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The maintenance phase of treatment is reached when a patient's cravings are well-managed on a stable dose of buprenorphine and when destabilizing forms of substance use have been eliminated. The maintenance phase of recovery looks different in different people. At one end of the spectrum are patients who use recovery from opioid dependence as an opportunity for profound personal change and growth. For these patients, recovery becomes a significant part of their personal identity and they typically develop a strong system of social connections to support their evolving identity as persons in recovery. For others, maintenance is a more modest process of preventing relapse to illicit opioid use. Some persons in the maintenance phase of treatment continue to use substances but the benefit of buprenorphine treatment is evidenced by a global improvement in functioning and a complete or near complete elimination of opioid misuse with its high risk for accidental poisoning and death.

Maintenance Dosing

Buprenorphine doses of 8-24 mg are common during the stabilization phase of treatment. Some patients fare best if they continue at these higher doses of buprenorphine. Others may be tapered back to a dose of 8-16mg and maintain high levels of stability. Any tapering of the buprenorphine dose should be gradual, collaborative, and conservative with respect to cravings and relapse risk. Generally patients' doses should not be tapered unless they are stable in other key domains of functioning--e.g. they have achieved housing, vocational, and psychological stability. If a patient and physician decide to taper back the dose of buprenorphine, it is generally best to inform the patient to return to their prior maintenance dose if their cravings return. Cravings always put a patient at increased risk for relapse.

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