Not with Methadone, but with street Fentanyl. Even with patients presenting with COWS 13, Suboxone 2 mg increments have resulted in precipitated withdrawal above Suboxone 2-4 mg. So with Street Fentanyl conversions, we typically would continue with the microdosing schedule. The theory is that street Fentanyl is a mixture of short/medium/long acting analogues with variable mu receptor binding affinities.
The principle is that small dose increases of Suboxone don’t cause precipitated withdrawal. And there’s many different ways to do this. Every clinical situation has little nuances and you just adjust your Suboxone dosing accordingly.
Ken Lee