What you’ll learn
We’ll explain what the Suboxone® induction phase is and how it sets the foundation for recovery. We’ll walk you through what to expect and how a telemedicine program can help you get the care you need from the comfort and privacy of home.
Starting treatment for opioid use disorder (OUD) is a big step on your personal recovery journey. Medications like Suboxone® (buprenorphine-naloxone) are life-changing for people battling OUD. When used as part of a Medication-Assisted Treatment (MAT) program under the guidance of a licensed provider, they can ease the transition from prescribed or nonprescribed opioids. When you start Suboxone in MAT, the first few days are called the induction phase.
These early days of your recovery can be both hopeful and challenging at the same time. If you or a loved one is starting Suboxone induction, we’re here to help you learn what to expect and how to make this early stage of recovery as manageable and supported as possible.
So, what is Suboxone? It’s the brand name of a medication used in MAT to help people recovering from OUD. It combines two key ingredients: buprenorphine and naloxone. Buprenorphine helps calm cravings and withdrawal, while naloxone helps deter misuse.
What are the phases of Suboxone therapy?
Treatment typically follows three phases:
- Induction: This phase is about helping you find the right starting point. You’ll take your first doses of Suboxone under medical guidance, monitored by your provider.
- Stabilization: In this phase, withdrawal symptoms have eased, and your provider fine-tunes your dose.
- Maintenance: You’re feeling better and staying on a steady dose that supports your recovery.
This last phase (Maintenance) lasts as long as you need it to. There’s no right timeline. Recovery is a very personal journey. Ultimately, it’s about what you and your provider decide is best for your situation.
What is the purpose of the Suboxone induction phase?
The goal of induction is simple, but important: Suboxone helps people start treatment for OUD without unnecessary discomfort. This medication helps prevent the worst of opioid withdrawal, but it needs to be introduced at the right time and in the right way. During this phase, your provider is there to help figure out the dose that works best for your body and your recovery journey.
What to expect during Suboxone induction
Everyone’s experience is different, but here are some common things to expect:
- Symptom relief: Most people feel noticeably better within 30 to 60 minutes after their first dose. This means feeling less anxious, less achy, and more calm.
- Mild, temporary side effects: You might experience things like headache, nausea, or drowsiness as your body gets used to the medication. These usually fade quickly.
- Ongoing monitoring: You’ll check in with your provider to make sure your dosage is working as it should and adjust if needed.
Can I go through the induction phase at home?
Yes. For many people, going through the induction phase from the comfort of home is the best place to start. Going through induction at home with a telemedicine MAT program can be especially helpful if you’re not feeling well, don’t have reliable transportation, or want privacy during this period. You’ll still have full medical supervision. Your provider will guide your timing, dosing, and next steps via private video visits.
What should I know before I take my first dose of Suboxone?
Before you take your first dose of Suboxone, you’ll need to wait until your substance of choice clears out of your system. If you take Suboxone too soon, it can trigger intense withdrawal symptoms called precipitated withdrawal. Timing your first dose correctly can help you avoid that experience.
How long you wait depends on what you’ve been using:
- If you’ve been using short-acting pharmaceutical opioids, including oxycodone (Percocet), hydromorphone (Dilaudid), or hydrocodone (Vicodin), you’ll typically wait at least 8 hours after your last dose.
- If you’ve been using long-acting pharmaceutical opioids like methadone, OxyContin, or extended release morphine, the wait is often 36 to 72 hours or longer.
- If you have been purchasing opioids privately (not from a pharmacy), the opioids likely contain a combination of fentanyl and other drugs. Since no one can predict which drugs are contained in these opioids, people cannot rely on a specific number of hours, but instead must wait until they are in ‘moderate opioid withdrawal’ before taking their first dose of Suboxone.
The goal isn’t just to count hours, though. It’s to start Suboxone when you’re in moderate withdrawal. This window is when buprenorphine works best and when the risk of precipitated withdrawal is lowest. You should feel at least three of these symptoms at a moderate level of discomfort before you start your first dose:
- Restlessness
- Body aches
- Drowsiness/heavy yawning
- Stomach cramps, nausea, vomiting, or diarrhea
- Runny nose
- Enlarged pupils
- Tremors, twitching, chills, or sweats
- Anxiety or irritability
Your provider will determine a dose that can help you start feeling better. Induction can start with a 2 mg dose or 4 mg dose of buprenorphine-naloxone followed by a second 2 mg or 4 mg dose about two hours later.
However, studies have shown that starting with multiple smaller, staggered doses (like 2 mg every few hours) of buprenorphine when you’re in moderate withdrawal can help avoid precipitated withdrawal, especially if you’ve been using high-potency opioids like fentanyl or methadone.
Tools like the Subjective Opiate Withdrawal Scale (SOWS) help you and your provider decide when it’s safe to start.
What is the SOWS score?
The SOWS is a simple self-assessment that helps measure how intense your withdrawal symptoms are:
- 1–10 = mild withdrawal
- 11–20 = moderate withdrawal (ideal time to start Suboxone)
- 21+ = severe withdrawal
Can precipitated withdrawal be avoided?
