I've noticed two doctors with FP residencies and an addiction fellowship are giving it out in a manner very different than the way I do.
For example the manufacturer does not recommend it at dosages higher than 16/4 mg a day though they say 24/6 mg is appropriate only under extreme circumstances. The 2 FPs I've encountered had quite a few patients on 32/8 mg a day. The only patient I ever had on more than 16/4 mg a day for more than 6 months was 450 lbs. Every other patient I told them we're getting them to 16/4 mg and gave them a taper down schedule to get them there within a few weeks to months tops.
This has been frustrating for me because I took over one of these doctor's 30 patients, and about 1/3 of them were being given Suboxone under circumstances I found very questionable. E.g. this doctor also gave them benzos, and even though the withdrawal was under control, she raised their Suboxone to dosages such as 24/6 mg or even 32/8 mg simply based on the patient's request because they were still having triggers to use drugs. I highly suspect these patients are using their Suboxone but being able to have excess they could sell off, or in these patient's minds, being somewhat buzzed is the "norm" for them.
I've pretty much only given out Suboxone under the manufacturer's guidelines with very few problems so I don't know why these doctors are practicing in that manner. I'm not trying to say they're wrong because I haven't talked to them at length as to why they're going it their way. Maybe they know more than me, but they are not in tune with the manufacturer's guidelines. As for that doctor whose patient's I've taken over, she was doing a lot of things whacky (e.g. she'd dump the patient's urine from the drug tests in the sink where people use for drinking water).
I have, however, found some of the manufacturer's guidelines to not work in clinical practice. For example, in some of their guides, they've recommended that a patient could be weaned off of Suboxone at a rate of up to 4/1 mg at a time and more than half the patients I've had where I've done this encountered pretty bad withdrawal. Another thing I've noticed is when I get patients off Suboxone they need to be weaned to dosages very much under what the manufacturer recommended. E.g. I've had patients on only 1/0.25 mg, stop from there, and still get bad withdrawal. I've had to have them go to 0.5/0.125 mg a day for about a week, then cut that to every other day, then even give clonidine and antihistamines.