Buprenorphine – Starting Your Treatment
Your step-by-step guide to the first three days of buprenorphine (Suboxone or Subutex). Keep this page open on your phone or print it, and follow it one step at a time.
Before you start
Wait until you feel withdrawal
Before your first buprenorphine tablet or film, you need to be in withdrawal and feel lousy. Very lousy. The worse you feel when you start, the better the medication will make you feel.
How long to wait after your last use
- At least 12 hours since you last used heroin or pain pills (OxyContin, Vicodin, etc.)
- At least 48 to 72 hours since you last used methadone
Why waiting matters
Buprenorphine pushes other opioids out of the body's opioid receptors. If you take it too early, while those opioids are still working, it can bring on sudden, severe withdrawal (called precipitated withdrawal). Waiting until you are clearly in withdrawal lets the first dose bring relief instead.
Day 1 · Before your first dose
Check your withdrawal signs
As withdrawal starts you will notice flu-like symptoms. Do not be scared: this is your body's normal response. Wait it out as long as you can. You are ready for your first dose when you have at least 3 of these signs:
Tick the signs you have: 0 of the 3 you need.
Every dose
How to take a dose
Under your tongue only
Put the tablet or film under your tongue. If you swallow it, it will not work. The medication only works when it absorbs under your tongue.
Let it dissolve
It takes 20–45 minutes to absorb and start working. After that you may swallow or spit out anything left; it is no longer active.
No food, drink or smoking
Not for 15 minutes before and 15 minutes after each dose, or you will not get the full effect.
Don't lie down right away
Stay upright after your dose so it can absorb properly.
Your supply
You will be given a 3-day supply of buprenorphine. Each tablet or film is 8 mg.
Day 1
Your first day, step by step
- 1When you have at least 3 withdrawal signs, place ½ a tablet or film (4 mg) under your tongue.
- 2Wait. If you feel good after ½ tablet or film (4 mg), don't take any more. This may be all you need.
- 3After 1–2 hours, if you still have withdrawal feelings and still feel lousy, don't worry: you just need more medication. Take another ½ tablet or film (4 mg).
- 4You may repeat ½ tablet or film (4 mg) every 1–2 hours until you no longer feel lousy.
Day 1 limit
Do not take more than 2 tablets or films (16 mg total) on Day 1.
If you also take buprenorphine for pain
Your pain may not be fully under control yet, but you should notice that you are no longer in withdrawal and no longer feel lousy. We will adjust your medications to control your pain in the coming days and weeks.
Days 2 and 3
Settling into your dose
Day 2
Start taking the full tablet or film twice a day: 8 mg twice a day, 16 mg in total for the day.
Day 3
Stay on the same dose as Day 2: 8 mg twice a day, 16 mg in total.
On Day 3: send us your medication update
Please fill out our online medication update form. If we need to adjust your dose or medication, we will discuss it with you then.
Comfort medications
Other medications you may take
Along with buprenorphine, we have prescribed other medications to help you through the transition. They will be sent to your pharmacy with clear instructions. You may take them on any day during these three days and for the rest of the week if you wish. You do not have to take them unless you need to.
Safety
Staying safe on buprenorphine
Avoid alcohol and sedatives
Mixing buprenorphine with alcohol, benzodiazepines (like Xanax, Valium or Klonopin) or sleeping pills can slow or stop your breathing. Tell us about every medication you take.
Lock it away
Keep your medication out of reach of children and pets. Even a small amount can be deadly to a child. If a child takes any, call 911 right away.
Keep naloxone at home
Naloxone (Narcan) can reverse an opioid overdose. Learn how to use it and ask us about a prescription.
Take care driving
Do not drive or use machinery until you know how the medication affects you, and do not stop taking it suddenly without talking to us.
Help
When to get help
Call 911 right away if you or someone with you has
- Trouble breathing, or very slow or shallow breathing
- Extreme sleepiness, or can't be woken up
- Blue or gray lips or fingertips
- Chest pain or a seizure
Call or message us
If you need us at any time during this process, call 844-782-6963 or message us and we will get back to you as soon as possible. Call us too if your withdrawal suddenly gets much worse after a dose, or if you are unsure whether to take more.
In an emergency, call 911. For a mental health crisis, call or text 988 (Suicide & Crisis Lifeline).
You are not alone.
We will be with you throughout the process, and we will see you soon.