Buprenorphine microdosing: the “Bernese Method” for induction

For many people living with opioid use disorder (OUD), the decision to start Suboxone® treatment, which can lead to improved treatment outcomes and successful buprenorphine induction, is a huge and hopeful step. But the standard approach, stopping all opioids, waiting for a specific time period or until moderate withdrawal sets in, and then beginning buprenorphine induction, can be one of the hardest parts of the process.

After all you’ve been through, that wait can be a lot to deal with, especially if it involves withdrawal symptoms.

Maybe you’ve tried buprenorphine before and felt so sick you went back to opioids. Maybe you’re juggling a job, taking care of kids, or managing your mental health, and you can’t afford to be completely out of commission for 24 to 48 hours. Maybe you’ve heard about precipitated withdrawal, and the idea of facing that feels overwhelming.

If any of that sounds familiar, there’s potentially another way to begin.

That’s where low-dose buprenorphine induction (also called microdosing) comes in. This method allows patients to start buprenorphine in very small doses while still taking their current opioid, easing them into treatment and avoiding full withdrawal.

Sometimes referred to as the “Bernese method” (after a Swiss study that popularized this approach), QuickMD uses a modified version of low-dose induction designed for real-world use through telemedicine. It’s tailored for patients who need a safer, more flexible alternative to traditional induction, especially those transitioning from methadone, using fentanyl, or unable to stop opioids cold turkey.

At QuickMD, we understand how complex this process can be. Our clinical team includes licensed providers and experienced Suboxone® prescribers who’ve helped thousands of patients transition into treatment safely. Our focus is always on evidence-based care that respects your pace and your needs.

In this guide, we’ll walk you through how the low-dose induction works, who it may be right for, and how it compares to standard opioid agonist treatment induction. We’ll also talk about why you need to involve a provider when trying this approach, and how telemedicine services like ours can support you through it, so you can take control of your health.

What is the Bernese method?

The Bernese method is one type of micro-induction (low-dose induction) strategy, and offers a more flexible path for treating opioid use disorder through medication treatment.

Developed in Switzerland, the Bernese method is one of several opioid microdosing approaches to buprenorphine induction. Instead of quitting opioids cold turkey, you continue your regular opioid, whether it’s methadone, oxycodone, or another full opioid agonist, while gradually adding in the initial buprenorphine dose as very small doses of sublingual buprenorphine.

Over several days, the buprenorphine slowly takes over the mu-opioid receptors in the brain (these are the receptors responsible for the pain relief and euphoria triggered by opioids) without fully displacing opioids all at once.

This slow, steady approach helps avoid one of the hardest parts of standard induction: precipitated withdrawal. That’s when buprenorphine kicks opioids off the receptors too fast, which can lead to a wave of uncomfortable symptoms.

While the name “Bernese method” is still sometimes used, there are now many evidence-based approaches to microdosing buprenorphine, including a version we developed for safe use via telemedicine. This is often referred to as a low-dose induction.

Why the low-dose induction matters, especially for methadone patients

Traditionally, transitioning from methadone to buprenorphine requires tapering your methadone dose down to 30 mg or lower, then waiting up to 72 hours for withdrawal to set in.

For people on higher doses (like 60 to 100 mg), who are often methadone maintenance patients, the process becomes even more complicated, and in some cases, too disruptive to even consider.

Low-dose induction skips the full opioid withdrawal phase. Instead, you stay on your usual opioid while microdosing buprenorphine, allowing your system to adjust gradually and safely. For many, it’s a gentler way to start opioid addiction treatment.

Especially those who’ve tried and failed traditional inductions or simply can’t afford to destabilize their lives just to switch medications.

While this strategy of microdosing buprenorphine is sometimes called the Bernese method, we use a modified low-dose induction protocol that builds on evidence-based approaches tailored to patient safety in a telemedicine setting.

Important considerations before starting microdosing

If you’re considering this path for opioid use disorder treatment, it’s okay to have questions or mixed feelings. Thinking about a new approach, especially when you’re already dealing with pain or stress, takes real strength.

This method isn’t right for everyone.

Because buprenorphine and methadone work very differently (combining them falls outside standard prescribing guidelines), the process must be medically supervised. Patient selection is key.

A QuickMD provider can help assess whether this approach makes sense for you, based on your current opioid use, physical and mental health, and other key factors.

