient require 24 mg of suboxone initially, but almost always can be reduced over a 2 to 4 week period to a maintenance of just 16 mg per day. One factor to consider is how well the patient is keeping the tablet under their tongue and how much is "wasted" in saliva that is then swallowed.
We have had two patients who were still in withdrawal (objectively) at 32 mg where we increased, ulimately to 48 mg, giving 8 mg q4h while inpatient. In both cases, we tapered to 32 mg or less by the time of discharge. My experience is that the curve begins to flatten at 24 mg- 32 mg but probably does not completely flatten until 48 mg.
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