How it Works

We offer Medication for Addiction Treatment (MAT) with Suboxone (buprenorphine/naloxone) to help patients stop their opioid use.

Combined with our empathetic care model, this transformative treatment boasts 95% of patients reporting no withdrawal symptoms at 7 days. It can change your life.

Why Bicycle Health?

Accessible
Care team

Our Clinical Support Specialists offer guidance and encouragement every weekday from 9 am to 7 pm via phone, text, or chat on our secure app.

Online Appointments & Easy Communication

Get quick advice from your medical provider on a video call or online chat. No travel or waiting rooms required, and it’s all completely confidential.

Prescription
Refills

We promptly send prescriptions via email to a pharmacy near you.

Online support
groups

Experiences are more powerful when shared. Our online meetings are a safe space for patients to connect with others in recovery.

How does
Bicycle Health work?

Step 1

A Quick, Free Call

We’ll chat with you about your situation and make sure our program is a good fit for you.
  • Private and secure: All communication with our care team is completely confidential.
  • Judgment-free: We’ve helped thousands of people just like you. We know it’s tough, and we’re here to support you.
  • Available 24/7: Call us now, or schedule a future call at a time that’s best for you.
Step 2

Your First Appointment

You’ll meet your provider and receive your full treatment plan.
  • Convenient: You don’t have to take time off work, travel to a clinic, or sit in a crowded waiting room. We make it easy.
  • Trustworthy: Our expert clinicians focus solely on treating opioid use disorder. They are the best in their field.
  • Customized: Your care plan is designed specifically for your needs and goals. It’s tailor-made just for you.
Step 3

Suboxone, the Same Day

If you and your medical provider decide Suboxone is the appropriate treatment, pick up your prescription the same day from a nearby pharmacy.
  • Affordable: We work with your insurance and providers to ensure you pay as little as possible for your medication.
  • FDA-approved: Suboxone, the gold standard for treating opioid use disorder, is proven to be safe and effective in treating opioid use disorder.
  • Full care: We can also prescribe comfort meds to ease discomfort during withdrawal.
Step 4

Heal Mind & Body – for Good

Get ongoing care and support to truly overcome opioid use disorder.
  • Prescription refills: Your provider will always refill your medication as needed.
  • Health coaching: A dedicated coach guides you through approaches to improve behavioral health issues.
  • Support groups: Online meetups are available for ongoing encouragement and support in a safe environment.

We’re committed to your privacy.

We never share any health information without your explicit consent. Your care is 100% confidential, and we take this very seriously.

Read our full privacy policy below, and reach out to our enrollment coordinators if you have any questions. With our technology-driven approach to treatment, you can access your medical records, communicate with your care team, and enjoy full rights to standard-of-care confidentiality through our secure and HIPAA-compliant mobile app.

With your consent, our team will design and coordinate a treatment plan that is ideal for you. And you can access this plan easily through our app.

Read our Privacy Policy

We’re serving patients across the country.

Bicycle Health is currently available in Arizona, California, Colorado, Connecticut, Delaware, Florida, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Oregon, Pennsylvania, Texas, Vermont, Virginia, Washington, Wisconsin, and Wyoming.

We’re continually expanding to new areas. Check back with us about availability in your area.

US map

Frequently asked questions

What happens before my first MAT appointment?

You’ll speak with an enrollment coordinator who will answer your questions about our program and what we offer, and we’ll also ask you questions to try to ensure that our program will be a helpful fit for your care.

We’ll also walk you through some required forms including consent to treatment, review of program policies and practices, payment, and directives for how we handle your medical records.

We’ll work with you to set an initial appointment which will be same-day if at all possible. We’ll then provide guidance for you to download the required app for the video visit with your provider, and your provider will contact you through the app at your appointment time.

How to Talk With Your Doctor About Taking Suboxone

If you’ve been misusing opioids, you might need professional help. But it can feel awkward or even frightening to talk to your doctor about Suboxone or another medication for opioid use disorder (OUD).

Almost 85% of Americans say they trust their doctors.[1] But even so, some patients fear starting this discussion with their health care professional.

The first thing to know is that disclosing your drug use to your physician is completely confidential. There are laws in place that prevent your doctor from disclosing your personal substance use history to law enforcement.