In most cases, precipitated withdrawal can be avoided with careful timing and provider support. Precipitated withdrawal happens when Suboxone is taken too soon, when other opioids are still active in your system. Buprenorphine then “kicks off” those opioids from your brain receptors, triggering sudden, intense withdrawal.
You’ll want to wait until you’re in moderate withdrawal before starting. Be honest with your provider about what you used, how much, and when. The more accurate you are, the safer and smoother your induction will be.
What are the steps of the induction process?
Here’s how the first few days of induction typically work:
Day 1:
- Start with your first dose of Suboxone under your tongue. It typically takes 15-30 minutes to dissolve.
- Wait another 15-30 minutes before eating, drinking, or swishing anything around in your mouth.
- Wait about 2 hours. If you’re still in withdrawal, take a second dose.
- If you’re still feeling sick after an additional 2 hours, take a third dose.
- Do not exceed 16-24 mgs on your first day of Suboxone induction.
If at any point you don’t feel safe or if your symptoms get worse, go to the nearest emergency room.
Day 2:
- Take your first dose.
- Wait 6 hours. If you still feel sick, take your 2nd dose.
- Wait another 6 hours and repeat as-needed.
- Do not exceed 16-24mg on Day 2.
Day 3:
- Hopefully, you should be feeling better. Repeat the dose you took on Day 2. (Note: If your dose was more than 8 mg, your provider may recommend you split that dose into a morning dose and an afternoon dose. If you have any questions about your medication or dosage, your provider will be there to help you make the best decision based on how you’re feeling.)
On Day 4 and beyond, you’ll continue to take the total dose you had on Day 2. Depending on how you feel, you can take more or less medication. However, if you need to increase your dose, you should not change it by more than 2 mg per day. Your provider can walk you through any questions to help you feel safe and confident when you start taking Suboxone.
At the end of the week, you’ll have a formal check-in with your provider to see how you’re responding to the medication, make any adjustments if needed, and refill your prescription.
Why must Suboxone induction be supervised?
Starting Suboxone isn’t like picking up an over-the-counter medication. Because of how buprenorphine works in the brain, it’s important to medical guidance, especially during induction. Here’s why supervision matters:
1. Prevents precipitated withdrawal
Suboxone contains buprenorphine, a partial opioid agonist. This means that buprenorphine can “push off” other opioids from your brain’s receptors. If taken too soon after other opioids, it can trigger sudden and intense withdrawal symptoms. A licensed provider helps you time your first dose so this doesn’t happen.
2. Adjusts dosage to your needs
Everyone’s recovery journey is unique. Your ideal dose depends on your body, your history, and how you respond. During induction, your provider watches for signs that your personalized dose is working for you and adjusts if needed.
3. Monitors for side effects
Suboxone is generally safe, but side effects like nausea, headache, or dizziness can occur during induction. With a licensed provider guiding the process, they can address any issues promptly if something feels “off.”
4. Builds confidence in your treatment plan
Supervision during induction not only provides medical safety but also gives you peace of mind. You’ll have access to support, guidance, and reassurance as you take this major first step in your recovery.
How do I avoid a difficult transition to Suboxone?
Methadone and fentanyl can be especially tricky to transition from because they stay in your system longer than other opioids. The longer you wait after your last dose of these opioids to start Suboxone, the better it is for preventing precipitated withdrawal. Unfortunately, the longer you wait, the more opioid withdrawal you go through and the higher your risk for relapse and overdose.
When transitioning from methadone or fentanyl, your provider may recommend alternative induction strategies if typical Suboxone induction methods aren’t working well for you.
It’s important to note that many people who use potent opioids have experienced precipitated withdrawal when switching to Suboxone, even after waiting more than 72 hours after their last use. Traces of these substances can stay in your system, which can cause precipitated withdrawal if Suboxone is started too soon. That’s why symptoms matter more than the clock. Many people use tools like the Subjective Opiate Withdrawal Scale (SOWS) to check in with their body before dosing.
What are the next steps after the Suboxone induction phase?
Once you’ve completed the induction phase (usually within 2-4 days), you’ll move into the stabilization phase.
During this time:
- Your provider will fine-tune your dose based on how you’re feeling.
- Cravings and withdrawal should continue to ease.
- You’ll start building routines that support long-term recovery.
After stabilization comes maintenance, where you stay on a steady, effective dose. Some people stay here for months, years, or indefinitely. And that’s okay. Recovery isn’t one-size-fits-all.
How do I get started with Suboxone for opioid use disorder?
If you’re living with opioid use disorder, you deserve support, not judgment. OUD is a treatable medical condition. If you’re ready to take steps on your recovery journey, you don’t have to go it alone.
Here at QuickMD, we offer same-day appointments, stigma-free care, and 7-day-a-week access. If you and your provider decide on Suboxone as part of your treatment, your prescription can be sent to your local pharmacy or delivered to you directly.
Whether you’re just beginning your recovery journey or continuing long-term care, we’re here to walk beside you. No waiting weeks. No complicated logistics. Just compassionate, evidence-based treatment that fits your life.
