A Patient’s Guide to Starting Buprenorphine at Home
PREPARATION
Receiving Medication Assisted Treatment (MAT) with Buprenorphone
Medication assisted treatment (MAT) with buprenorphine is a safe and eective method to help people with an
opioid use disorder stop using prescription pain medications, heroin, and other opioids. There are three main phases
of MAT: induction (rst 1-2 days), stabilization (several weeks), and maintenance (as long as it takes). Before you
start treatment, be sure to talk with your health care provider about your plans for treatment.
Your care team should schedule an MAT Procedure Review Appointment with you. This is a great time to discuss your
decision to receive MAT, your goals and motivations, concerns, and receive important information. Before starting
treatment, your health care team will also conduct a physical evaluation and some lab tests.
Home or Doctor’s Oce?
This process of getting started on buprenorphine is called Induction. You can be at your doctor’s oce to get started,
or you can do this at home. Talk with your doctor and care team about which option is better for you. There are pros
and cons for both options. Which option do you prefer?
Induction at the Doctor’s Oce Induction at Home
Pros Cons Pros Cons
• Your care team is there to check on
you and answer questions.
• You can build a connection and
relationships with your care team.
• In some practices, a peer counselor
or a behavioral health provider might
be there to talk with you.
• You might
not be as
comfortable
as home.
• Someone
should drive
you there and
home, ideally.
• You might
be more
comfortable
at home.
• You do not
need to drive
anywhere.
• Waiting to be in withdrawal before
taking your rst dose of buprenorphine
can be dicult. If you take your rst
dose too soon, you increase the
chance of an intense withdrawal that
comes on very quickly (precipitated
withdrawal).
• Your health care team is not there to
check on you and talk with you.
When to Stop Taking Opioids
Your treatment will more successful if you prepare for your rst dose of buprenorphine (or induction). Before
starting your medication, you will need to stop using opioids for a required period. This period of time when you are
not using opioids protects you from undesirable side eects, which could delay you from feeling normal again. Be
truthful with yourself and your health care team about when you last used opioids and what you used.
Type of Opioid Examples When to stop
Short-acting Percocet, Vicodin
(hydrocodone), Heroin
12-24 hours before rst dose.
Example: Stop at Sunday at 12 noon for a Monday induction.
Long-acting Oxycontin, MS Contin/
Morphine,
Methadone
• 36 hours before rst dose for Oxycontin, Morphine
• >48 hours for Methadone
Example: Stop at Saturday at 12 noon for a Monday induction
MAT Procedure Review Appointment
Before you start taking buprenorphine and receiving MAT, you and your care team should meet for about 30
minutes. At this meeting, you will receive important information and be able to ask questions. This includes:
q Review and sign your Consent Form and Treatment Agreement Form.
q Discuss treatment steps, your goals and motivations, and buprenorphine information.
q Review the Subjective Opioid Withdrawal Scale (SOWS). This will ensure that you take your rst dose of
buprenorphine when it will be most eective. Your SOWS score should be ≥17 before starting your rst dose.
q Identify whom you should call to check in.
q Map out a follow-up plan.
q Discuss safety, including interaction risks, avoid driving, safe storage
Checklist
Check the boxes next to each step to help you
track your progress. Be patient — you’re close to
feeling better!
Before taking your rst dose, stop taking all opioids
for 12-36 hours. You should feel pretty lousy, like
having the u. These symptoms are normal. You will
feel better soon.
q Before your rst dose of medication, you should
feel at least three of the following:
m Very restless, can’t sit still
m Twitching, termors, or shaking
m Enlarged pupils
m Bad chills or sweating
m Heavy yawning
m Joint and bone aches
m Runny nose, tears in your eyes
m Goose esh (or goose bumps)
m Cramps, nausea, vomiting or diarrhea
m Anxious or irritable
q Complete the SOWS. You need your SOWS
score to be ≥17 before taking your rst dose of
buprenorphine.
Schedule
q Take 4 mg of buprenorphine under the tongue
(tablet or lm strip). (Half of an 8 mg tablet, or two
2 mg tablets). Usually one lm strip.
q Put the tablet or lm under your tongue. Do
not swallow it. Buprenorphine does not work if
swallowed.
q Wait an hour.
