You must wait between 12 and 72 hours after your last dose of opioids before taking your first dose of Suboxone. Your specific time frame depends on the opioids you took, your health and the severity of your opioid symptoms.
You won’t go through withdrawal alone. Your doctor will guide the process and ensure you take the right doses at the right time.
Before taking Suboxone, your body must fully metabolize the last dose of opioids you had taken. Otherwise, your first dose of Suboxone will make you feel very sick.
You’ll know it’s time when you experience opioid withdrawal symptoms, such as the following:[1]
You’re not required to experience significant symptoms. No one wants you to feel sick. But you must have some signs that your body has processed the last dose of opioids you took.
Body SystemSymptomsGastrointestinalNausea, abdominal cramps, vomiting, diarrhea NervousTwitching, tremors, shaking Musculoskeletal Joint, bone or muscle pain Mental Anxiety, irritability, nervousness, insomniaVisual Large pupils, runny nose, weeping eyes, goosebumps
Doctors who prescribe suboxone don’t guess when to start the medication. Instead, they use data to guide their decisions and ensure you’re not taking Suboxone too early. Two methods exist to guide them.
Interviews start this process. Doctors form a complete picture of your opioid use, and they use the information to build an individualized Suboxone induction plan.
Your doctor might ask the following questions:
Be honest when answering these questions. Your doctor must understand your opioid use disorder to provide a withdrawal plan that’s safe and effective for your body.
The Clinical Opiate Withdrawal Scale (or COWS) is an 11-item screening tool doctors use to measure withdrawal symptoms.[3] The results can help your doctor understand when it’s time to start Suboxone and when you’ve reached the appropriate maintenance dose.
When doctors use COWS, they measure the following points:[3]
Each symptom is scored from 0 (not present or normal) to 4 (high). Some symptoms (such as extreme GI upset or restlessness) can get scores as high as 5 if they’re severe.
Your total COWS score can help your doctor understand how your body is reacting to sobriety. Typically, scores of 8 to 11 indicate that it’s time to begin Suboxone therapy. If your score is lower than 8, your doctor might reassess your progress in two hours.[2]
The duration of wait time depends on which opioids you were taking. Some persist in your body longer than others do. The drugs you take can dictate how long you’ll wait before your first Suboxone dose.
Type of OpioidRecommended Wait TimeOpioid Examples Short-acting12 to 24 hoursHeroin, Percocet, Vicodin Long-actingAt least 36 hours Oxycontin, morphine Maintenance medication48 hours or moreMethadoneSource [1]
These are typical timelines. Know that your body is unique. You may need more or less time than we’ve listed here, and your doctor can help you determine an appropriate timeline.
The first day of Suboxone treatment is exciting. You’re starting a new way of life. But it can also be uncomfortable. Plan to stay home from work for a day or two, so you can focus on your healing and recovery.
Starting Suboxone typically means following these steps:
Suboxone is a very safe and effective medication for opioid use disorder, but it’s also powerful. If you take Suboxone too soon, you could get very sick.
It is important to wait until your last opioid dose completely metabolizes out of your body before beginning Suboxone treatment. Buprenorphine binds more strongly to opioid receptors in the brain than other opioids. It can therefore replace other opioids on the receptors in your brain too quickly and trigger withdrawal.[4]
Precipitated withdrawal is the rapid onset of withdrawal symptoms, including pain, nausea, anxiety, goosebumps, and anxiety. About 9% of people taking buprenorphine products like Suboxone for the first time experience precipitated withdrawal.[5] With planning, you can avoid it.
Preparing for your first Suboxone dose is uncomfortable, and few people enjoy spending time shivering, shaking, and feeling nauseated. But if you reach for your Suboxone for relief, you’ll make things worse. Precipitated withdrawal will amplify your symptoms very quickly.
Always follow your doctor’s plans about when to start taking Suboxone. Together, you can create a schedule that might be a bit uncomfortable but certainly won’t be excruciating.
These are some of the questions that people often ask about when to start Suboxone:
Suboxone contains buprenorphine and naloxone — two ingredients that can remove drugs like heroin from their receptors and plunge you into immediate (and uncomfortable) withdrawal. Waiting means letting your body process opioids naturally, so your Suboxone won’t make you sick.
It depends on the drugs you’ve been taking. People with a history of methadone use, for example, might need to wait much longer. Your doctor can help you create an appropriate timeline.
It typically takes 20 to 60 minutes for Suboxone to kick in. But your age, weight, history of substance abuse, and other factors could make it work faster or slower for you.
Suboxone timelines by dosage don’t vary. Most people feel Suboxone’s impact for about 24 hours.
If you’re wondering how to get emergency Suboxone, know you have options. You could visit an emergency room, urgent care clinic, or your doctor. You will need a prescription for the drug, so you should go somewhere with a qualified medical professional on staff.
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
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