• The type and amount of opioid you’re currently using
• Your physical and mental health
• Risk factors like liver function or co-use of other substances
• Your stability in areas like housing, mental health, and support systems
• Your access to mental health services, which can support recovery and address co-occurring psychiatric conditions

Effective mental health administration is also important, as it helps coordinate behavioral health support and ensures comprehensive care for individuals with opioid use disorder.

Though international case studies and clinical reports show promising outcomes, low-dose induction is still considered off-label in the U.S. That means it isn’t officially approved by the FDA. However, it uses medications approved for opioid use disorder, like Suboxone®, even though the protocol itself is not FDA-approved. But doctors use it safely in real-world care, especially when other options don’t feel doable.

Overall, it’s a helpful tool we have for helping people access the benefits of buprenorphine treatment without needing to go through painful, destabilizing withdrawal first.

How microdosing works for opioid use disorder

Low-dose induction works by introducing very small doses of buprenorphine while continuing your usual opioid. 

Over time, the buprenorphine builds up slowly in your system and begins to take over the brain’s mu-opioid receptors, without triggering full withdrawal. 

A 2020 CMAJ letter from physicians in British Columbia highlighted how microdosing buprenorphine helped patients and reported smoother transitions with fewer symptoms.

Here’s a simplified example of how that schedule might look. Keep in mind, this is just a general framework. Your provider may adjust timing, doses, or taper based on your current opioid tolerance and other health factors.

This gradual increase in buprenorphine dose allows the medication to slowly “occupy” the opioid receptors, reducing cravings and withdrawal symptoms as you taper off the original drug.

Unlike this microdosing approach, some protocols use high-dose buprenorphine induction, especially in emergency department settings, to provide rapid symptom relief and initiate treatment with higher initial doses.

How microdosing helps avoid opioid withdrawal symptoms

By microdosing, you ease buprenorphine into the system so that it coexists with your current opioid at first, gradually replacing it over several days. It’s like slowly turning down one dial while gently turning up another. 

Important notes on the low-dose buprenorphine induction

• Daily monitoring is often recommended, especially early on, to track symptoms using tools like the Clinical Opiate Withdrawal Scale (COWS). The Clinical Opiate Withdrawal Scale is a simple checklist used by providers to measure the severity of opioid withdrawal symptoms, like sweating, restlessness, pupil size, and stomach upset, to guide safe timing and dosing decisions.
• You need a health professional with training to administer the COWS score. There is a Self Opiate Withdrawal Scale, which is for patients to do themselves.
• If withdrawal symptoms do appear, they’re usually milder and shorter-lasting than the full withdrawal required in standard inductions.

Do not try to microdose Suboxone® on your own. Buprenorphine is a powerful medication, and combining it with opioids without proper oversight can be dangerous. 

Always do this under the care of a licensed medical provider familiar with microdosing buprenorphine.

Who should consider low-dose induction for the treatment of opioid use?

Low-dose induction methods aren’t for everyone. But for some, it can be the difference between starting treatment and staying stuck in a cycle of use. 

So, how do you know if this path might make sense for you?

Here are a few situations where they may be helpful:

1. You’ve tried (and struggled with) traditional Suboxone® (buprenorphine/naloxone) induction

The physical and emotional toll of going “cold turkey” for 24-48 hours can be intense. And if you’re working, parenting, or dealing with mental health symptoms, it might not feel doable.

Low-dose induction softens that experience by letting you stay on your usual opioid at first, introducing Suboxone® (buprenorphine/naloxone) in small doses, and gradually making the switch.

2. You’re on methadone and want to transition to buprenorphine

Switching from methadone to Suboxone® is tricky. Methadone stays in the body for a long time, and jumping off it too quickly can lead to precipitated withdrawal.

These methods let you overlap methadone (daily dose of methadone must be 50 mg or less) and buprenorphine in tiny doses, giving your body time to adjust before stopping methadone altogether.

That said, this kind of transition must be done carefully. In many cases, your doctor may recommend tapering your methadone down to a safer dose before starting the microdosing process.

3. You’re using fentanyl or other high-potency illicit opioids

Fentanyl and similar synthetics are short-acting, highly potent opioids that are increasingly involved in opioid dependence. Because of how strongly they bind to receptors and how long they sometimes stay in fat tissues, they make standard Suboxone® induction even riskier. There is an increased risk of precipitated withdrawal and other complications when transitioning from fentanyl, especially without proper medical oversight. Additionally, fentanyl use is associated with a heightened risk of opioid overdose due to its potency and unpredictable effects.

