Hello and welcome to Bicycle Health. This video was created to help guide you through the first 3 days of taking your Suboxone medication. In this video we will go over the materials needed to have a successful induction, review withdrawal symptoms, and how and when to take your medication. 

Here are some of the materials that will be very helpful when watching this video. If you have not received your medication, you can always return to this video at a later time. The materials needed will be your Suboxone tablets or films, a tablet cutter and clean sharp scissors for cutting films. 

Beginning Suboxone at home is safe to do as long as you take care to follow the directions closely regarding the timing and the dose. When transitioning from short-acting full opioids like oxycodone, morphine, or heroin then going to Suboxone, it's necessary to wait long enough for these other opioids to be mostly gone from the body before starting Suboxone. You know the time is right by how you feel. We call this moderate opiate withdrawal and this lets us know that your body may be ready to start Suboxone.

Moderate opioid withdrawal tells us that most of the effects of the other opioids have worn off. However, if the Suboxone is taken too early prior to the correct timing or before entering into moderate withdrawal symptoms there will be a decrease of the total opioid-effect. And this in turn can cause a condition called precipitated withdrawal. Precipitated withdrawal is a severe withdrawal that can last hours up to one day before the symptoms resolve. The risk of this happening is very low but we want you to understand and make sure to follow the providers directions correctly. Now that we reviewed moderate withdrawal symptoms and the importance of waiting at least 36 hours after your last dose of illicit substance, let's get started with step-one of taking the medication.

When taking Suboxone, make sure to follow these tips to maximize the effects of a medication. Do not swallow the medication and do not eat or drink while the medication is dissolving. This can cause the medication to have little or no effect. It is usually best practice to not eat or drink 10 minutes before and 10 minutes after taking the medication. It is also important to rinse the mouth to help decrease the risk of dental irritation in the future. 

Step 1

Remove one 8 mg tab or film sometimes labeled 8/2 from the package. You will either use a tablet cutter for the tabs or clean sharp scissors for the film and divide them in half. Then take one-half and divide it in half again to make two quarters. Make sure nothing is in the mouth then place one-quarter tablet or film directly out of the tongue on the bottom of the mouth just off to either side. Put the other quarter and one-half of the remaining medication back in the bottle or foil pack to use in Step 2. It can take up to 10 minutes for the medication to dissolve completely. You can either spit or swallow the accumulated saliva while the medication dissolves. Make sure to wait at least 2 hours before moving on to Step 2.

During these two hours of waiting before moving on to Step 2, you can ask the following questions; Do I feel slightly better? Slightly worse? or No change at all? It is important to know that dizziness, increased sedation or sleepiness, trouble breathing or a sudden and severe increase in your withdrawal symptoms should prompt you to immediately contact your provider to guide you on the next steps for your induction. Before moving on to Step 2, consider how you feel. Are you feeling withdrawal symptoms? If not, that's great that the first dose of Suboxone has been effective for you. It's also uncommon but in a good way. If you're feeling well on this dose, then your total day one dose is 2 mg or one-quarter of one tablet or a film. Record this dose and skip Steps 3 and 4 to proceed directly to Step 5 and learn what to do tomorrow. If you answered yes, please move on to Step 2. 

Step 2

If you answered yes and continue to experience withdrawal symptoms, remove the other one-half of the 8 mg tab or film cut previously and place it directly under the tongue to dissolve again for another 10 minutes. Remember to wait two hours before moving on to Step 3. As in Step 2, consider how you feel. Do you still feel withdrawal symptoms? If no, that is somewhat  uncommon but normal. You can record this new daily dose at 6 mg and then move on to Step 5. If yes, and you continue to have withdrawal symptoms please proceed on to step three. 

Step 3

If you answered yes and continue to experience withdrawal symptoms remove the other one-half of the 8 mg tab or film cut previously and place it directly under the tongue for another 10 minutes. Remember to wait 2 hours before moving on the Step 4. Again, consider how you feel. Do you feel withdrawal symptoms? If no, that is normal and you can now record this daily dose at 10 mg or one full tab plus a quarter tab or film. Then, move on to Step 5. If you answered yes and continue to have withdrawal symptoms, please proceed to Step 4. 

Step 4

If you answered yes and continue to experience withdrawal symptoms, remove the remaining one-quarter of the original 8 mg tab or film from the beginning and place it under the tongue to dissolve for another 10 minutes. At this time you will continue to assess your symptoms as you have now reached the maximum daily dose for day one which is 12 mg. For this final dose of the day you have reached the 12 mg max. You can continue to assess your symptoms and take any comfort medications to help decrease any remaining symptoms of withdrawal. The goal is to sleep overnight and reassess your symptoms again in the morning. Where we will then continue on with step number 5.

Step 5

Step 5 is normally day two of induction. Day two or tomorrow, is considered 12 to 24 hours after the last dose of Suboxone. Once again, consider how you feel. Do you feel withdrawal symptoms? If no, then you can continue on with your daily dose from yesterday as recorded and then move on to see your provider at the next follow up. If you answered yes, and you continue to have withdrawal symptoms please add another half a tab or film or 4 mg to your daily dose from yesterday, record and then that will now be your new daily dose. This concludes the video for traditional induction. Please feel free to rewind this video to go over parts of the induction that were maybe unclear and reach out to your provider for continued guidance on any issues that were not addressed in this video. We're excited that you're here and officially welcome you to this new season of sobriety

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