Starting at-home buprenorphine treatment—a process called “induction”—represents a significant step forward in recovering from opioid dependence. The key to a successful home induction is understanding when to take your first dose. With proper medical guidance and preparation, you can safely begin buprenorphine treatment and regain the sober life you once had.
How do I prepare for buprenorphine induction?
You may have heard that you have to stop using opioids for some time before starting buprenorphine. The thought of going through withdrawal sounds intimidating, but the symptoms are very similar to having the flu. And, just like the flu, there are similar ways of making the symptoms more tolerable.
Staying hydrated is critical for getting through withdrawal, so keep plenty of water on hand and drink more frequently than you usually do. It may seem simple, but drinking water can have a significant positive impact by lessening the severity of withdrawal symptoms.
When it comes to eating during withdrawal, it’s important to eat nourishing food. Stick to small portions of easily digestible foods, like crackers, bananas, and rice. Your digestive system will be sensitive, so avoiding heavy meals is for the best. Broth, chocolate milk, and non-caffeinated electrolyte drinks—like Pedialyte® and sports drinks—can also provide gentle nourishment during this time.
Over-the-counter medications can’t shorten withdrawal, but they can significantly reduce discomfort. Consider having these on hand (after consulting with your pharmacist):
- For digestive issues: Imodium® or Pepto Bismol®
- For stomach discomfort: Pepcid® or Tums®
- For body aches: Advil® (ibuprofen) or Aleve® (naproxen)
- For sleep and anxiety: Benadryl®, Unisom®, or melatonin supplements
- For chills and sweating: Tylenol® (acetaminophen) or Advil
Many people have found relief through these additional strategies:
- Rest as much as possible—this is the time to “sleep it off” as much as you can.
- Practice calming activities—like meditation, yoga, and even journaling—to help manage the increased stress response.
- Avoid caffeine and energy drinks, which can increase anxiety.
What is the washout stage?
The washout stage, also known as the waiting period, is the critical time between stopping opioids and starting buprenorphine. During this time, people need to be completely off opioids and experience moderate withdrawal symptoms. Fentanyl use can affect this process, so it’s important to be transparent with your care team about which drugs are present in your system.
The required washout period varies based on the type of opioid being used:
- Short-acting opioids: 12–24 hours
- Long-acting opioids: 48–72 hours
While many people want to start early to avoid withdrawal symptoms, taking buprenorphine too soon will lead to precipitated withdrawal, which is more severe and abrupt than regular withdrawal.
A precipitated withdrawal occurs because of how buprenorphine works in your brain. While traditional opioids fully activate your opioid receptors, buprenorphine is a partial agonist with high binding affinity—it only somewhat activates these receptors, but the binding affinity means it will remove and block any remaining opioids. If you induct too early, the sudden opioid removal can cause intense withdrawal symptoms at one time, rather than the gradual onset that’s much easier on the mind, body, and spirit.
Think of the washout stage as easing into a pool or lake, allowing your body to gradually adjust to the water temperature rather than jumping in all at once. While those first steps into cold water might be uncomfortable, wading in is much more pleasant than the jarring shock of full-body cold.
The washout period similarly allows your body to slowly transition away from opioids, just like it would adjust to chilly water. While the washout stage is challenging, it’s much safer than diving into a precipitated withdrawal.
How does the Clinical Opiate Withdrawal Scale (COWS) factor into recovery?
Knowing when to start buprenorphine takes careful monitoring of your symptoms. To help navigate this stage, healthcare providers use the Clinical Opiate Withdrawal Scale (COWS) to measure withdrawal levels. This tool assigns points to your symptoms, resulting in a score ranging from 0 to over 36.
Your body will send clear signals when you’ve reached the right stage of withdrawal, including:
- Anxiety and restlessness
- Runny nose and watery eyes
- Sweating and goosebumps
- Muscle and joint aches
- Dilated pupils
- Digestive issues (nausea, diarrhea, stomach pain)
Most people are ready to start buprenorphine when they reach a score of 10–12, which indicates moderate withdrawal. COWS is all about finding the sweet spot: Starting too early risks precipitated withdrawal and waiting too long means unnecessary discomfort.
It’s important to note that the 10–12 scoring range is typical for prescription drug and heroin use. For people who have used illicit fentanyl and other non-opioids, their COWS scoring range is abbreviated to 5–8.
While determining the right balance can be challenging, it’s important to remember that you aren’t in this alone. Before starting buprenorphine, gather up local phone numbers for medical and mental help. This can include your pharmacy, healthcare provider’s contact info, or crisis intervention services.
Most importantly, you should surround yourself with loved ones who can provide physical and emotional support. They’re the ones who will listen to you without judgment, run errands for you, or help prepare meals. They can also help monitor your symptoms and help if your situation changes.
Experienced care teams you can trust
Asking for help isn’t always easy, but you don’t have to go through the tough parts alone. Ophelia’s medical providers are here to oversee the induction process and ensure your comfort and safety. We’ll advise you on when to start taking buprenorphine and whether to take a prescription or over-the-counter medication to help counteract or manage symptoms during induction.
Once you make it through these initial few days, you’ll be ready to begin treatment with Ophelia. In addition to regular virtual appointments with your clinician, you’ll have access to care coordinators and triage nurses for additional support seven days a week. Our job is to provide comprehensive care at every step, so you can focus on your physical and emotional wellness.
Sources
