Suboxone dosing needs to be adjusted for each individual based on what they need to prevent cravings for opioids. Some people need as little ast 2 mg once a day while others may need as much as 8 or 10 mg up to three times a day. Getting the dosing right can take a little time. Your doctor is your partner during your first day of Suboxone treatment.
When therapy begins, you’ve likely had many conversations about what will happen and what you should do. Follow your doctor’s instructions, and you’ll likely have a smooth transition to starting your Suboxone therapy.
Everyone’s first day is a little different, but in general, the first day is about finding the right Suboxone dose. Prepare to spend most of the day observing how you feel after your first dose and discussing dose adjustments with your doctor.
Critical Decisions on the First Day
There’s no right or wrong way to start Suboxone. Your doctor will help you move through the variables and find a plan that works for you. These are three important aspects you should decide on together.
1. Location: At home, or in the office?
Some people opt to start treatment at home so they can feel comfortable and relax if they do experience any side effects such as dizziness, sedation, nausea or GI upset.
Other people prefer to take their first dose at the clinic so that they can be near their doctor in case they have symptoms or want to ask questions. This is sometimes referred to as an “in-office induction”.
Studies show that both at home as well as in-office inductions are safe and equally effective. It mostly comes down to what your doctor offers and what you personally feel would be best for you.
Talk to your doctor about what location you would like to be at when you take your first day of Suboxone.
2. Medication Form
Most people start Suboxone in either a strip or a tablet form, both of which are ultimately meant to be placed under the tongue and dissolved. For this reason, it can be a little trickier than just swallowing a pill. Ensure you understand how to use the form you’ve chosen and how to administer it properly under the tongue to ensure it is fully dissolved and absorbed by your body.
3. Medication Dose
Your doctor will estimate your Suboxone need based on factors like your weight, height, and drug use history. But this dose is an estimate, and some people may need less or more medication in order to minimize their cravings but also minimize any side effects.
Your doctor will walk you through a typical induction process, but it typically looks like this:
- Determine Your Last Dose of Opioids You must be in drug withdrawal before your first Suboxone dose, or you’ll be kicked into active (and uncomfortable) withdrawal immediately. Make sure your doctor gives you instructions on how long to wait after taking any opioids (either opioid pills or heroin, fentanyl, etc.) before you take your first dose of Suboxone. Ideally, you will start to feel some withdrawal symptoms and strong cravings for opioids – this is a sign that other opioids are gone from your body and it is safe to take your first dose.
- Take your first dose. Your doctor will tell you how much to take and how to use the medication.
- Wait for a response. Typically, your body needs one to three hours to respond to the medication.
- Measure your symptoms. If you have no side effects but still have cravings to use opioids, you may need a higher dose. If you do not have cravings but have side effects, you may need a lower dose.
- Repeat these steps. Your doctor will give you instructions on when to take a second dose, and what number of milligrams it should be. Communicate openly and closely with your doctor over the first few days of therapy.
Your doctor may give you pamphlets and other documents that explain what will happen and what you will do. Read these carefully and ask all questions you have – there are no bad questions.
Suboxone can make you feel better during withdrawal, but it’s not uncommon to experience some discomfort, both from transitioning off of opioids and also potentially from side effects from the new medication. Be patient – it gets easier.
Be proud that you have completed your first day of MAT, and rest assured that it is putting you on a path to a better future. With your withdrawal symptoms and cravings under control, you can focus on the essential work you’re doing to discontinue your opioid use.
By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
- COWS Score for Opiate Withdrawal. MD Calc. https://www.mdcalc.com/cows-score-opiate-withdrawal. Accessed June 2022.
- Buprenorphine Quick Start Guide. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf. Accessed June 2022.
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