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Discharge Instructions

Information about buprenorphine

• Buprenorphine is a long-acting medication used to treat opioid use disorder. Long-acting means the medication acts slower in the body for a longer time. It is a partial opioid agonist, which means that it partially activates the opioid receptors in the body.
• When taken as directed, buprenorphine helps people with opioid use disorder get out of the cycle of use and withdrawal, feel more stable, and have a chance to focus on other aspects of their lives so they can recover.
• When used as prescribed, buprenorphine significantly reduces the risk of opioid overdose if you take other opioids.
• Buprenorphine-naloxone contains naloxone in addition to the buprenorphine. The naloxone is not absorbed when the medication is taken as directed (under the tongue). If the medication is injected, the naloxone will be absorbed and can cause severe opioid withdrawal.
• Buprenorphine is safe and there is no limit to how long a person can take the medication. It is recommended that most people be on the medication long-term.
• Side effects may occur and are typically mild and improve over time. They can include constipation, sweating, headache, dizziness, trouble sleeping, nausea, and sleepiness. If these occur notify your healthcare provider, nurse, or pharmacist.
• Over time, your body will get used to the medicine. If you stop taking it suddenly, you will feel withdrawal symptoms within a few days.

How to take the medication

• You will receive the medication in either film or tablet form.
• Do not swallow the medicine; it will not work if it is swallowed.
• Place medication under your tongue and allow it to completely dissolve; this can take 5-15 minutes. Drinking water before taking the medication can help it dissolve faster. Do not drink water while the medication is under the tongue.
• Do not eat, drink, talk, or smoke while the medication is dissolving.
• Do not smoke, eat or drink anything for at least 15 minutes after it has dissolved.
• To prevent tooth decay, rinse your mouth with water 30 minutes after you take the medication.

CAUTION

• Continue to take your regular buprenorphine dose, even after you feel better. Stopping buprenorphine may cause withdrawal and cravings to use other opioids, and your risk of opioid overdose will be much higher if you do use opioids without being on this medication.
• Don’t take other sedatives, like benzodiazepines or alcohol. The combination could make you so sleepy that you stop breathing. Talk to your healthcare provider, nurse, and pharmacist about what other medications and substances you are taking.
• Do not drive while you are starting buprenorphine because it may slow your reaction time. Wait until you know how this medication affects you.
• Remember that changes in use patterns can alter tolerance and increase your risk of opioid overdose. If you use other opioids, take steps to reduce the risk associated with overdose, like having naloxone, not using alone or calling the Never Use Alone lifeline (877-696-1996), and starting low and going slow.

Buprenorphine dose and time taken 

________mg @___:____

Return to the Emergency Department if these occur

If you are so sleepy that people are having a hard time waking up. Rashes, hives, wheezing, swelling of the face, difficulty breathing, problems with coordination, blurred vision, slurred speech; vomiting and can’t keep anything down, fever or severe pain, you feel sicker, or if you have any other questions, concerns, or problems. 

Discharge Instructions

DAY ONE 

Wait at least 12-24 hours since your last opioid use. Take other prescribed medications to treat symptoms.

When you are in moderate withdrawal (3 or more symptoms) take 2 tablets or films at once (16 mg). Wait 30-60 minutes.

Take an additional 1-2 tablets or films if needed. Do not take more than 4 tablets or films (32 mg total) on day 1.

DAY TWO

Take 1 tablet or film (8 mg) in the morning, afternoon, and evening. Continue taking it three times daily until your next visit.

Information about buprenorphine

• Buprenorphine is a long-acting medication used to treat opioid use disorder. Long-acting means the medication acts slower in the body for a longer time. It is a partial opioid agonist, which means that it partially activates the opioid receptors in the body.
• When taken as directed, buprenorphine helps people with opioid use disorder get out of the cycle of use and withdrawal, feel more stable, and have a chance to focus on other aspects of their lives so they can recover.
• When used as prescribed, buprenorphine significantly reduces the risk of opioid overdose if you take other opioids.
• Buprenorphine-naloxone contains naloxone in addition to the buprenorphine. The naloxone is not absorbed when the medication is taken as directed (under the tongue). If the medication is injected, the naloxone will be absorbed and can cause severe opioid withdrawal.
• Buprenorphine is safe and there is no limit to how long a person can take the medication. It is recommended that most people be on the medication long-term.
• Side effects may occur and are typically mild and improve over time. They can include constipation, sweating, headache, dizziness, trouble sleeping, nausea, and sleepiness. If these occur, notify your healthcare provider, nurse, or pharmacist.
• Over time, your body will get used to the medicine. If you stop taking it suddenly, you will feel withdrawal symptoms within a few days.

How to take the medication

• You will receive the medication in either film or tablet form.
• Do not swallow the medicine; it will not work if it is swallowed.
• Place medication under your tongue and allow it to completely dissolve; this can take 5-15 minutes. Drinking water before taking the medication can help it dissolve faster. Do not drink water while the medication is under the tongue.
• Do not eat, drink, talk, or smoke while the medication is dissolving.
• Do not smoke, eat or drink anything for at least 15 minutes after it has dissolved.
• To prevent tooth decay, rinse your mouth with water 30 minutes after you take the medication.