Even if there weren’t legal protections, doctors aren’t policemen: their job is not to punish you. Their job is to keep you as healthy and safe as possible, and most of them are happy when you disclose your concerns about your substance use as it gives them an opportunity to help you.

Know that you can always trust your doctor with information about your drug use. Starting the conversation could be lifesaving, and help you get the treatment you need.

Here's what you need to know about starting these conversations with your doctor. 

Things to Tell Your Doctor When Discussing Taking Suboxone

First, know that your doctor is not legally allowed to talk to others about your drug use, including making a report to law enforcement. Anything you say to your doctor is confidential and protected under a law called HIPAA [2]

You're not required to talk about where you obtain your drugs, and your doctor isn't likely to ask.

Your doctor may ask about the following:

1. Your Drug History

Your doctor may ask you questions like, what substances do you use habitually? What substances do you use intermittently? Have you tried a drug once and never used it again? Is there a substance that you are using regularly? This helps them to understand what drugs you might be dependent on and what medications and therapies would be the most helpful for treatment. 

2. Your Typical Dose 

How much of each substance do you take? Do you have symptoms (like nausea, shaking, or a headache) if you don't take your drug? Do you need more to get the results once delivered with a small dose? This helps your doctor understand if you have a tolerance of a physical dependence on the drug, which can help guide him or her in what types and doses of treatments can be offered to you. 

3. Your Drug Use Methods 

Your doctor may ask about this because different delivery methods of drugs pose different risks to your health. For example, individuals who use injection drugs are at risk for different infections than those who merely snort or smoke. Your doctor may ask if you swallow pills, snor/crush pills, or if you inject drugs. If so, they may ask if you share needles with others, which increases your risk of infections. 

4. Your Treatment History

Have you tried to quit using drugs before? What methods did you use? How did you feel when you tried to quit? What made you relapse? This can help your doctor understand right away what treatments have or have not worked for you in the past so that you can decide together what treatments - either pharmacological or behavioral - are the right ones for you. 

Which Types of Doctors Prescribe Treatments for Addiction?

Many primary care or family medicine doctors treat patients with Substance use disorders. Therefore, if you have a primary care doctor that you know and see regularly, talking to him/her is a good place to start. However, some primary care doctors do not treat a lot of patients with addiction, and may refer you to another specialist doctor. Oftentimes, these doctors are psychiatrists or physicians who have done additional training as addiction medicine specialists.

In some states, doctors must get a special license to prescribe Suboxone (although this is changing and becoming less common in many states in order to facilitate more easy administration of this medication. [3] In other states, Nurse Practitioners (NPs) can also prescribe Suboxone.

If you have a doctor you know and trust, ask them if they prescribe Suboxone, or if they can refer you to a provider that does.

You can also use an online tool like this one to find a buprenorphine doctor near you.[3]

Suboxone treatment programs can last for months, years, or indefinitely for some patients who need life-long treatment [4] It's important to work with someone you trust, as you'll be connected for a long time.

Don’t let fear or intimidation prevent you from talking to your doctor openly and honestly about Suboxone: they are there to help. Ask your doctor about Suboxone, or reach out to us here at Bicycle health for more information.

Sources

  1. Surveys of Trust in the U.S. Health Care System. ABIM Foundation. https://www.norc.org/PDFs/ABIM%20Foundation/20210520_NORC_ABIM_Foundation_Trust%20in%20Healthcare_Part%201.pdf. February 2021. Accessed August 2022.
  2. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
  3. Buprenorphine. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. July 2022. Accessed August 2022.
  4. Buprenorphine Practitioner Locator. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/find-treatment/treatment-practitioner-locator. Accessed August 2022. 
  5. Factors to Consider Before Prescribing Buprenorphine. American Psychiatric Association. https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2018.11b12. December 2018. Accessed August 2022.

What is Suboxone used for?

Buprenorphine/naloxone (Suboxone) is a long-acting, partial opioid agonist used to treat opioid use disorder. 

Patients who have been taking opioids, like oxycodone (percocet), hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone, heroin, fentanyl, on a daily basis can become dependent on these substances, meaning that if they do not take them daily, they will experience awful withdrawal symptoms, like nausea/vomiting, diarrhea, body aches, agitation/anxiety. Many people become addicted and the opioids start to take control of their life. They have cravings, think about opiates all the time, and are unable to fulfill their daily responsibilities like going to work or taking care of friends and family. It becomes an “all consuming disease”.

