First Visit and Induction
Preparing for the first visit
No short-acting painkillers or heroin for at least 24 hours
No methadone or long-acting painkillers for at least 36 hours
Arrive to the office with Signs & Symptoms of Opiate Withdrawals
I feel anxious!
I feel like Yawning!
I am perspiring!
I have Goosebumps!
I have tremors!
I have Chills!
I feel nauseated!
I have stomach cramps!
I may need to vomit!
I have diarrhea!
I feel dehydrated!
I have not had much appetite!
I am having difficulty sleeping!
My nose is running!
My eyes are watery!
My face is flushed or red
My muscles twitch!
My muscles and bones ache!
Your 1st visit may last anywhere from 1 to 3 hours.
Arrive with a full bladder
It is important to arrive experiencing mild-to- moderate withdrawals.
Because SUBOXONE can cause drowsiness and slow reaction times, particularly during the 1st few days of treatment, driving yourself home after the 1st office visit is not recommended, so you must make arrangements for a ride from a family member or friend accordingly.
Induction
The goal of induction is to safely suppress opioid withdrawal as rapidly as Possible with adequate doses of SUBOXONE.
Induction procedure generally proceeds as follows: Patient’s withdrawal Symptoms are assessed with Clinical Opiate Withdrawal Scale Assessment (COWS) and documented for mild-to- moderate opioid withdrawal Symptoms.
The first dose of SUBOXONE is administered. After 1 to 2 hours, the patient’s Withdrawal symptoms are reassessed with COWS, and a second dose of SUBOXONE is administered if needed. After approximately 30 minutes, an Assessment and a brief physical exam are performed prior to discharge.
The induction phase usually averages 2 to 5 days. During this period, Doses are adjusted to control cravings, opiate withdrawal signs and symptoms.
Doses are progressively adjusted in increments or decrements of 2 to 4 mg. After each dose adjustment, 3 to 7 days should be allowed for steady-state blood levels to be achieved, before evaluating the need for further dose changes.
Upon leaving the office
Physicians will ask patients to document their withdrawal symptoms and SUBOXONE use in the home dosing record form. An appointment for the next office visit will be given!
Maintenance
The goals of the maintenance phase are:
Prevent opioid withdrawal symptoms
Suppress opioid cravings & relapse
Greatly attenuate the use of self-administered opioids
Caution!
Despite the favorable safety profile of buprenorphine, caution is advised Regarding its concomitant use with other sedatives, such as Benzodiazepines, (e.g., Xanax, Valium) due to the additive effects exerted by buprenorphine. Inappropriate concomitant use (eg, higher doses than prescribed, parenteral administration) of psychotropics (especially benzodiazepines) and buprenorphine appears to be one of the risk factors for buprenorphine-related fatalities.
SUBOXONE Therapy & Counseling
SUBOXONE therapy and psychosocial counseling continue. Treatment compliance and progress are regularly monitored, and may entail urine screening tests and other laboratory evaluations as appropriate.