How To Prep For Opioid Withdrawals When Beginning Suboxone Treatment — The First 10 Days

November 26, 2022

Table of Contents

Transitioning from opioids to buprenorphine/naloxone (Suboxone) can be intimidating.

You will have to undergo withdrawal symptoms to transition from opioids to Suboxone. Bicycle Health's care team will be with you along the way to ensure a transition that is as safe and comfortable as possible. You'll work closely with the team during your first 10 days. 

The First 10 Days With Bicycle Health

Bicycle Health is here to help you through this process from start to finish with these day-by-day steps.

Day 1

What you do with Bicycle Health:

  • Meet with your medical provider for a telemedicine assessment. In our platform, the provider and patient can see each other.
  • Receive written instructions on starting Suboxone safely.
  • Receive a prescription for Suboxone and comfort medications if you meet the criteria for opioid use disorder (addiction to opioids) and Bicycle Health's standards. Bicycle Health providers usually provide about 12 mg of Suboxone on the first day, followed by an increase to 16 mg on day two.

What you do at home:

  • Stop your opioids and allow the withdrawal process to begin.
  • Monitor your symptoms using Bicycle Health's tool to measure withdrawal severity.
  • Take comfort medications as needed.
  • Start a small amount of Suboxone when your withdrawal is severe enough when measured on the SOWS scale.

Days 2–3 (or one day after your anticipated start)

What you do with Bicycle Health:

  • Meet with your medical provider again to assess your status, make appropriate medication adjustments, and answer any questions.
  • Receive instructions and prompts to complete urine drug screenings at home.

What you do at home:

  • Continue your 12 mg dose of Suboxone or increase it to 16 mg (based on the provider's guidance).
  • Monitor your symptoms, especially cravings and withdrawal symptoms to report to your medical provider at each visit.
  • Complete the first urine drug screening at home and show results via your smartphone camera.

Days 7–10

What you do with Bicycle Health:

  • Meet your medical provider periodically to assess your status, make appropriate medication adjustments, and answer any questions.

What you do at home:

  • Monitor your symptoms, especially cravings and withdrawal symptoms, to report to your medical provider at each visit.

After Day 10

Once you feel comfortable on your dose, your medical provider will see you weekly until you are stable with appropriate drug screenings.

When to Stop Taking Opioids 

Different opioid types require different withdrawal timelines before you can start Suboxone.

The following examples are rough estimates of the hours it takes to withdraw:

  • Short-acting opioids, including heroin, oxycodone/Percocet, hydrocodone/Vicodin/Lortab, and kratom: approximately 12 to 16 hours
  • Long-acting opioids, including OxyContin, MS Contin, and Opana ER: approximately 20 to 24 hours
  • Methadone: approximately 48 hours
  • Fentanyl: approximately 72 hours (but varies by method of use)

Why Do I Have to Feel Withdrawal Symptoms?

Some people have had the unpleasant experience of trying to take Suboxone without going through opioid withdrawal. This can make someone feel very ill, although it is generally not dangerous.

Opioids act at the opioid receptors of cells in your brain. Buprenorphine sticks in those receptors much more strongly than opioids and kicks opioids out of the receptors. When this happens, the patient can experience sudden and severe withdrawal symptoms called precipitated withdrawal.

You can avoid precipitated withdrawal by going through moderate withdrawal before taking Suboxone. This ensures that full opioids are out of your body and the Suboxone will not “kick those opioids off” receptors in your brain too quickly and cause a withdrawal.

Most people who are physically dependent on opioids have felt withdrawal symptoms at one time or another. Withdrawal from opioids can include symptoms like nausea, vomiting, diarrhea, anxiety, restlessness, dilated pupils and goosebumps.[1]

Induction at Home vs. Office Treatment 

Bicycle Health uses telemedicine techniques, so you address your addiction while living at home. Telehealth has both benefits and downsides. 

Pros of At-Home Care

It's safe and effective for most patients to start Suboxone at home in a comfortable and familiar environment without the dangers of driving while in withdrawal or taking a new medication. In the COVID-19 era, self-management with expert support is even more critical to avoid potential exposure in health care settings. Your medical provider can assist you in deciding if this is the right pathway for you.

Cons of At-Home Care

Home induction of Suboxone is safe for most individuals, and emergency help is rarely needed. But if you feel something is wrong or having concerning side effects, contact Bicycle Health during business hours or consider going to urgent care or the emergency room after hours. 

How Do I Prepare To Start Suboxone?

The best way to prepare to start Suboxone is to consult with your medical provider and have all your questions answered ahead of time. Bicycle Health providers will walk you through the process before you start your first dose.

Gather your medications, including Suboxone and comfort remedies like NSAIDS, before you begin the withdrawal process, so you do not have to go to the pharmacy once you start to feel ill.

Prepare a comfortable environment at home with a bathroom nearby, as you may have unpleasant symptoms such as vomiting or diarrhea.

How Do I Manage Withdrawal Symptoms?

Your medical provider can select targeted medications that help with specific withdrawal symptoms, such as diarrhea, nausea, anxiety, and muscle aches.

Stay in your comfortable, safe, and private environment with a bathroom nearby. You can use distraction techniques, meditation, or other comfort measures that work for you.

Use Bicycle Health's withdrawal tool to measure the severity of withdrawal and assess when you are ready to take buprenorphine/naloxone (Suboxone) by assigning a numerical score to each symptom. A similar tool can be found here.

Listen to your body. Keep in mind that if you feel so ill that you do not think you can tolerate any further withdrawal symptoms, you are most likely ready to start a small amount of Suboxone. Check your symptoms against Bicycle Health's withdrawal severity tool to be sure.

You can read more about managing withdrawal symptoms here.[3]

Opioid Withdrawal Tips & Tricks

Here are some tips and tricks to help you get through withdrawal symptoms and the induction process:

  • If you have supportive friends and family who are aware of your condition, enlist them to check on you periodically.
  • Plan to take a day or two to transition from opioids to Suboxone. If you work, you might pick a weekend to start. If you have young children, make sure you have help caring for them if possible.
  • Do not intentionally start the withdrawal process before talking to your medical provider. It is difficult to communicate effectively when you are already feeling ill.
  • You do not need to cut down your opioid dose ahead of time. Cutting opioid doses before induction to Suboxone rarely helps but does cause unnecessary discomfort.
  • Know that Suboxone stops withdrawal symptoms in almost all patients, even those with severe symptoms or who use high-dose opioids. Please contact Bicycle Health for assistance if you do not feel that this medication is relieving your symptoms.

To learn more about the success rates and safety of Bicycle Health's telemedicine addiction treatment compared to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

Medically Reviewed 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 she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Opiate and Opioid Withdrawal. MedlinePlus. https://medlineplus.gov/ency/article/000949.htm. Accessed August 2022. 
  2. Subjective Opiate Withdrawal Scale (SOWS). IT ATTRs Colorado. https://www.asam.org/docs/default-source/education-docs/sows_8-28-2017.pdf?sfvrsn=f30540c2_2. Accessed August 2022.
  3. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/. 2009. Accessed August 2022.

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