Buprenorphine/naloxone (Suboxone) works by stabilizing the brain. By binding to the opiate receptors in the brain, Buprenorphine/naloxone (Suboxone) prevents withdrawal symptoms, staves off cravings, and also blocks these receptors so other opioids (like heroin or fentanyl) cannot bind, preventing overdoses and saving lives. As a partial agonist (meaning it only partially stimulates the opioid receptor), Burpneorphine/naloxone (Suboxone) rarely causes patients to feel “high.” Rather, patients taking buprenorphine/naloxone (Suboxone) should feel NORMAL, able to go about their day and live their life to its fullest. For these reasons, Buprnorphine/naloxone (Suboxone) is considered very safe, and it is considered evidence-based treatment for opioid addiction. 

Buprenorphine/naloxone (Suboxone) is most effective when used in conjunction with counseling and psychosocial support.

How Long Will It Take to Complete Suboxone Treatment?

The National Quality Forum says that treatment with buprenorphine-based medications (like Suboxone) should last between six and nine months.[1] Some say treatment should take much longer.

Stopping Suboxone is closely associated with relapse. Therefore, most doctors encourage you to be on Suboxone for months to even years, particularly if the alternative is a relapse to opioid use. In some cases, it’s safest for people to stay on Suboxone indefinitely.

Effectiveness of Long-Term MAT

Medication for Addiction Treatment (MAT) involves using medications and therapy to combat opioid use disorder (OUD). Using a buprenorphine-based medication like Suboxone reduces a person's chance of early death by any cause by about half.[2] The medication you take could save your life.

Researchers say treatment lasting at least 15 months could reduce the risk of the following:[1]

  • Opioid-related hospital visits (by 128%)
  • Overdoses (by 173%)
  • Opioid prescriptions (by 120%)

When compared to people taking buprenorphine for six to nine months, those staying in treatment for 15 to 18 months have fewer instances of the following:[3]

  • Emergency room visits
  • Inpatient hospital stays
  • Filling opioid prescriptions

Statistics like this demonstrate how effective MAT can be when used over a long period.

How Long Should I Be on Suboxone?

There is no maximum duration for a MAT program.[4] Some people need treatment for a few months, but others stay on their medications indefinitely.

In multiple studies, the majority of people left MAT programs involuntarily. One month later, about half of them had relapsed to drug use.[5]  In a 2011 study, researchers found that people on long-term treatment often relapsed to drugs when they quit their buprenorphine therapies. More than 90% relapsed after a three-week taper.[6]

Before you quit your therapy, balance the risks and benefits. Talk with your doctor about whether quitting is really right for you. Staying in the program might be a better option. 

Are There Dangers in Using Suboxone Long Term?

The only real contraindication to Suboxone would be an allergic reaction, which is extremely rare. [8] As far as we know, there are no long term health risks to using Suboxone for many years to even life long. In fact, there are certainly more long term health risks with active drug use. For these reasons, Suboxone is thought to be safe long term for patients hoping to curb cravings and maintain their abstinence from opioids.

Sources

  1. Impact of Long-Term Buprenorphine Treatment on Adverse Health Care Outcomes in Medicaid. Health Affairs. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01085?journalCode=hlthaff. May 2020. Accessed September 2022.
  2. Buprenorphine: An Overview for Clinicians. California Health Care Foundation. https://www.chcf.org/wp-content/uploads/2019/08/BuprenorphineOverviewClinicians.pdf. August 2018. Accessed September 2022.
  3. Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder. The American Journal of Psychiatry. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19060612. December 2019. Accessed September 2022.
  4. Information About Medication-Assisted Treatment (MAT). U.S. Food and Drug Administration. https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat. February 2019. Accessed September 2022.
  5. Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes. Journal of Substance Abuse Treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382404/. May 2016. Accessed September 2022.
  6. Guide for Families: Medications for Opioid Use Disorder. Providers Clinical Support System. https://pcssnow.org/resource/guide-for-families-medications-for-opioid-use-disorder/. June 2021. Accessed September 2022.
  7. A Patient's Guide to Starting Buprenorphine at Home. It Mattrs. https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed September 2022.
  8. Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed September 2022.

