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How long do I have to be in withdrawal before starting Suboxone?

Buprenorphine/naloxone (Suboxone) should be taken when the body has already started to feel withdrawal symptoms. When taken at the appropriate time,  Buprenorphine/naloxone (Suboxone) should make you feel BETTER (not worse!). 

When you should take Buprenorphine/naloxone (Suboxone) depends on your level of tolerance (how much your body has become “used” to having opioids) and the specific substance and dose you have been taking. 

In general, patients should wait the following number of hours after taking their last opioid before starting their buprenorphine/naloxone (Suboxone) induction:

  • 12-24 hours after their last dose of short-acting opioids (heroin, hydrocodone/Vicodin, oxycodone-immediate release/Percocet, hydromorphone/Dilaudid);
  • 24 hours after their last dose of intermediate-acting opioids (oxycodone-sustained release--Oxycontin or morphine-sustained release--MS Contin);
  • 36 hours after their last dose of methadone
  • 48-72 hours after their last dose of long-acting opioids (Note: since fentanyl’s metabolite, norfentanyl, lasts a long time in the body, it is recommended that patients experience significant withdrawal symptoms before starting Buprenorphine/naloxone (Suboxone))

A good rule of thumb to make sure you experience the appropriate amount of withdrawal before starting Buprenorphine/naloxone (Suboxone) is to make sure you have AT LEAST 3 symptoms of withdrawal AND you feel pretty uncomfortable:

  • Twitching, tremors, or shaking
  • Enlarged pupils
  • Bad chills or sweating
  • Heavy yawning
  • Joint and bone aches
  • Runny nose, tears in your eyes
  • Goose flesh (or goose bumps)
  • Cramps, nausea, vomiting or diarrhea m Anxious or irritable

A final good rule of thumb is to wait until you feel pretty uncomfortable in your withdrawal and THEN wait an additional 1-hour (set an alarm clock!) before taking Buprenorphine/naloxone (Suboxone).

At Bicycle Health, we provide patients with a home-induction handout that will walk you through your withdrawal symptoms so you take Buprenorphine/naloxone (Suboxone) at the appropriate time. We also provide clinical support specialists who are available 24/7 by phone to answer questions and provide support during patients’ home induction.

Rebekah L. Rollston, MD, MPH

Rebekah L. Rollston, MD, MPH, is a board-certified Family Medicine Physician and Head of Research at Bicycle Health. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston completed her residency at Tufts University and Cambridge Health Alliance, a Harvard-affiliated community healthcare system in Greater Boston, with emphases in addiction medicine and sexual & reproductive health. Her professional interests focus on social determinants of health & health equity, addiction medicine, gender-based violence, sexual & reproductive health, rural health, homelessness & supportive housing, and immigrant health. Dr. Rollston has published on these topics in The Lancet, Journal of Health Care for the Poor and Underserved, American Journal of Health Promotion, Journal of Appalachian Health, and Medical Care.

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Rebekah L. Rollston, MD, MPH

Rebekah L. Rollston, MD, MPH, is a board-certified Family Medicine Physician and Head of Research at Bicycle Health. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston completed her residency at Tufts University and Cambridge Health Alliance, a Harvard-affiliated community healthcare system in Greater Boston, with emphases in addiction medicine and sexual & reproductive health. Her professional interests focus on social determinants of health & health equity, addiction medicine, gender-based violence, sexual & reproductive health, rural health, homelessness & supportive housing, and immigrant health. Dr. Rollston has published on these topics in The Lancet, Journal of Health Care for the Poor and Underserved, American Journal of Health Promotion, Journal of Appalachian Health, and Medical Care.

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