Your healthcare provider gave you a 2-day buprenorphine/naloxone (common brand name: Suboxone) treatment plan. This medicine is given to help treat an opioid use disorder. It’s important for you to take this medicine and follow the instructions carefully.

You’ve been given the number of doses of buprenorphine/naloxone that you need to take at home over the next 2 days. You should have an appointment with your healthcare provider booked for day 3. Together you’ll review your progress and make a plan for your ongoing treatment.

Watch this video to guide you through the home dosing process: https://youtu.be/dw7Ue21V618

What is buprenorphine/naloxone and how does it work?

Buprenorphine/naloxone is a pill that has 2 medicines. The reason this medicine is given is to help you be safer and healthier by reducing or stopping use of other opioids.

Buprenorphine is a type of opioid (like heroin or methadone), but it works differently than other types of opioids. Buprenorphine helps treat withdrawal and can get rid of cravings more safely than other medicines. Once you get the right dose of buprenorphine, it will prevent withdrawal symptoms and can help you stop taking other prescribed or purchased opioids.

Naloxone (Narcan) is added to buprenorphine to prevent people from injecting, snorting, or smoking it. If the pill is used in these ways, the naloxone can cause bad withdrawal symptoms or prevent opioids from working. When the buprenorphine/naloxone pill is dissolved under the tongue, the naloxone doesn't do anything.

How do I take buprenorphine/naloxone?

Take buprenorphine/naloxone by mouth and dissolve it under your tongue. The medicine may take 15 to 30 minutes to dissolve. It’s important to dissolve this medicine under your tongue as it won’t work if you chew or swallow it. After you take the medicine, wait at least 30 minutes before you eat or drink.

When should I take buprenorphine/naloxone at home?

Take this medicine only when you’re in moderate to severe withdrawal. This is the point when you feel like you want to use opioids to prevent more withdrawal symptoms.

It’s important that you feel really sick before you take your first dose of buprenorphine/naloxone. If you take it before you feel really sick, it can make your symptoms much worse.

To find out if you are ready to start the medicine, rate how you feel right now for each of the symptoms below on a scale from 0 to 4.

0 = don't feel the symptom at all

1 = feel the symptom a little

2 = feel the symptom moderately

3 = feel the symptom quite a bit

4 = extreme symptom experience

Add your numbers together. If your total score is 17 or higher, you should be ready to start the medicine. If your score is less than 17, you may need to wait longer to start. The longer you can wait before starting, the better you’ll feel afterwards.

2-day dosing

Each dose of buprenorphine/naloxone is 2 mg/0.5 mg. Be sure to wait at least 1 hour in between doses. You should feel a little better or about the same after you take each dose.

Day 1

Dose 1: Take dose 1 (2 mg/0.5 mg) and wait 1 hour. It will take 30 to 45 minutes for the medicine to start working.

• If all of your withdrawal symptoms are relieved, continue to day 2. Your medical team will tell you whether you should call your clinic or pharmacist for follow-up information before starting your day 2 doses.
• If you still have withdrawal symptoms, continue to take 1 dose (2 mg/0.5 mg) of buprenorphine/naloxone (1 pill) each hour, up to a maximum of 8 doses (16 mg/4 mg). The most you can take on day 1 is 16 mg/4 mg (8 pills).

Do not take your next dose if, at any point in this process, you feel worse, sleepy, sedated, or have a hard time focusing. If this happens, call your clinic or pharmacist. Your dose may be too strong.

If you need to stop taking the medicine early, write down the number of pills you took on day 1. This will make sure that your medical team has the most accurate information to help you feel better.

Day 2

• If you had to stop before taking all 8 doses on day 1, your medical team will tell you whether you should call your clinic or pharmacist for follow-up information before starting your day 2 doses, or if you should take a different number of pills for dose 1.
• If you took all doses on day 1 (8 pills) and didn’t feel worse, sleepy, or sedated, you can start your day 2 doses.

Dose 1: If you took all doses on day 1, then dose 1 on day 2 will be 8 pills (16 mg/4 mg). Take dose 1 (8 pills) and wait 1 hour. It will take 30 to 45 minutes for the medicine to start working. If you didn't take all 8 pills on day 1, then dose 1 on day 2 for you may be however many pills you did take on day 1 (your medical team will give you more information about this).

• If all of your withdrawal symptoms are relieved, this is your only dose for day 2.
• If you still have withdrawal symptoms, continue to take 1 dose (2 mg/0.5 mg) of buprenorphine/naloxone (1 pill) each hour, up to a maximum of 16 doses (32 mg/8 mg) for the whole day. The most you can take on day 2 is 32 mg/8 mg (16 pills).

Getting the right dose

When you start taking buprenorphine/naloxone, it usually takes 2 days to get the right dose of this medicine into your body. Until then, you may have some cravings or withdrawal symptoms.

It is important that you see your healthcare provider on day 3 to review your progress and make a plan for your ongoing treatment.

While you’re taking buprenorphine/naloxone

• Don’t use another type of opioid (“dope” or “down”) such as heroin, fentanyl, morphine, hydromorphone, methadone, Percocet, or Dilaudid. This can increase the risk of opioid poisoning. If you choose to use other opioids, use as little as possible to lower the risk of poisoning.
• Don’t take buprenorphine/naloxone with other medicines that make you sleepy or relaxed such as benzodiazepines (“benzos”), alcohol, sedatives, or sleep aids.
• Be careful doing any activity where you need to be alert.
• Stop taking buprenorphine/naloxone if it makes you feel worse, sleepy, or you have a hard time focusing.

If you have side effects that you’re worried about, call Health Link at 811, go to the emergency department, or call 911 for help.

To see this information online and learn more, visit MyHealth.Alberta.ca/health/pages/conditions.aspx?Hwid=custom.ab_suboxone_homedosingrapid2day_ac_adult.

For 24/7 nurse advice and general health information call Health Link at 811.

Current as of: November 21, 2024

Author: Recovery Alberta: Mental Health and Addiction Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.