The patient actually came into the clinic 36 hours off of oral morphine in moderate withdrawal. Her COWS was 14. We did begin suboxone a that time. In my experience I have not seen people continue to have withdrawal symptoms after 24 hours of suboxone, but she returned 2 days later with a COWS of 11. Is this typical? To answer your above questions she adamantly denies having an OUD, but reports she has tried and failed most opioids and her pain management doctor thought she may do well on Suboxone. She did well on belbuca for 1 year, before it seemed to stop working. She has been on the Suboxone at 4 MG QID dosing for 1 week and is still experiencing 10/10 pain. When treating chronic pain with suboxone is it common for it take longer to become effective?