How Much Does Suboxone Cost?

Prescription drugs like Suboxone can be life saving for those recovering from OUD. 8 in 10 American adults say the cost of prescriptions is unreasonable.[1] If you’re one of them and you’re considering skipping Suboxone due to costs, we have good news: Insurance companies typically cover Suboxone, and if you don’t have insurance, programs exist to help you.

how much does suboxone cost

Suboxone Cost with Insurance 


Federal law requires health insurers to provide the same level of care for mental health issues that they do for physical health concerns.[2] These laws ensure that medications like Suboxone are covered by most insurance policies, both public and private.

Medicare Coverage

Medicare coverage is for people over the age of 65 and with certain disabilities. Medicaid Suboxone coverage is complex. Medicare Part D covers medications like Suboxone.[3] Depending on how much you've paid in deductibles and other factors, you may have a copay, or your medication may be entirely paid for. 

Medicaid Coverage

Medicaid is run by State governments for people who make a certain percent of the poverty level. About 12% of people older than 18 with Medicaid benefits have substance misuse conditions. [4] All State Medicaid plans are required to cover Suboxone and other addiction treatment medications.[5] Depending on where you live and other factors, your Suboxone could be entirely covered, or may have a small copay. [6]

Private Insurance 

Private health insurance plans usually cover Suboxone or a generic equivalent. It’s almost impossible to determine how much you’ll pay, as coverage varies from state to state and plan to plan. If you have private insurance, the best thing to do is to call your insurance company and inquire as to whether your Suboxone is covered in full or in part. 

Suboxone Cost Without Insurance 


The number of people without any insurance dropped to an all-time low in 2022. Now, about 8% of people don't have any coverage.[7] If you're in this uninsured group, you can still get Suboxone. Talk to your doctor about your hospital or clinic’s policy for medication coverage for people without insurance. Some hospitals have “charity care” programs or discount programs for people paying out of pocket or without insurance. 

Discounts for Suboxone

Suboxone's manufacturer offers a discount program. If you don't have insurance, you'll pay about $86 per month for up to 90 2 mg films.[8]

You must apply for the program, and some people aren't eligible. If you're approved, the company sends a discount card you'll present to the pharmacist when you refill your prescription. 

GoodRx

GoodRx is a private company that offers discounts on common drugs, including Suboxone.[9] It's free to get started. You will do the following:

  • Sign up: Head to the GoodRx website to register for an account.
  • Access: Sign in via the website or download the GoodRx app to use it on the go. 
  • Search: Find pharmacies near you that have the lowest Suboxone price available. 
  • Show: Bring your prescription and your phone to the pharmacy. Show the staff your phone when it’s time to pay. The team will understand how to use the codes on the app.

GoodRx also provides coupons for your medications, which could save you even more.

Factors That Impact Suboxone’s Cost 

The United States government doesn't regulate drug prices.[10] Suboxone may cost more or less depending on a few factors: 

Name Brand vs. Generic 

Suboxone is the brand name form of Buprenorphine-Naloxone. It is also available in generic form. The FDA regulates all medications such that brand and generic formulations should work equally well. Generic forms are often a lot less expensive than brand forms. [11] Therefore, it might be cheaper for you to have a generic rather than brand name Suboxone. Your plan may also choose to cover the generic but not the brand name medication. 

Type of Insurance Coverage 

Every insurance plan is different, and companies have a lot of control over how much they charge their clients for medications. One might charge you almost nothing for your Suboxone, while another could cost you much more. If you are choosing a new insurance plan and know that you will need a Suboxone prescription, it might be worth investigating whether the plan covers Suboxone prior to enrolling. 

Suboxone Formulation 

Suboxone comes in two main forms: tablets and strips. The tablet or the strip might be cheaper in your location. If the tablet or strip is more expensive, you might consider switching to another type. 

Where Can I Go to Get My Prescription Filled?

While all pharmacies are allowed to carry products containing buprenorphine, fewer than half of them do so.[12] The medication is tightly regulated, and some small pharmacies don't feel comfortable keeping it on their shelves. 

In general, it's best to work with a large pharmacy. These facilities tend to keep Suboxone for patients. 