CAUTION

• Continue to take your regular buprenorphine dose, even after you feel better. Stopping buprenorphine may cause withdrawal and cravings to use other opioids, and your risk of opioid overdose will be much higher if you do use opioids without being on this medication.
• Don’t take other sedatives, like benzodiazepines or alcohol. The combination could make you so sleepy that you stop breathing. Talk to your healthcare provider, nurse, and pharmacist about what other medications and substances you are taking.
• Do not drive while you are starting buprenorphine because it may slow your reaction time. Wait until you know how this medication affects you.
• Remember that changes in use patterns can alter tolerance and increase your risk of opioid overdose. If you use other opioids, take steps to reduce the risk associated with overdose, like having naloxone, not using alone or calling the Never Use Alone lifeline (877-696-1996), and starting low and going slow.

Discharge Instructions

Continue taking buprenorphine. Buprenorphine only causes severe withdrawal symptoms when you have high levels of opioids in your system. When you are farther out from your last dose of opioids, buprenorphine makes withdrawal and cravings better, not worse. You’ve made it through the hardest part — it gets easier from here.

Other medications were prescribed to help with nausea, agitation, difficulty sleeping, belly cramping, etc. Ask your provider about these medications and continue to treat symptoms that are giving you trouble. You can also take over-the-counter ibuprofen and acetaminophen for pain. 

Remember that changes in use patterns can alter tolerance and increase your risk of opioid overdose. If you use other opioids, take steps to reduce the risk associated with overdose, like having naloxone, not using alone or calling the Never Use Alone lifeline (877-696-1996), and starting low and going slow.

Discharge Instructions

Information about methadone

• Methadone is a long-acting opioid medication. Long-acting means that the drug acts slower in the body for a longer period of time.
• Methadone is prescribed to treat opioid use disorder by preventing withdrawal symptoms and reducing cravings. When taken as directed, methadone reduces the need for other opioids and gives individuals a chance to stabilize their lives. Methadone is a safe, effective medication that can be used for long term management of opioid use disorder.
• Because of the cumulative effects of methadone, doses are started low and slowly up-titrated until an adequate dose is achieved over days or weeks. You may need other medications during this time to help you manage symptoms of withdrawal. Ask your provider about these medications and take them for symptoms that are giving you trouble. You can also take over-the-counter ibuprofen and acetaminophen for pain.
• Common side effects of methadone include constipation, sweating, dry mouth, changes in sex drive, drowsiness, light-headedness, nausea and vomiting, and weight gain.
• Over time, your body will get used to the medicine. If you stop taking it suddenly, you will feel withdrawal symptoms within a few days.

Getting methadone

• Methadone can only be obtained from a specialty clinic, known as an opioid treatment provider (OTP).
• You may need to go in person to the OTP daily to receive your dose of methadone. Over time, you may be able to receive “take home” doses, but you will still need to go in person regularly.
• Do not start methadone if you cannot connect with an OTP for ongoing care. Ask your provider about buprenorphine instead.

CAUTION

• Don’t take other sedatives, like opioids, benzodiazepines, or alcohol. The combination could make you so sleepy that you stop breathing. Talk to your healthcare provider, nurse, and pharmacist about what other medications and substances you are taking.
• Do not drive while you are starting methadone because it may slow your reaction time. Wait until you know how this medication affects you.
• Remember that changes in use patterns can alter tolerance and increase your risk of opioid overdose. If you use other opioids, take steps to reduce the risk associated with overdose, like having naloxone, not using alone or calling the Never Use Alone lifeline (877-696-1996), and starting low and going slow.

Methadone dose and time taken 

________mg @___:____

Return to the Emergency Department if these occur

If you are so sleepy that people are having a hard time waking up. Rashes, hives, wheezing, swelling of the face, difficulty breathing, problems with coordination, blurred vision, slurred speech; vomiting and can’t keep anything down, fever or severe pain, you feel sicker, or if you have any other questions, concerns, or problems. 

Discharge Instructions

If you are taking buprenorphine or methadone, continue taking this medication at your usual dose. It is okay to take medications for opioid use disorder along with the medications you were prescribed today. Let your opioid treatment program or buprenorphine provider know that you have a painful condition and tell them what medications you were given today. It is common for people on medications for opioid use disorder to need additional support when they have a painful condition. 

If you are taking buprenorphine at home you may want to try splitting your doses – taking it 2 to 3 times a day instead of once can sometimes help control pain better. 

Use other pain management strategies as well: positions of comfort, heat, cold, and over-the-counter medications like acetaminophen and ibuprofen. 

Remember that changes in use patterns can alter tolerance and increase your risk of opioid overdose. If you use other opioids, take steps to reduce the risk associated with overdose, like having naloxone, not using alone or calling the Never Use Alone lifeline (877-696-1996), and starting low and going slow.