Hello and welcome to Bicycle Health. This video was created to provide you with more information and guidance on taking Suboxone safely while at home. Feel free to rewind this video or contact us if you have any more questions. Let’s get started.

Buprenorphine is an effective first-line medication for the treatment of opioid use disorder. Suboxone is the brand name for a combination of buprenorphine and naloxone. This is the medication we offer to patients here at Bicycle Health. Buprenorphine is an opioid that binds to the opiate receptors in the brain but only partly activates them. This relieves withdrawal symptoms, decreases cravings, and protects against relapse long-term by blocking other opioids from binding to the receptor. It’s usually a once daily medication. And because buprenorphine doesn’t fully stimulate the opioid receptor, there is no feeling of a “high” while taking the medication. It restores stability to the opioid receptors

The second ingredient, Naloxone, is used in conjunction with buprenorphine to help deter abusing the medication. It has no effect and is not even absorbed when the medication is dissolved in the mouth as directed; it helps prevent misuse of the medication by causing withdrawal injected.

Buprenorphine is an effective first-line medication for the treatment of opioid use disorder. Suboxone is the brand name for a combination of buprenorphine and naloxone. This is the medication we offer to patients here at Bicycle Health. Buprenorphine is an opioid that binds to the opiate receptors in the brain but only partly activates them. This relieves withdrawal symptoms, decreases cravings, and protects against relapse long-term by blocking other opioids from binding to the receptor. It’s usually a once daily medication. And because buprenorphine doesn’t fully stimulate the opioid receptor, there is no feeling of a “high” while taking the medication. It restores stability to the opioid receptors

The second ingredient, Naloxone, is used in conjunction with buprenorphine to help deter abusing the medication. It has no effect and is not even absorbed when the medication is dissolved in the mouth as directed; it helps prevent misuse of the medication by causing withdrawal injected.

Suboxone has 4 different strengths: 2/0.5, 4/1, 8/2 & 12/3. These numbers are in milligrams or mg. When reading the medication dosing, it is important to know that the first number represents the amount of buprenorphine in each film or tab and the second number represents the amount of naloxone in each film or tab. For our purposes, we will focus only on the first number for the buprenorphine. This gives us 2mg, 4mg, 8mg and 12mg strengths. The availability of dose strength and tabs vs films is based on pharmacy stock and is subject to insurance approval. In our treatment setting the most common doses used are 2mg and 8mg and we will use these as your reference throughout the remainder of these videos.

During your treatment, it may be necessary to divide the film or tab into smaller pieces. By doing so, we can provide you with the most ideal daily dose while also ensuring you can access available medication at your pharmacy. To cut your tablets we ask that you purchase a tablet cutter from your local pharmacy or use a clean, sharp knife. This helps ensure precise and equal division of the medication. Please do not use a dull object, tearing, or your teeth to divide the medication. A sharp knife on a dry cutting board will work but is also a hazard for cutting your hands, so we don’t recommend it. To cut your films, you may use clean, sharp scissors, and place the remaining film back into the original foil package, or into an airtight/humidity- proof package or a pill container at your local pharmacy.

Preparing to for your induction to Suboxone will help keep the process as smooth as possible while you are experiencing withdrawal symptoms. If you can, plan for the time you expect to be in withdrawal: take time off work and be in a calm setting with support from family or a friend. Be close to a bathroom. Stay well-hydrated with water or electrolyte drinks. Opioid withdrawal is generally not medically dangerous but is very uncomfortable, so it’s important to expect that. Be sure to review any other medications your provider has prescribed to help with your withdrawal symptoms and understand how and when to use them. Also, have an over-the-counter pain reliever and anti-diarrhea medication available.

Here is a list of useful materials you will need for your induction: your Suboxone medication, a tablet cutter and/or a clean, sharp pair of scissors and a pill box for storage. Review the link to our description of common over-the-counter support medications below.

The most important part of ensuring a safe Suboxone start, is waiting long enough between your last opioid use and your first Suboxone dose. Your Bicycle Health provider will have told you the MINIMUM amount of time to wait before starting to assess your level of withdrawal. Wait the amount of time they told you, then complete the Subjective Opioid Withdrawal Scale (SOWS) below to assess your level of withdrawal. If you don’t remember the amount of time they told you to wait, ASK, and we’ll be glad to help. Waiting longer is safer than accidentally starting Suboxone too soon.

Now that we have reviewed moderate withdrawal symptoms, precipitated withdrawal, and the importance of waiting long enough after your last dose of other opioids, let’s get started with taking the Suboxone.

When taking Suboxone make sure to follow these tips to maximize the effects of the medications: Do not swallow the medication. Suboxone is intended to be dissolved under the tongue and is NOT absorbed in the stomach. Also, DO NOT eat, drink, swish or rinse the mouth 15 minutes before taking Suboxone, while the medication is dissolving or for 15 minutes after the medication is dissolved even though it does not taste very good. This WILL decrease the overall effects of the medication. Lastly, if you smoke nicotine, try to avoid smoking at least 1 hour prior to taking your medication. This all can cause the medication to have lessened or no effect.