Try a large pharmacy chain, such as these:

  • Albertsons 
  • Costco 
  • CVS 
  • Kroger 
  • Rite Aid 
  • Walgreens 
  • Walmart

Call ahead to ensure the pharmacy can fill your prescription. Once you’re there, tell the team you’ll be coming back again for your refills in the future to make sure the pharmacy continues to stock your medication. 

Bicycle Health Pricing for Suboxone 

At Bicycle Health, we don't believe cost should keep people away from the care they need. Our treatment plans for opioid use disorders are cost-effective and incredibly helpful.

Schedule a call to learn more about our telemedicine treatment model, and find out if it's right for you. We can get you started on a treatment plan that will work for your situation.

Sources

  1. Public Opinion on Prescription Drugs and Their Prices. Kaiser Family Foundation. https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/. April 2022. Accessed October 2022. 
  2. Does Insurance Cover Treatment for Opioid Addiction? U.S. Department of Health and Human Services. https://www.hhs.gov/opioids/treatment/insurance-coverage/index.html. September 2020. Accessed October 2022. 
  3. Opioid Use Disorder Treatment. Medicare.gov. https://www.medicare.gov/coverage/opioid-use-disorder-treatment-services. Accessed October 2022. 
  4. Substance Use Disorders. Medicaid.gov. https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/substance-use-disorders/index.html. September 2014. Accessed October 2022.
  5. Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment. Centers for Medicare and Medicaid Services. https://www.medicaid.gov/federal-policy-guidance/downloads/sho20005.pdf. December 2020. Accessed October 2022.
  6. Medicaid Benefits: Prescription Drugs. Kaiser Family Foundation. https://www.kff.org/medicaid/state-indicator/prescription-drugs/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. 2018. Accessed October 2022.
  7. Number of Uninsured Americans Drops to an All-Time Low. PBS NewsHour. https://www.pbs.org/newshour/health/number-of-uninsured-americans-drops-to-an-all-time-low. August 2022. Accessed October 2022.
  8. Savings Card. inSupport. https://www.insupport.com/suboxone/savings. Accessed October 2022.
  9. How GoodRx Works. GoodRx. https://www.goodrx.com/how-goodrx-works. Accessed October 2022.
  10. Regulating Prescription Drug Costs. The Regulatory Review. https://www.theregreview.org/2020/10/17/saturday-seminar-regulating-prescription-drug-costs/. October 2020. Accessed October 2022.
  11. Generic Drugs and Biosimilars Secure Big Savings for U.S. Patients. Association for Accessible Medicines. https://accessiblemeds.org/sites/default/files/2020-09/AAM-2020-Generic-Drug-Biosimilars-Savings-US-Fact-Sheet.pdf. 2020. Accessed October 2022. 
  12. Fewer Than Half of U.S. Pharmacies Carry One of the Most Effective Drugs for Opioid Abuse. TIME. https://time.com/6186319/buprenorphine-overdoses-pharmacy-drug-treatment/. June 2022. Accessed October 2022.

Can I get addicted to Suboxone?

Addiction to a substance is a disabling chronic condition that has two components:

  • Physical dependence on the substance; and
  • Negative impact of uncontrolled substance use on one’s life.

Patients are physically dependent on taking buprenorphine/naloxone (Suboxone) daily in order to feel normal and healthy—similar to patients with high blood pressure, diabetes, heart disease, or depression who take daily medications to feel healthy. Buprenorphine/naloxone (Suboxone), when taken as prescribed by a medical provider, treats addiction and does not cause the negative impacts of uncontrolled substance use on one’s life, goals, and daily functioning. Buprenorphine/naloxone treatment is NOT replacing one addiction with another.

Does Suboxone Help With Pain?

The U.S. Food and Drug Administration (FDA) does not currently give approval for Suboxone purely as a pain medication (with the exception of the Butrans patch, which is FDA approved for chronic pain).

However, many other countries do use Buprenorphine as a pain medication because it does have analgesic properties in the same way that other opioids do. In the US, many doctors use Suboxone as an off-label treatment for chronic pain, particularly in patients who have previously been on opioids and do not want to continue to use opioids long term due to the risks of addiction and dependence.

If you're using Suboxone to address an opioid use disorder (OUD), your prescription could help with pain too. Some people start using opioids in the first place to address a chronic pain condition. Suboxone can be a wonderful alternative to treat pain off-label, particularly if a person is recovering from an OUD. 