– If you feel ne, do not take any more
medication today. Record your total for the day
dose below.
– If you continue to have withdrawal symptoms,
take a second dose under your tongue (4 mg).
DAY 1
Congratulations! You are through Day 1.
See instructions for Day 2 on the next page.
You’re doing great.
– If you are feeling worse than when you started,
you might have precipitated withdrawal. Call
and talk with your provider about treatment
options.
q Call your provider or oce sta to check in.
q Wait 1-2 hours.
– If you feel ne, do not take any more medication
today. Record your total for the day dose below.
– If you continue to have withdrawal symptoms,
take a third dose under your tongue (4 mg).
q Call your provider or oce sta to check in.
q Wait 1-2 hours.
– If you feel ne, do not take any more medication
today. Record your total for the day dose below.
– If you continue to have withdrawal symptoms,
Dose Amount Time
1st dose (if needed) 4 mg
2nd dose (if needed) mg
3rd dose (if needed) mg
4th dose (if needed) mg
Total mg on Day 1 mg
Do not take more than 16 mg total of buprenorphine on Day 1.
If you have taken up to 16mg of buprenorphine and still fee bad,
call your doctor right away.
DAY 1 Dose Summary
Total from Day 1
What was the total amount of buprenorphine you
took yesterday (Day 1)?
Total buprenorphine
taken on Day 1
mg
If your Day 1 total was 4 mg:
q If you feel ne, take 4 mg this morning; however,
if you feel some withdrawal symptoms, start with
8 mg this morning.
q Later in the day, see how you feel. If you feel okay,
do not take more. If you still feel withdrawal, take
another 4 mg dose.
q Talk with your provider or oce sta.
If your Day 1 total was 8 mg:
q If you feel ne, take 8 mg this morning; however,
if you feel some withdrawal symptoms, start with
12 mg this morning.
q Later in the day, see how you feel. If you feel okay,
do not take more. If you still feel withdrawal, try
another 4 mg dose.
q Talk with your provider or oce sta.
If your Day 1 total was 12 mg:
q If you feel ne, take 12 mg this morning. You
might want to split the dose into a morning dose
(6 mg) and afternoon dose (6 mg).
q If you feel some withdrawal symptoms, start with
16 mg this morning.
q Later in the day, see how you feel. If you feel okay,
do not take more. If you still feel withdrawal, try
another 4 mg dose.
q Talk with your provider or oce sta.
Dose Amount Time
1st dose (if needed) mg
2nd dose (if needed) mg
Total mg on Day 2 mg
DAY 2 Dose Summary
DAY 2
NOTES, IDEAS & THOUGHTS
q If you felt good at the end of Day 2, repeat the
dose you took on Day 2. If the dose was more
than 8 mg, you might want to split the dose into a
morning dose (6 mg) and afternoon dose (6 mg).
If you felt too tired, groggy, or over-sedated on
Day 2, take a lower dose on Day 3 (2-4 mg less).
If you still felt some withdrawal at the end of
Day 2, take the same total dose you took on Day 2
plus another 4 mg dose.
q See how you feel as the day goes on. If withdrawal
symptoms persist, take another dose.
Dierent people need dierent doses of buprenorphine.
If symptoms persist, consider seeing your provide in
the oce. Talk with your provider about additional
withdrawal treatments that might help.
*Do not take more than 32 mg of Buprenorphine in
one day.*
Dose Amount Time
1st dose (if needed) 4 mg
2nd dose (if needed) mg
Total mg on Day 2 mg
DAY 3 Dose Summary
DAY 3
DAY 4 & BEYOND
On Day 4 and beyond, take the total dose you used
on Day 2. You can take more or less medication,
depending on how you feel overall, if you still have
cravings, or if you are still using.
At this point, you should discuss any dose
adjustments with your doctor. If you need to
increase your dose, you should not change it by
more than 4 mg per day.
Adapted from NYU School of Medicine Division of General Internal Medicine and PCSS-MAT. Created in partnership with the High
Plains Research Network Community Advisory Council for IT MATTTRs. For permission to use outside of IT MATTTRs, please contact
ITMATTTRsColorado@ucdenver.edu.
NOTES, IDEAS & THOUGHTS
