How to Start Suboxone at Home via Telehealth

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“Induction” is the process of starting Suboxone.

Historically, a lot of doctors used to have the patient come into the office to start Suboxone so that they can be monitored for symptoms of withdrawal and their dose can be quickly and easily adjusted.

However, the more we prescribe Suboxone for OUD, the more comfortable providers are starting it at home just like most other medications. Studies show that “home’ inductions are usually just as effective as “office based” inductions.

For some, telehealth offers a nice compromise: You can start your medication at home without having to be at the doctor’s office all day, but you can still see and speak directly to your provider in real time to keep them updated on your symptoms and ask questions. 

How Does Suboxone “Induction” Work?

The trickiest part of starting Suboxone is that you need to be in mild to moderate withdrawal to make sure other opioids are out of your system before starting Suboxone. The reason for this is that, if your body still has other opioids in it, starting Suboxone will kick those other opioids off of your opioid receptors and cause worsening withdrawal. This is called “precipitated withdrawal”, or withdrawal that is created by taking Suboxone. While “precipitated” withdrawal, like regular withdrawal, is not dangerous or life threatening, it is pretty miserable! Thus, doctors usually make sure you are in natural withdrawal prior to starting Suboxone. This can be done in 2 ways. First, you can simply go by symptoms: when you feel like you are withdrawing, it is a safe bet that opioids are fully out of your system. If you aren’t sure, some doctors will also just go by time: If it has been at least 12 hours after your last dose of opioids, most of the opioids are probably out of your system and you are unlikely to experience precipitated withdrawal.

Once you are in withdrawal, here are the common steps:

  • Get started. Take your first dose as recommended by your doctor. Most people use about 2-4 mg to start on day one. 
  • Wait and watch. Did your withdrawal symptoms improve? If so, this dose may be enough for you. If not, your doctor may encourage you to take a second dose 4-8 hours later. 
  • Take the same dose on day 2. Suboxone “inductions” usually take at least two days. On the second day, your doctor and you will determine how many doses you took on the first day and use that to calculate the appropriate dose on the second day. For example, if you took 2 mg doses three times on the first day, a good dose on the second day will probably be a total of 6 mg.

Over the course of the one or two days, you’ll be in close contact with your treatment team throughout the day. You’ll report your craving severity, physical symptoms, and more. Together, you’ll settle on a dose that helps you feel normal.

Can I Do an Induction Via Telehealth?

Yes! Using telemedicine has been shown to be equally effective as an in-person clinic visit for starting Suboxone.[3] Ask your doctor if you can start Suboxone via telehealth. The two of you will decide together what works best for you. 

How Can I Tell if Suboxone Is Working?

Medication for Addiction Treatment aims to help you stop using drugs while feeling as healthy as possible. Your therapy is working if you don't feel withdrawal symptoms or cravings to use opioids.

Remember: while starting Suboxone, patience is key. It can take a few days to come up with the right dose. It’s better to go slow. Make sure you communicate openly and often with your provider over those first few days so they can monitor how you are feeling and adjust your dose. With a little patience, you can start use of what is often a life-saving medication and begin the process toward true recovery from opioid use.

Sources

  1. A Patient's Guide to Starting Buprenorphine at Home. It Matttrs. https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf?sfvrsn=16224bc2_0. Accessed July 2022.
  2. Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings. Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/pep21-06-01-002.pdf. 2021. Accessed July 2022.
  3. Use of Telemedicine for Buprenorphine Inductions in Patients with Commercial Insurance or Medicare Advantage. JAMA. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787656. January 2002. Accessed July 2022.
  4. Clinical Opiate Withdrawal Scale. National Institute on Drug Abuse. https://nida.nih.gov/sites/default/files/ClinicalOpiateWithdrawalScale.pdf. Accessed July 2022.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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