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.
The following directions have been prescribed by a licensed medical provider for the individual named above, may not be redistributed, and are not to be used by any other person for any reason.
This video series contains your instructions to start buprenorphine (Suboxone) safely at home. Watch the series completely, and if anything is unclear let us know through chat in the Bicycle Health app.
It’s an effective first-line medication for opioid use disorder that prevents opioid overdose and restores normal stability of opioid receptor activity when taken daily as directed.
After initially adjusting to the medication, a person taking buprenorphine (Suboxone) at an effective daily dose should feel neither withdrawal nor any impairment or high from the medication.
Buprenorphine (Suboxone) reduces the potential of other opioids to cause a ‘high’ by maintaining stable, low-level activation of the opioid receptor system, and preventing other opiods from fully accessing opioid receptors.
“Precipitated Withdrawal” is an intense, sudden onset of severe withdrawal that will occur if buprenorphine (Suboxone) is started too soon, before the effects of other opioids have worn off adequately.
Avoid precipitated withdrawal by following these instructions carefully and by NOT starting buprenorphine (Suboxone) sooner than directed. Precipitated Withdrawal will not occur if moderate withdrawal is allowed to onset gradually before starting buprenorphine (Suboxone).
To start buprenorphine (Suboxone) effectively, it is usually necessary to divide the films or tablets into smaller doses for the first 1 to 3 days. Be sure you understand the directions and feel confident in your ability to do so in a clean, dry, precise way.
Information about Common over-the-counter medications that may be helpful before, while, or also after starting buprenorphine (Suboxone).
The most important step for a comfortable at-home treatment start is to WAIT long enough between your last use of any other opioid and your first dose of buprenorphine (Suboxone).
Your Bicycle Health provider has told you the MINIMUM wait time before starting to consider your first dose of buprenorphine (Suboxone). Follow the wait-time they gave you. If you’ve forgotten, ask through chat in the Bicycle Health app. If you’d like to know more about how your provider determined the wait time, or if you’d like to check their work yourself :), here’s some more information about wait-times.
Once you have waited the amount of time directed, proceed to the next video segment to complete a set of questions called the SOWS (Subjective Opioid Withdrawal Scale) test. The SOWS is a set of 16 short questions. When answering, select the response that best describes how your are feeling RIGHT NOW.
After waiting for AT LEAST the amount of time directed by your Bicycle Health provider, answer the 16 questions above based on how you’re feeling RIGHT NOW.
The test is a validated way to determine whether it is safe to start buprenorphine (Suboxone) now, or whether it’s necessary to wait longer. Follow the direction you receive above after completing the test.
Hovering over why is this important expands the below information:
You’ve already waited the MINIMUM amount of time for the AVERAGE person to have no or very little opioid remaining in their body, but you’re not the average person; your metabolism is uniquely yours.
The way you feel is the only sure way to determine when you have sufficiently little opioid remaining in your body to start buprenorphine (Suboxone) without causing worsened withdrawal. We know it’s very challenging to wait for moderate withdrawal, but it’s worth it because you’ll want the medication to WORK when you take it instead of making you feel worse.
Buprenorphine (Suboxone) must be dissolved under the tongue or between the gums and cheek (diagram here) to be effective. If you swallow it, it won’t work at all!
If you eat or drink shortly before taking buprenorphine (Suboxone), that increases saliva production and swallowing, and decreases effectiveness of the medication.
Now, place 4mg of buprenorphine (Suboxone) under your tongue.
This is one-half of an 8mg film or tablet.
Wait until it is completely dissolved. This takes 10 minutes.
Once completely dissolved, it’s ok to either swallow or spit any remaining saliva in your mouth.
After the medication dissolves, it’s normal to feel either a little better, a little worse, or no change at all. It’s not normal to feel sudden, severe worsening of withdrawal, or to feel dizziness, sedation, or difficulty breathing. Advance to the next video now to learn more about normal vs abnormal reactions to a first dose. Be sure not to take your second dose until at least 2 hours have passed since your first dose.
Precipitated withdrawal is a severe withdrawal reaction that can occur if buprenorphine (Suboxone) is started too soon.
If you experience sudden, dramatic worsening of withdrawal after starting buprenorphine (Suboxone), contact your provider in the Bicycle Health app for direction.
Time always resolves symptoms of precipitated withdrawal, but there are often medications that can ease discomfort while waiting. Your Bicycle Health provider may direct you to use over-the-counter medications or prescribed medications for withdrawal symptoms to improve comfort while waiting to take your next dose of buprenorphine (Suboxone).
If it’s been 2 hours since your first dose of Suboxone, consider how you’re feeling right now.
If it’s been 1 hour since your second dose of Suboxone, consider how you’re feeling right now.
Be sure that at least 8 hours have passed since your last dose of buprenorphine (Suboxone).
If it’s been 8 hours since your first dose of Suboxone, consider how you’re feeling right now.
Congratulations! You’ve started treatment successfully. We’re here to work with you toward ongoing success.
If you accidentally take more buprenorphine (Suboxone) than directed, this is usually not medically dangerous. Buprenorphine (Suboxone) has a ceiling effect which usually occurs at a dose between 16 and 24 mg. At this ceiling dose, the medication is causing its maximum effect, and taking more will have no additional positive or negative effect. There are exceptions to this rule.
It’s best to avoid missing doses of buprenorphine (Suboxone), but it may happen, and it’s helpful to understand the following if you do:
If you miss a single dose, typically you’ll feel very little or no withdrawal.
If you miss 2 doses in-a-row, typically you will start to feel minimal withdrawal, but it’s rarely severe.
If you’ve realized that you’ve missed a dose, and your next usual dosing time is MORE THAN 8 HOURS away, go ahead and take your missed dose late. Then continue your usual daily medication routine.
If you’ve realized that you’ve missed a dose, and your next usual dosing time is LESS THAN 8 HOURS away, consider how you feel.
A ‘slip’ is when you use another opioid in an unintentional or otherwise potentially harmful way while in care for opioid use disorder.
Slips are common. The most important thing to do if you experience a slip is to continue taking buprenorphine (Suboxone) as you usually would. Continued use of buprenorphine (Suboxone) helps improve your ability to stop a slip without progressing into uncontrolled ongoing opioid use, often called a ‘relapse.’
Buprenorphine (Suboxone) helps you control a slip by inhibiting the ‘high’ you may otherwise get from other opioid, by reducing cravings, and by protecting against overdose.
Slips are common, and your Bicycle Health provider understands that. Be sure to talk to your Bicycle Health provider about it if you experience a slip so they can partner with you to improve the effectiveness of your care.