We upgraded AAFP.org security on Dec. 7.
Account holders must create a new password. Previous passwords will no longer work.

brand logo

BRENDAN JACKSON-FOWL, DO, AGNES KIM, MD, AND VIVIAN CHENG, PharmD

Am Fam Physician. 2026;113(1):85-86

 This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

CLINICAL QUESTION

What is the optimal dose of sublingual buprenorphine for maintenance treatment of opioid use disorder (OUD)?

EVIDENCE-BASED ANSWER

Physicians managing patients with OUD should consider prescribing maintenance dosages of buprenorphine 24 to 40 mg/day. (Strength of Recommendation [SOR]: B, cohort studies.) In international trials, use of higher dosages (8 mg/day) of buprenorphine results in higher rates of treatment retention at 12 months than lower dosages (3 mg/day, 1 mg/day). (SOR: A, meta-analysis of randomized controlled trials [RCTs].) In US trials, for 12-month treatment retention, dosages of 24 to 40 mg/day are superior to 16 mg/day (number needed to treat [NNT] = 17–31). (SOR: B, cohort studies.) Dosages of 32 to 40 mg/day are superior to 24 mg/day for treatment retention. (SOR: B: cohort study.)

Dosages of buprenorphine greater than 16 mg/day are associated with lower overdose-related mortality (NNT = 167) and all-cause mortality (NNT = 334). Dosages of 24 mg/day or greater are associated with longer times to emergency department and hospital admission than lower dosages. (SOR: B, cohort studies.)

EVIDENCE SUMMARY

Already a member/subscriber?  Log In

Subscribe

From $180
  • Immediate, unlimited access to all AFP content
  • More than 125 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Interested in AAFP membership?  Learn More

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email questions@fpin.org.

Copyright © Family Physicians Inquiries Network. Used with permission.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

Continue Reading

More in AFP

Copyright © 2026 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.

Copyright © 2026 American Academy of Family Physicians. All Rights Reserved.