Should Suboxone Be Used as a Pain Reliever?

The FDA currently has not approved buprenorphine as a pain medication alone, with the exception of Butrans which is a subdermal patch form of Buprenorphine that is in fact FDA approved to treat chronic pain.[1]

However, the majority of medications in the US are used by doctors “off label”, aka for indications other than strictly what the FDA has approved them for. For example, Hydroxyzine is approved as an antihistamine drug to treat allergies, but because of its sedating properties, it is often used “off label” as a drug to treat anxiety and poor sleep. In this same way, Suboxone can be safely and effectively used “off label” to treat chronic pain, particularly when the alternative is subjecting an individual to chronic opioid use which may prolong or put them at risk of developing an OUD.

Researchers say buprenorphine is a safe and effective pain medication.[5] In one overview study of 25 trials, researchers found 14 proving buprenorphine's efficacy.[6] And in another study, researchers found no evidence of respiratory depression (a hallmark of overdose) in people using this medication for pain control.[7]

So yes, there is good evidence that Suboxone can be used as a medication for pain, particularly in patients who already have an opioid use disorder but also potentially in patients who are opioid naive and in whom doctors want to prevent resorting to long term opioid therapy. 

How Commonly Is Suboxone Used for Pain Relief?

Some doctors may use Suboxone for pain relief, although it's not common. Many more clinicians are starting to use Suboxone as a pain medication as we become more familiar with it over time.

Several roadblocks keep doctors from using this medication to ease discomfort. 

FDA Oversight 

Although many medications are used off label, because of the stigma around opioid use disorder and the barriers to this treatment, some doctors have been more hesitant to use Suboxone “off label” to treat chronic pain in their patients with or without concurrent OUD.

Waiver Requirements 

Doctors must go through significant training and registration processes to prescribe buprenorphine, a process called obtaining an X-waiver. This creates additional barriers to prescribing this medication.

Insurance Coverage 

When a doctor writes a prescription for Suboxone, the doctor must offer a diagnosis code.[4] Doctors who use any code other than OUD can be rejected by insurance companies. 

Availability of Other Medications 

Suboxone isn't the only medication that can ease discomfort. Other choices are available, and most doctors prefer to start with non-opioid medications for pain control due to their better safety profiles and lower likelihood of dependency.

What About Pain Relief for People Already Using Suboxone?

Sometimes patients with OUD on Suboxone have chronic pain, or like anyone else have an acute episode of pain after an accident or after requiring surgery. Patients on Suboxone or with a history of OUD may be even more sensitive to pain than their counterparts. In this case, they may require alterations in their dose or even the addition of other pain medications temporarily. If you are a patient on Suboxone and anticipate having a worsening of your pain (an upcoming surgery, for example), talk to your doctor well ahead of time to help plan for how you will manage your pain while on Suboxone. There are a number of options available.

Sources

  1. Prescribing Information: Suboxone. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed July 2022.
  2. Buprenorphine-Naloxone Therapy in Pain Management. Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999180/. May 2015. Accessed July 2022.
  3. Treating the Opioid-Addicted Chronic Pain Patient: The Role of Suboxone. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/addiction-medicine/opioid-use-disorder/treating-opioid-addicted-chronic-pain-patient-role. March 2019. Accessed July 2022.
  4. Suboxone for Pain Makes Sense. Why Don't More Doctors Prescribe it? MedPage. https://www.kevinmd.com/2018/11/suboxone-for-pain-makes-sense-why-dont-more-doctors-prescribe-it.html. November 2018. Accessed July 2022.
  5. Buprenorphine: An Attractive Opioid With Underutilized Potential in Treatment of Chronic Pain. Journal of Pain Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640/. 2015. Accessed July 2022.
  6. Treatment of Chronic Pain with Various Buprenorphine Formulations: A Systematic Review of Clinical Studies. Anesthesia and Analgesia. https://journals.lww.com/anesthesia-analgesia/fulltext/2018/08000/treatment_of_chronic_pain_with_various.36.aspx. August 2018. Accessed July 2022. 
  7. Benefit-Risk Analysis of Buprenorphine for Pain Management. Journal of Pain Research. https://www.dovepress.com/benefit-risk-analysis-of-buprenorphine-for-pain-management-peer-reviewed-fulltext-article-JPR. April 2021. Accessed July 2022.