Next place one half or 4mg piece of tablet or film directly under the tongue on the bottom of the mouth just off to either side. Put the other one half piece, for a total of 4mg remaining Suboxone, back in the bottle or foil pack to use later. It can take up to 10 min for the medication to dissolve completely. You may either spit or swallow the accumulated saliva after the medication dissolves. Make sure to wait 2 hours prior to moving on to the next step.

What to expect? (Will use video heading): During these 2 hours of waiting before moving on, you may notice feeling slightly better, slightly worse, or feel no change at all. Any of these outcomes is perfectly normal and expected. It is important to know that dizziness, increased sedation or sleepiness, trouble breathing or a sudden and severe increase in your withdrawal symptoms are not normal. If you experience severe discomfort, immediately contact your provider to guide you on the next steps or contact emergency services; if you have trouble breathing, dizziness, or other symptoms that seem dangerous to you, please contact emergency services (911).

Precipitated withdrawal is a severe withdrawal reaction that can occur if Suboxone is started too soon. Generally, it is not medically dangerous but is extremely uncomfortable and can last from several hours to a day. If you experience sudden, dramatic worsening of your withdrawal after starting Suboxone, contact your provider in the Bicycle Health app for direction. They will assess your symptoms and give direction about wait times and further doses of Suboxone to alleviate your symptoms. Time will always resolve precipitated withdrawal, but to minimize symptoms while waiting you may use any “comfort” medications that have been provided to you for withdrawal symptoms. If you experience dizziness, sedation, or difficulty breathing, contact emergency services.

If it’s been at least 2 hours since your first dose of Suboxone, let’s consider how you feel. Are you still feeling withdrawal symptoms? If no, and you feel comfortable, that is uncommon but a great response to a first dose. You don’t need to take any more Suboxone today. Write down and remember that your total dose today was 4mg, then skip the rest of today’s video segments and return to the Day 2 video segment tomorrow.

If you answered yes, and continue to experience withdrawal symptoms, this is normal and expected. Remove the other one half, 4mg tab or film cut previously and place it under the tongue to dissolve for another 10 minutes. Then wait one hour before moving on.

If it’s been at least one hour since your last dose of Suboxone, let’s consider how you feel. Do you still feel withdrawal symptoms? If no, and you feel comfortable, that is uncommon but a great response to a second dose. You do not need to take any more Suboxone today. Write down and remember that your total dose today was 8mg, then skip the rest of today’s video segments and return to the Day 2 video segment tomorrow.

If you answered yes, and you continue to have withdrawal symptoms, let’s prepare for the next dose of Suboxone.

If it’s been at least an hour since your last dose of Suboxone, let’s see how you feel. Do you still feel withdrawal symptoms? If no, and you feel comfortable, that is uncommon but a great response to a third dose. You don’t need to take any more Suboxone today. Write down and remember that your total dose today was 12mg, then skip the rest of this video segment and return to the Day 2 video segment tomorrow.

If you answered yes and you continue to have withdrawal symptoms, take another 8mg tab or film and divide it in half so that you have two 4mg halves. Place one half back in the bottle or foil pack to use later. Then, place one 4mg half tab/film under the tongue to dissolve for 10 minutes. You have reached the 12 mg max for day 1. If you are still feeling withdrawal, this is common, and you may use any comfort medications as directed to help relieve ongoing discomfort until your next Suboxone dose. The goal will be to sleep overnight and reassess your symptoms again in the morning where we will then continue day 2 and taking your new daily dose.

Day two is normally between 8-16 hours after your last dose of Suboxone. For most patients, this will be after getting some sleep and waking up the next morning. Poor sleep is normal on the first night after starting Suboxone. The medication has not yet had its full effect, and this will continue to improve over the next few days. If it has been less than 8 hours since your last dose, please wait until 8 hours have passed.

At this point, let us again consider how you feel. Do you feel w/d symptoms? If no, your first day of Suboxone was effective and you may continue with your daily dose recorded from yesterday which will either be 2mg, 4mg, 8mg, or 12mg. Take this dose all at once now, then continue to take this same dose, once daily in the morning, until you see your Bicycle Health provider again.

If you continue to have withdrawal symptoms, this is normal, please add an additional 4mg to your recorded dose from yesterday to find your daily dose for today. This dose will NEVER be more than 16mg, so if you’re calculating a dose over 16mg, stop and ask your Bicycle Health provider for direction before continuing. If you’re calculating 16mg or less, great, go ahead and take this new daily dose ALL AT ONCE now. Then continue to take this same dose once daily each in the morning until you see your Bicycle Health provider again.

Congratulations! You’ve made it through one of the hardest parts of treatment! Now that you’ve completed your induction onto Suboxone, your provider will guide you on next steps during your follow-up visits. Together, you will work towards finding a daily, consistent therapeutic dose of Suboxone that relieves opioid cravings and helps your brain start healing from opioid use disorder.

In addition to visits with your medical provider, Bicycle Health offers many services that may be helpful to patients early in treatment. You can ask your provider about them or reach out on the Bicycle Health app. Congratulations again!