How to start taking buprenorphine
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Starting buprenorphine is a big step, and there's more than one way to do it. You and your clinician will choose the method that fits you, based on things like what you've been using, when you last used, and how you'd like your first day to go.
This page covers what every method has in common. For your exact steps and doses, follow the instructions for the method you and your clinician chose.
Why timing matters
Buprenorphine, the medicine in Suboxone, attaches strongly to the same parts of your brain as other opioids like fentanyl, heroin, pain pills, kratom, and 7-OH. If you take it while a lot of another opioid is still in your system, it can cause sudden, intense withdrawal. This is called precipitated withdrawal.
Each method avoids this in its own way. Some have you wait until you're already in withdrawal. Others start with very small doses, or use Narcan (naloxone) to get through withdrawal quickly.
Ways to start
- Standard. Wait until you're in withdrawal, then take a full film or tablet. See the standard transition instructions.
- Macrodose. Wait until you're in withdrawal, then start with a larger first dose. See the macrodose transition instructions.
- Low dose. Wait until you're in withdrawal, then take small doses often throughout the day. See the low dose transition instructions.
- Microdose. Skip withdrawal. Take tiny doses over about a week while slowly using less of other opioids. See the microdose transition instructions.
- QuickStart. Use Narcan to bring on a short period of withdrawal, then take a high dose right away. The whole thing takes less than an hour. See the QuickStart instructions.
Everyone starts with films or tablets, even if you plan to switch to a monthly or weekly shot later.
Tips for any method
- Make sure to closely follow the dosing guidance and instructions from your clinician.
- Let each dose dissolve all the way under your tongue without chewing or swallowing. This can take up to 15 minutes. See tips for taking your buprenorphine for more.
- If your clinician prescribed medicines to ease withdrawal symptoms, have them ready and take them as recommended.
- If you've been taking methadone, make sure your clinician knows. It stays in your body longer, which changes the timing.
- Pick a comfortable place to start, and if you can, have someone you trust nearby.
After your first day
You'll have a follow-up visit in the next few days to talk about how you're feeling. Dosages vary for each individual, with most maintaining a daily amount between 16 and 24 mg. If your dose is too low, you may feel withdrawal between doses. If it's too high, you may feel sleepy and slow. Your clinician will work with you to find what feels right, and that can change over time.
If something doesn't feel right
If your withdrawal isn't easing, or anything worries you, call 888-316-0451 or message your care team right away. You don't have to wait for your next visit. You can reach an on-call medical provider 24/7 at the same number, even when Boulder is closed.