How Long Do I Have to Be in Withdrawal Before Starting Suboxone?

It depends. Most people should wait at least 12 hours after your last opioid dose before you start taking Suboxone. However, some people may enter withdrawal sooner or later than this. Your doctor can guide you as to when is the right time for you to start your first dose.

Doctors use one of two models.

  • Timeframes: If you don’t know how long it usually takes for you to feel opioid withdrawal symptoms, there are basic timelines that most people’s body’s follow. For example, most short acting opioids take about 12 hours to leave the body. 
  • Monitoring: Many people know exactly how long it usually takes for them to start feeling withdrawal symptoms. You and your doctor watch for signs and symptoms of withdrawal. When they appear, you start taking Suboxone. 

Most people feel mild-to-moderate withdrawal symptoms before their first Suboxone dose. It’s uncomfortable, but it’s temporary. Your medication should ease your symptoms.

when you can start taking suboxone

Starting Suboxone

Before taking Suboxone, your body must fully metabolize the last dose of other opioids. You'll know that it's time when you experience withdrawal symptoms.

Your physician might measure the severity of your withdrawal symptoms using a scale like the Clinical Opiate Withdrawal Scale (COWS).[1] To be considered in withdrawal, you will probably experience the following:

  • Twitching, tremors, or shaking
  • Enlarged pupils
  • Chills, shaking, or sweating
  • Heavy yawning
  • Joint, muscle, and bone aches
  • Runny nose or tears in your eyes
  • Goosebumps
  • Cramps, nausea, vomiting, or diarrhea
  • Feeling anxious or irritable
  • Insomnia

A COWS score of 11 to 12, which is generally mild to moderate opioid withdrawal symptoms, indicates that you can begin taking Suboxone.[2] If you begin Suboxone treatment at home, wait one hour after the onset of withdrawal symptoms and then take your first dose of Suboxone. You should feel relief within 30 minutes.

Other clinicians might be less systematic and simply ask you to wait 12 to 14 hours after your last dose of an opioid before starting Suboxone.

You may need a larger dose if you do not experience significant relief from withdrawal symptoms. Your physician can guide you through the process of increasing your dose.

How Many Hours or Days Should You Wait Before Beginning Suboxone?

Your physician will tell you when to start taking this medication. In general, patients are counseled to wait a certain number of hours after taking their last opioid before starting their buprenorphine/naloxone (Suboxone) induction.[3]

  • Short-acting opioids: 6–12 hours after the last dose of opioids like heroin, Vicodin, Percocet, or Dilaudid
  • Intermediate-acting opioids: 12–24 hours after the last dose of sustained-release OxyContin, morphine, or MS Contin
  • Long-acting opioids: 24–72 hours (1–3 days) after the last dose for medications like methadone

Once you begin Suboxone treatment, you will likely follow these general steps:

  • Take your first dose of Suboxone on day one.
  • If withdrawal symptoms improve, you may continue this dose on day two.
  • If withdrawal symptoms do not improve, you may take a second or third dose on that first day.
what if you being suboxone treatment too early

What Happens if You Begin Suboxone Treatment Too Early?

It is important to wait until your last opioid dose completely metabolizes out of your body before beginning Suboxone treatment. Buprenorphine binds more strongly to opioid receptors in the brain than other opioids. It can therefore replace other opioids on the receptors in your brain too quickly and trigger withdrawal.[4]

Precipitated withdrawal is the rapid onset of withdrawal symptoms that can occur by taking Suboxone too soon after taking other opioids. Precipitated withdrawal symptoms include pain, nausea, anxiety, goosebumps, and physical and emotional discomfort.[5]

Precipitated withdrawal occurs in about 9% of patients taking buprenorphine inductions, almost always because the individual is impatient to relieve the withdrawal symptoms that occur when their body hasn't had opioids and they take their Suboxone too soon.

Opioid withdrawal symptoms can be extremely unpleasant and uncomfortable. Work closely with your doctor and understand the instructions for starting Suboxone before your first dose. Suboxone can be a truly life saving medication for those with opioid use disorder, and when used appropriately, it can mitigate withdrawal and cravings.

