Loving Mom,
shocking, to say the least, how expensive sub therapy is. Most addicts probably can't afford it in one go and stay on the streets, how prohibitively high costs of addiction treatments benefit the society is beyond me, to the best of my knowledge no European country charges any substantial amount, if anything at all, for
methadone or subutex treatment, the reasoning is that such programs reduce crime and infections, which has been proven. There is also no pressure to get off methadone or subutex in most European countries, again same logic as above, but motivated patients who do want to kick get free psychotherapy and until recently we even had free gym membership in this country (not that it was the fanciest gym in town, but I'm paying $100 a month for gym now).
The reason I mention gym is because your son should start working out, it is amazing how quickly and to what extent exercise (proper aerobic exercise + some weights) restores natural endorphine production and improves general well-being mentally and physically. It prevents depression, which often accompanies even partial detox and also helps boost the immune system. I don't know why, but for some reason many addicts get clean and soon afterward experience some medical problems, perhaps symptoms were blocked by opiates, at any rate exercise helps and you should push your son to start working out and if you can afford it, take him to a dentist, chances are his teeth are in bad shape.
Most importantly, your son should not stay on subutex/suboxone for too long as he will get addicted to subs and the longer he's on meds and the higher the dosage the longer and more painful withdrawal will be, assuming he does not plan to be on subs forever (which in some cases seems to be necessary, relapse risk is high as you know).
32mgs sounds like a lot, probably too much, sub has a "ceiling" effect on 30mgs, i.e. anything more than 30mgs doesn't do anything. For most people 16mgs is more than enough while stabilizing and some people actually feel better on lower dosages. I suspect your son is still in addict's mental state and asked the doctor for max dosage fearing wd symptoms. Read as much as you can on sub so you know what you're doing.
You have to know that sub is a relatively new drug, many unknowns there, some people swear by it, others want to sue the manufacturer as they are unable to get off it. It is very subjective (like any drug), but what it certain is that it reduces if not eliminates wd symptoms and cravings, blocks full agonists like Heroin or Methadone and what is almost certain is that it should be used as detox treatment, not substitution therapy, otherwise methadone will do just fine.
What they often do in this part of the world is a rapid detox, either overnight (under anaesthesia) or over 1 week's time (somewhat uncomfortable but bearable) and once this is done they insert a capsule with opiate antagonist like Naltrexon with super slow release time in addict's lower abdominal area (small scar). What it does is it blocks heroin or methadone for 6 months or so, in fact if addict were to use it IV style he would experience severe wd symptoms and thereby his brains learns a new trick, he doesn't associate drug use with pleasure anymore. Cost of such therapy (detox + blocker) is about $1.500 for overnight, $500 for 1 week's method. If interested let me know and I will refer you to an excellent private clinic (no, I'm not getting a cut).
I would recommend this: you be in charge of your son's med intake. Taper down
suboxone to the lowest level possible by means of increasing the time between dosages (sub has 37.5 hrs half time, i.e. after 37.5 hrs he still has 1/2 of what he took 37.5hrs ago in his system + whatever's left from previous dosages) so once he's on sub for a month he cannot be sick even 48 hrs after taking it. If you can taper quickly do so, if you (or he rather) cannot, keep reducing till you get to like 1mg or so, then you'll have to be crushing tablets (should probably do this from the start anyway) begin mixing it with something like
aspirin and gradually keep reducing the active substance (sub) and increase the aspirin until he's getting nothing but aspirin for a couple of weeks. The placebo effect works, you can keep him on aspirin for a few years.
By the way, there are some non-opiate meds that are surprisingly effective at reducing wd symptoms. Clonidin is the best known such drug, otherwise it is used for hypertension and your doctor probably knows about it. A mild antidepressant might be needed, herbal is best, St John Wort or something, but a few
Valiums won't kill him either as long as he doesnt start abusing benzos, then you will have an evern more wicked substance to detox from.
Important note: if risk of relapse is high, ask for an agonist blocker like Naloxon, Naltrexon etc. which he should take daily so if he messes up he suffers enough for his brain to do a U turn. As painful as withdrawal looks it is not life threatening.
If I were American I would definitely consider detoxing in another country, meds like Sub though are probably illegal to import so don't bother.
Finally, loving your son is OK, but bear in mind addicts are manipulative, keep a close eye on him and ask something in return for paying his medical bills. Have him build his life back, get a job, socialize with straight people, find a hobby, a girlfriend would probably help if he can get one.
Cost of Subutex/Methadone therapy in different countries 
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