First Day of Suboxone Treatment: What to Expect

Suboxone (buprenorphine/naloxone) is a life-saving medication for the treatment of opioid use disorder (OUD). Thanks to the elimination of the X waiver, more doctors can prescribe buprenorphine than ever before—and you can receive a prescription in-person or virtually through an online Suboxone doctor.

When Suboxone therapy begins, you’ve likely had many conversations about what will happen and what you should do. Follow your doctor’s instructions to ensure the process goes smoothly.

Everyone’s first day on Suboxone is a little different, but in general, the first day is about finding the right Suboxone dose. Prepare to spend most of the day observing how you feel after your first dose and discussing dose adjustments with your doctor.

Preparing for Your First Day of Suboxone Therapy

Once you and your doctor have determined that you will start taking Suboxone for the first time, there are some things you can do to prepare.

Pre-Suboxone Withdrawal

You cannot start taking Suboxone if you are not in acute opioid withdrawal—taking Suboxone too shortly after using heroin or prescription opioids can send you into precipitated withdrawal, which can be more severe than acute symptoms. 

As such, you need to be experiencing opioid withdrawal symptoms before you can start your Suboxone treatment. Use the Clinical Opiate Withdrawal Scale (COWS) to determine if you’re ready to take your first dose or not. You should have a score of 17 or higher before initiating Suboxone. 

Of course, you shouldn’t need to figure this out all on your own—especially because the symptoms can be uncomfortable. If you aren’t sure whether you should take your first dose or not, reach out to your provider for help.

Factors Affecting How Long to Wait

There is no set time that you must wait before taking your first Suboxone dose—it’s contingent upon the severity of your opioid withdrawal symptoms. But there are a few factors that affect your opioid withdrawal timeline and severity, which in turn, affect how long you have to wait before initiating Suboxone therapy. 

These factors include:

• The type of opioid
• Whether the drug is short-acting, immediate-acting, or long-acting
• How much you were taking and for how long
• Previous withdrawal experiences
• Individual physiology
• Liver function

An opioid’s half-life affects how soon withdrawal symptoms emerge—short-acting opioids cause a more rapid onset of symptoms and shorter timeline whereas long-acting opioids have a delayed and longer timeline. Regardless, you should stop taking opioids like fentanyl, heroin and painkillers for at least a couple days before Suboxone—if not longer.

An essential part of starting Suboxone is being transparent about your opioid misuse and history. You need to disclose to your doctor every drug you’re taking, the dose and the duration you were taking it. This allows them to individualize your care and ensure your safety and comfort.

Critical Decisions on the First Day

On your first day of Suboxone therapy, your doctor will help determine your dose and find a plan that works for you. These are three important aspects you should decide on together.

1. Location: At Home, Or in the Office?

Some people opt to start treatment at home so they can feel comfortable and relaxed if they do experience any side effects, such as dizziness, sedation, nausea or GI upset.

Other people prefer to take their first dose at the clinic so that they can be near their doctor in case they have symptoms or want to ask questions. This is sometimes referred to as an “in-office induction.”

Studies show that both at-home and in-office inductions are safe and equally effective. It mostly comes down to what your doctor offers and what you personally feel would be best for you.

Talk to your doctor about what location you would like to be at when you take your first day of Suboxone.

2. Medication Type

Most people start Suboxone in either a strip or a tablet form, both of which are ultimately meant to be placed under the tongue and dissolved. 

For this reason, it can be a little trickier than just swallowing a pill. Ensure you understand how to use the Suboxone form you’ve chosen and how to administer it properly under the tongue to ensure it is fully dissolved and absorbed by your body. 

In general, the instructions for the strip and tablet are similar:

• Eat 15-30 minutes before you take your dose to minimize GI symptoms
• Make sure you don’t have food in your mouth before taking the Suboxone
• Take a sip of water 
• Wash your hands
• Place the strip or tablet under your tongue
• Avoid talking, eating, drinking or moving the medication
• Wait until it dissolves 
• Rinse your mouth with some water
• Wait at least 30 minutes to eat or drink something

You can expect your Suboxone dose to begin working within about 30 to 45 minutes after taking it, which means it will begin to alleviate your withdrawal symptoms and cravings. If you don’t feel an improvement, your doctor may adjust your dose.

3. Suboxone Dose

Your doctor will estimate your Suboxone dose based on factors like your weight, height, and drug use history. But this dose is only an estimate, and some people may need a higher or lower dose in order to alleviate their opioid cravings and withdrawal symptoms while also minimizing Suboxone side effects.

Your doctor will walk you through the induction process, but it typically looks like this:

• Determine your last dose of opioids: You must be in opioid withdrawal before your first Suboxone dose, or you’ll be kicked into active (and uncomfortable) withdrawal immediately. Make sure your doctor gives you instructions on how long to wait after taking any opioids (either opioid pills or heroin, fentanyl, etc.) before you take your first dose of Suboxone. Ideally, you will start to feel some withdrawal symptoms and strong cravings for opioids – this is a sign that other opioids are gone from your body and it is safe to take your first dose. 
• Take your first dose: Your doctor will tell you how much to take and how to use the medication. 
• Wait for a response: Typically, your body needs one to three hours to respond to the medication, though you may feel effects as soon as 30 minutes. 
• Measure your symptoms: If you have no side effects but still have cravings to use opioids, you may need a higher dose. If you do not have cravings but have side effects, you may need a lower dose. 
• Repeat these steps: Your doctor will give you instructions on when to take a second dose, and what number of milligrams it should be. Communicate openly and closely with your doctor over the first few days of therapy.

Your doctor may give you pamphlets and other documents that explain what will happen and what you will do. Read these carefully and ask all questions you have – there are no bad questions.

Suboxone can make you feel better during withdrawal, but it’s not uncommon to experience some discomfort,  both from transitioning off of opioids and also potentially from side effects from the new medication. Be patient – it gets easier.

Be proud that you have completed your first day of MAT, and rest assured that it is putting you on a path to a better future. With your withdrawal symptoms and cravings under control, you can focus on the essential work you’re doing to discontinue your opioid use.

Frequently Asked Questions About the First Day of Suboxone