A fairly specific question, but also a fairly common situation. All is not lost; buprenorphine has a long half-life and binds very tightly to the opiate receptor, so the use probably had minimal effect on what is happening at the receptor level. I recommend just continuing the Suboxone each morning, without any pause. The only thing that would change my recommendation would be if the person happened to use enough to break through the blockade from the Suboxone and get a ‘buzz’; in that case I would wait a good 18-24 hours to avoid the risk of precipitated withdrawal.
While not a problem from a neurochemical perspective, the person in this situation is at significant risk of lowering the effectiveness of Suboxone treatment.  When a person starts Suboxone, he/she has a certain level of commitment toward staying clean.  This commitment provides a small degree of protection against using– a ‘boundary’.  Once a person crosses this boundary it immediately disappears, and nothing will bring it back.  This is the way it works for all boundaries;  once they are crossed they essentially cease to exist to any meaningful degree– unless there is something meaningful or symbolic to re-establish the boundary.
The person can try to look at it as a ‘one-time screw up’ and find some inner determination that it will never happen again.  But if it does happen again, Suboxone will lose much of its effectiveness at keeping the person clean, and he/she will be right back to will power again– and will power doesn’t work.
I have even had patients who started using on Suboxone and who never got any buzz at all from the use, but who still couldn’t stop using.  That is frustrating… paying for Suboxone, paying for oxy, and not benefitting from either!
The people who use on Suboxone should realize that not only are they wasting their money;  they are taking away the possibility that they will benefit from Suboxone– ever.


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