First Day of Suboxone Treatment: What to Expect

The decision to heal and take control of your life is a courageous one. While the path to overcoming addiction has its challenges, the result is well worth it.

If you are taking the first step away from opioid addiction, Suboxone treatment can be incredibly effective in this process. Read on to learn about the first day on Suboxone and how to prepare for it.

Preparing for the First Day on Suboxone

When taken as prescribed, Suboxone is proven to be an effective medication in treating opioid use disorder.

Suboxone (buprenorphine and naloxone) sublingual film is prescribed to be placed under the tongue once per day. The dose will be set by your Suboxone provider and adjusted accordingly.

Your Suboxone provider will provide details about timing and help you through the process so that you don't skip over any important steps.

Pre-Suboxone Withdrawal Process

Before your first dose, you will need to be in withdrawal to start your Suboxone regimen. This step is crucial because taking Suboxone while your body is not in sufficient withdrawal from opioids can cause even more severe withdrawal symptoms.

The Substance Abuse and Mental Health Services Administration (SAMHSA) warns that those "with opioids in their bloodstream or who are not in the early stages of withdrawal may experience acute withdrawal," often called "precipitated withdrawal." The symptoms associated with precipitated withdrawal are severe.

A guide like the Clinical Opiate Withdrawal Scale (COWS) helps determine whether or not you have reached or surpassed mild withdrawal symptoms. If you are at this stage, you are ready to begin treatment.

If you are unsure whether your opioid withdrawal symptoms have reached the threshold for taking your first dose of Suboxone, you can always reach out to the Suboxone provider who wrote your prescription. They can help you make the assessment.

How Long To Wait Before Taking Suboxone

If you are wondering how long to wait before taking Suboxone, the answer has to do with the symptoms of withdrawal rather than a set amount of time. However, factors, including the type of opioid drugs and the dosage strengths you are taking, influence how long to wait before taking Suboxone.

For instance, short-acting opioids such as Vicodin typically leave the body within 24 hours. Long-acting and stronger opioids like Oxycontin and Morphine can take 48 hours to work their way out of the system. Ideally, you should stop taking any opioids at least 72 hours before you start Suboxone.  

It is critical that you are upfront about exactly what drug forms and dosages you are using, as this allows providers to determine when it's safe to take Suboxone and the best course of action for treatment. Street drugs such as heroin and fentanyl are often mixed with unknown additives, and some of those additives have very long half-lives. This makes paying attention to opioid withdrawal symptoms even more important.

What To Expect for Your First Day on Suboxone

The initial appointment at our Suboxone clinic includes a conversation with a medical provider to determine which medication is right for you. It also often involves providing a urine sample. If you and your provider agree that medication assisted treatment (MAT) is right for you, you'll move on to the next phase.

The Suboxone prescriber will take a detailed history of your struggles with addiction, as well as your overall mental and physical health. Based on your situation, if the prescriber determines that you are a good candidate for Suboxone, they will write an initial prescription, typically for seven days or less. After you pick up your prescription medication at the pharmacy, you need to avoid taking any opioids and let yourself start to feel common opioid withdrawal symptoms, including:

  • Body aches
  • Increased heart rate
  • Cravings
  • Chills or sweating
  • Vomiting or diarrhea
  • Inability to sleep
  • Anxiety
  • Fatigue
  • Difficulty focusing

These are normal and indicate that you are likely ready to begin the path to healing. Your provider may even prescribe you additional medications to manage the uncomfortable withdrawal symptoms. Once you take your first dose of Suboxone, the symptoms should decrease almost entirely.Once you are experiencing mild to moderate withdrawal symptoms (>13 on the COWS scale), you can take your initial dose of Suboxone film. This is a sublingual medication; to be effective, it must go under your tongue and dissolve. Note that you should leave it under the tongue until it dissolves on its own and that it should never be swallowed or chewed.

If there is concern about precipitated withdrawal, contact your provider. Your provider may instruct you to take a very small amount to start for your initial dose and then adjust with additional doses later, as needed.

How Long Does It Take for Suboxone To Work?

So how long does it take for Suboxone to kick in? Typically, Suboxone combats withdrawal symptoms and leaves patients feeling better within 30 to 45 minutes.

If you don't experience an improvement in withdrawal symptoms, your provider may prescribe a dosage adjustment accordingly. Staying in close contact with your Suboxone provider's office can relieve some of the anxiety around determining the correct dose of medication for you and in knowing how long it takes for Suboxone to start working. The approach is unique per individual patient.

For your first few weeks on Suboxone, you and your provider will work through any dosage adjustments. Once you determine the correct dosage, Suboxone will help curb withdrawal symptoms and reduce the cravings for opioid drugs.

How Long Should You Be on Suboxone?

There is no maximum recommended duration to be on maintenance Suboxone treatment. Some patients could require treatment for an indefinite period. According to its drug literature, patients should also continue with their daily dose for as long as they are benefiting from it and the use of Suboxone contributes to the intended treatment goals.

Frequency of Appointments

Treatment for opioid addiction using Suboxone starts with patients coming in often, then slowly progresses to longer intervals of time as the patient's clinical stability permits. Its product literature states that in determining the prescription length, your provider takes into account your level of psychological and physical stability, the security of your home situation, and other factors might affect your ability to manage supplies of take-home medication.

Ideally, you should see your provider at least once a week during the first month, though this will depend on your specific needs. Medication will be prescribed in conjunction with the frequency of your visits. Your provider will conduct a regular assessment to determine compliance with your dosing regimen, your progress, and the effectiveness of the treatment plan.

Once a stable dosage has been achieved and your assessment results do not indicate illicit drug use, the follow-up visits could be reduced. Some patients would be asked to visit just once a month if they have made good progress on their regimen.

When To Adjust Suboxone Dosage

Your Suboxone provider will consider several factors when deciding whether to continue with your current daily dose or to modify it, including:

  • the absence of behavioral or medical adverse effects
  • the absence of medication toxicity
  • abstinence from illicit drug use, as well as problematic benzodiazepine and/or alcohol use
  • whether you are deemed responsible to handle medications by yourself
  • compliance with all elements of your treatment plan (psychotherapy, recovery-oriented activities, and/or other psychosocial factors as your provider sees fit)

There is no single clear path to recovery from opioid addiction. There will be bumps along the way and relapsing is often expected. With that said, you must have a Suboxone provider that truly cares for you and that you can trust.

Find Suboxone Treatment in Maryland at MATClinics

If you are searching for a medication assisted treatment program in Maryland, MATClinics is here to help. We take an individualized approach to treating opioid dependence and opioid use disorder so that each patient gets the care and support that suits their needs.

At MATClinics, new Suboxone patients come in weekly for check-ins before adjusting to a monthly schedule. We work with you through the challenges and successes of overcoming addiction. At the same time, our clinic is designed to allow you the freedom and independence to live your life while receiving treatment.

To learn more about what MATClinics offers and how to start Suboxone treatment, contact us today.

Speak to a member of our team to schedule a New Patient visit, or just to get more information.

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