Deciding to start medication-assisted treatment for opioid use disorder is huge. Congratulations! But once you make that decision, you can’t just dive right in. You will need to take some steps to prepare. Here’s what you need to do to get ready to begin Suboxone (buprenorphine/naloxone) induction.
Talk to your provider
Suboxone (buprenorphine/naloxone) is a prescription medication and is also a Schedule III controlled substance, so you will need to work with a licensed provider in order to start Suboxone treatment. Here are some of the things that might happen in an appointment before induction begins:
- Complete an evaluation and any necessary drug screening—Your provider will need to conduct a medical evaluation. This could take place in person or via telehealth, but they are not allowed to prescribe a buprenorphine medication without conducting one. This evaluation will include talking about your substance use history and may require submitting a drug screen. Be as honest as possible with your provider, even if it’s hard to open up about your drug use. That information can be important to your treatment.
- Discuss your Suboxone induction plan—This is where you will learn when to take your first Suboxone dose, when to take additional doses, how you will feel … all the details. When your provider talks to you about how induction will go, pay attention and don’t be afraid to ask questions. Induction can be scary, and being uncertain about what is happening to you will only make it feel worse. Clear away that fear and uncertainty by asking all of your questions about the induction process. If doctors make you feel intimidated or if you suspect you’ll have trouble remembering their instructions, ask if you can bring a friend or family member to support you in the appointment.
- Learn how to use naloxone—You may have heard of naloxone by the brand name Narcan. It is an opioid overdose reversal medication, and many doctors prescribe it to all of their patients who use opioids (including partial agonists like buprenorphine). It’s now even available without a prescription. Having naloxone on hand and knowing how to use it can save lives. Even if you feel certain you’ll never use again, it’s still worthwhile to know how to use naloxone in case a friend ever overdoses in your company.
- Get your prescription—In most cases, after your evaluation, your provider will either give you a Suboxone prescription to take to the pharmacy or will send the prescription in electronically.
Understand the need for withdrawal
To be very honest, opioid withdrawal sucks. It can range from uncomfortable to utterly miserable, but it’s never a good time. But your provider will likely tell you that you must wait until you reach a certain level of withdrawal symptoms before you can begin Suboxone. This is a common part of the induction plan for many people. You may use the Subjective Opiate Withdrawal Scale (SOWS), the Clinical Opiate Withdrawal Scale (COWS), or another tool to determine how severe your withdrawal symptoms are. Your provider will help you understand how to score your symptoms, and what score you must meet before taking your first dose of Suboxone.
Why do you have to go through withdrawal at all? To prevent you from suffering from an even worse, more intense kind of withdrawal called precipitated withdrawal. Precipitated withdrawal is particularly severe and is precipitated, or set off, by another substance. If you take buprenorphine too soon after your last use of other opioids, it will send you into precipitated withdrawal, and you will suffer far more and for far longer than you need to.
When should you stop taking other opioids?
The length of time it will take for your body to be clear enough of other opioids will vary based on your own physiology and on what kind of opioid you’ve been using. For example, if you took short-acting opioids like Percocet, Vicodin (hydrocodone), or heroin, it will probably take between 12-24 hours before it will be out of your system enough for your first Suboxone dose. If you took long-acting opioids like Oxycontin or morphine, it could take closer to 36 hours before you’re ready to begin induction.
This is why your provider will help you determine the withdrawal score that will prompt you to take your first dose—because this timing varies so much from person to person and situation to situation.
What will the opioid withdrawal symptoms be like?
Opioid withdrawal symptoms are often compared to having a bad flu, so anticipate that kind of discomfort for a little while. You will feel at least some of the following symptoms:
- Restlessness, difficulty sitting still
- Sweating and/or chills
- Muscle tremors, twitching, or shaking
- Enlarged pupils
- Runny nose and/or watery eyes
- Heavy yawning
- Joint and bone aches
- Upset stomach (cramps, nausea, vomiting, diarrhea)
- Anxiousness or irritability
Prepare for when withdrawal kicks in
Just because you have to experience some withdrawal symptoms for a little while doesn’t mean you can’t do anything to make them more tolerable. Prepare ahead of time to make the situation more comfortable:
- Cue up some distractions—Pick a show to binge, find a long YouTube playlist to cycle through, have some old favorite books to read. Having distractions can make it easier to bear the discomfort of withdrawal symptoms.
- Hydrate—Start drinking water early, before your symptoms even begin. Your body is likely already a little dehydrated. Stock up on water, electrolyte drinks like Powerade and Gatorade, or Pedialyte (from the baby-care aisle). DO NOT DRINK ALCOHOL.
- Be ready for temperature shifts—Your body temperature can swing from fever to chills and back again while you’re in withdrawal. Dress in comfy layers so you can bundle in a hoodie when you’re cold and pull it off when you’re hot. It can be smart to have both blankets and a heating pad and ice packs and a fan on stand-by.
- Showers or baths—Baths and showers can help with the temperature shifts (run them hot or cold as needed). They also feel good on muscle aches and wash away the sweat. Win-win-win.
- Have tissues and a trash can—A runny nose and watery eyes will mean going through a whole lot of tissues. Get soft ones if you can afford them, and have a trash bag or can ready for the used ones.
- Remember the goal—This period of experiencing withdrawal symptoms is temporary. Soon you’ll be at the point where you can safely begin taking your Suboxone dose, and you’ll be able to stop the cycle of dopesickness.
Take your Suboxone doses as directed
Your induction plan will not only include how to know when you’re ready for your first dose, but also when to take additional doses. The process of induction is one of steadily adding more of the medication until you reach the best dose for you. The most common maintenance dosage is 16 mg/4 mg once a day, but your own dose may end up being higher or lower than that.
Don’t wing it! To stabilize your recovery, you’ll need to follow the plan you discussed with your provider.
Suboxone (buprenorphine/naloxone) gives you a chance to heal and to get your life back from opioid use disorder. I hope that knowing a little more of what to expect and how to prepare will help your induction to go smoothly, so that your recovery gets off to a great start.