Sources

  1. Clinical Opiate Withdrawal Scale. National Institute on Drug Abuse (NIDA). https://nida.nih.gov/sites/default/files/ClinicalOpiateWithdrawalScale.pdf. June 2003. Accessed February 2022.
  2. National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society for Addiction Medicine (ASAM). https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf. June 2015. Accessed February 2022. 
  3. A Patient’s Guide to Starting Buprenorphine at Home. American Society for Addiction Medicine (ASAM). https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed February 2022.
  4. Suboxone Sublingual Tablets. Medsafe, New Zealand Government. https://www.medsafe.govt.nz/Consumers/cmi/s/suboxone.pdf. July 2021. Accessed February 2022.
  5. Managing Opioid Withdrawal Precipitated by Buprenorphine With Buprenorphine. Drug and Alcohol Review. https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13228. January 2021. Accessed February 2022.

Is My Medical Information Confidential?

Many people struggling with opioid use disorders (OUD) put off treatment because they worry that their family, friends, or boss might find out they are taking Suboxone. This shouldn’t be the reason you don’t receive the medication you need. Under the law, all your health information is private from friends, family and employers, including the fact that you are on treatment for OUD. 

Laws Protect Your Privacy

The Health Insurance Portability and Accountability Act (HIPAA) restricts access to protected health information, including your name, medical conditions, and prescriptions.[1]

Per this act, a Suboxone provider cannot give out any information about a patient or their health (that the patient is enrolled in a Suboxone program, how the patient is doing, their diagnosis, any test results, their medical records, etc.).

A provider can't break the rules of confidentiality unless one of the following occurs:

  • The patient consents in writing to have their medical information shared 
  • The disclosure is demanded by court order. 
  • The disclosure is made to other medical personnel in a medical emergency to help you receive emergency treatment. 
  • The patient is at immediate risk of suicide or homicide.

This law exists so that doctors do not ever share your medical information, including the fact that you are on Suboxone, unless you give them permission to do so.

For example, it would be illegal for your boss to call your doctor and ask if you are on Suboxone, unless you give your doctor explicit permission to share this information. Physicians are very aware of the laws of HIPAA and are usually very careful about never revealing confidential health information. 

Telehealth & HIPAA

HIPAA rules also apply to telehealth visits in the same way that they do to in-person visits. [2]. Telehealth providers must comply with federal laws and regulations that keep patients’ information confidential. Connecting with a doctor virtually doesn’t mean that the provider can tell anyone about your prescription. 

Bicycle Health & Your Privacy 

At Bicycle Health, we protect the privacy of our patients’ health information per federal and state law. In particular, we protect the privacy and security of your substance use disorder per 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”) in addition to HIPAA and applicable state law. 

If you are interested in learning more about how Bicycle Health protects your health information, see this Notice of Privacy Practices (“Notice”) that outlines our legal duties and privacy practices.

Sources

  1. The HIPAA Privacy Rule. U.S. Department of Health and Human Services. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html. March 2022. Accessed July 2022. 
  2. Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. U.S. Department of Health and Human Services. https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html. January 2021. Accessed July 2022.

Is telehealth safe/real?

Telehealth, or telemedicine, offers virtual healthcare through the use of digital devices, like telephones and computers. It is a safe, effective way for patients to meet with their medical providers and is often more accessible and convenient. Many services are available and effective via telehealth, including diagnosis and treatment of chronic disease, as well as behavioral health therapy. 

At Bicycle Health, patients download a smartphone app to engage in video conferencing calls with their providers, and health coaches are available to help patients with setup prior to their first appointment with the medical provider, as well as any ongoing technology questions or concerns. Telehealth for addiction services allows patients to meet with their providers to check-in on their symptoms, medication management, social conditions, and more.

As telehealth becomes more popular as a safe, effective means of seeking medical care, patients and providers alike are responsible for telehealth privacy. Healthcare organizations must ensure their telehealth systems employ encrypted, password-protected videoconferencing, and this is something Bicycle Health takes seriously to best protect our patients’ privacy. Patients are also responsible for engaging in security best practices, like only using home WiFi (not public WiFi) and ensuring the security of their passwords.

Before the first video conferencing visit with your provider, patients at Bicycle Health will be educated on security best practices in order to ensure the highest level of privacy and security possible. You can read more about Bicycle Health’s Telehealth Informed Consent here.

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