Microdosing may help reduce the chance of precipitated withdrawal when switching from fentanyl. However, it’s important to note that research here is still evolving. Some people still report symptoms even with low-dose inductions, which is why close medical supervision is crucial.

4. You can’t afford to be down for days

Maybe you’re the sole caregiver in your family. Maybe you’re working full-time and don’t have sick days to spare.

Or maybe the idea of withdrawing alone, without medical support, just isn’t safe for your mental health.

Microdosing buprenorphine can offer a more flexible and realistic option if a traditional induction jeopardizes your safety, income, or responsibilities. This approach can also be safely implemented in an outpatient setting, making it accessible for those who cannot commit to inpatient care.

Who shouldn’t use low-dose induction methods?

Of course, this method isn’t suitable for everyone. 

It’s usually not recommended if you’re:

• Using high doses of methadone (>100 mg) and can’t taper to <50 mg.
• Currently using multiple substances (like benzos or alcohol) that raise the risk of overdose.
• Dealing with unstable medical or psychiatric conditions.
• Pregnant, unless under close OB-medical management.
• Experiencing severe liver disease (since the liver processes both methadone and buprenorphine).

That’s why medical guidance is so important. At QuickMD, your provider will walk you through the process, looking at your health, substance use, and goals before building a plan that actually works for your life.

What to expect from care with QuickMD

If you’re thinking about trying the low-dose induction methods of microdosing buprenorphine, QuickMD makes it easier to start with experienced clinicians, flexible scheduling, and support that meets you where you are.

Here’s what treatment with QuickMD can look like:

• Same-Day Telehealth Appointments: You can book an appointment online, often for the same day. Access to opioid addiction treatment is a huge barrier to good, consistent care. There’s no waiting weeks just to get in the door.
• Microdosing Plans Tailored to You: If you’re a good candidate for the low-dose induction, your provider will create a day-by-day plan. They’ll consider your current opioid use, health history, and goals to guide dosing safely.
• Supportive Follow-Up: QuickMD doesn’t stop at the prescription. Your provider will check in, adjust doses as needed, and help you manage any symptoms. Your provider can also support you through the emotional side of recovery, which can be just as important as the physical process.
• Pharmacy Coordination: Suboxone® prescriptions are sent to your local pharmacy. If there are any issues, your QuickMD provider can help troubleshoot. We’re here to support you at every step, not just hand over a prescription.

Final thoughts: Are low-dose induction methods right for you?

Suppose the idea of going into full withdrawal before starting Suboxone® feels overwhelming, whether because of work, caregiving, mental health, or just fear of feeling awful, you’re not the only one. Many people with opioid use disorder want to get better but feel stuck by the logistics of the induction phase of opioid addiction recovery.

Low-dose induction offers a more flexible, gradual path into buprenorphine treatment. It won’t be the right fit for everyone. But for some, it’s the first time treatment has actually felt possible.

No matter how many times you’ve tried or how uncertain you feel right now, the fact that you’re reading this means you’re looking for something better, and that matters. Change doesn’t have to happen all at once.

There’s more than one way to start Suboxone®. Microdosing buprenorphine may not be the standard path, but for some, it’s the only option that feels possible. And if that’s where you are, there is still a way forward.

[Ready to talk? QuickMD makes it easy to get started with a licensed Suboxone® provider who understands low-dose induction and can help you take the first step safely.]

Frequently asked questions about microdosing buprenorphine

Are low-dose induction methods safe to use at home?

They can be, but only with proper medical supervision.

Since buprenorphine is a strong medication that interacts with other opioids at the brain’s receptors, the timing and dosing must be done carefully to avoid precipitated withdrawal. During home induction, it is essential to monitor for respiratory depression, as this can be a serious and potentially life-threatening side effect.

Recognizing signs of buprenorphine toxicity, such as severe drowsiness, confusion, or difficulty breathing, is important, and you should seek medical help immediately if these occur. If you’re using this method outside of an inpatient setting, it’s important to have regular check-ins with a provider who knows how to guide you through microdosing.

How is this different from the usual way to start Suboxone®?

Normally, you have to wait until you’re in moderate withdrawal before taking Suboxone®. Otherwise, it can make you feel worse. With low-dose induction, you ease into treatment while your body adjusts gradually, making the process smoother and more comfortable.

What’s the success rate of the low-dose induction?

There isn’t a published success rate yet, since low-dose induction methods, like the Bernese method, are still considered off-label in the U.S. But based on real-world use, many patients and providers report better treatment retention, fewer dropouts, and reduced discomfort compared to traditional Suboxone inductions.