Starting buprenorphine at home

• Put the buprenorphine under your tongue.
• Don’t swallow it—the medication won’t work!
• Keep the medication there until it’s fully dissolved.
• Drinking water beforehand can help the medication dissolve. Do not talk, eat, drink, or smoke while the medication is dissolving and do not eat or drink for 15 minutes after.
• To prevent tooth decay, rinse your mouth with water 30 minutes after you take the medication.

Taking buprenorphine when you have other opioids in your system can cause sudden and severe withdrawal symptoms. This is called precipitated withdrawal. Precipitated withdrawal can happen when your body is used to having opioids, and you take buprenorphine while other opioids are still in your system. This is because buprenorphine kicks other opioids off your brain’s receptors. It replaces the other opioids and only activates the opioid receptors a little bit, causing your body to suddenly go from having a full opioid effect, to only a little opioid effect, which triggers intense withdrawal.

Precipitated withdrawal is treated with additional doses of buprenorphine. Other medications can help with managing symptoms.

To avoid it, wait until you’re already in withdrawal before taking your first dose. This makes sure that other opioids have already left your brain’s receptors naturally, so buprenorphine isn’t forcing them off.

Make sure you have support and other medications you were prescribed for managing symptoms, just in case. You can use these medications to help you feel better while you wait for the right time to start buprenorphine.

Precipitated withdrawal is unlikely to happen if you are already in withdrawal when you take your first dose. Try to wait 24 hours or more. The longer you wait, the more likely you are to avoid precipitated withdrawal. You should feel sick and have at least three of the symptoms below. At least one of those symptoms should be objective (something that another person could see, like big pupils). This helps make sure your withdrawal is bad enough to start.

How long will buprenorphine take to work?

Most people start to feel better after 30 minutes and feel the full effect after 60 minutes.

Can I overdose on buprenorphine?

It is very unlikely to overdose on buprenorphine by itself. Buprenorphine does not affect breathing as much as other opioids do. An overdose ca happen if you take buprenorphine with alcohol or other "downers", like Xanax and other pills that make you sleepy.

Can I take buprenorphine after having an overdose?

If you are in opioid withdrawal after being revived with naloxone (Narcan), buprenorphine can treat your withdrawal and help you feel better quickly. It is safe to use after an overdose, and can reduce your risk of having a repeat overdose in the next 24 hours.

What happens if I use other opioids while on buprenorphine?

Other opioids will have less effect, or no effect at all. Continue to take buprenorphine even if you use other opioids. Once you have started the medication, you do not need to be in withdrawal to take your dose. Try to take your dose around the same time each day.

How long should I take buprenorphine?

Continue taking buprenorphine regularly, even after you feel better. Buprenorphine reduces the risk of death by over 50%. It treats and prevents opioid withdrawal, and reduces cravings to use other, less safe opioids.

If you suddenly stop buprenorphine, you will experience withdrawal within a few days, and your risk of overdose will be much higher if you use other opioids.

It is recommended that most people stay on buprenorphine for at least 6 months. If you decide to stop, talk to your healthcare provider about how to do it safely, including slowly reducing the dose over time and making sure you have a plan to avoid using other opioids.

If I am under 18 do I have to tell my parents or caregivers?

People 13 years and older can get treatment for opioid use disorder without a guardian’s knowledge or consent. However, adolescents often have better treatment results when a trusted adult is involved. Ideally, an adult should help you start the medication and give you each dose.

Will buprenorphine make me “high”?

No. Buprenorphine helps you feel normal and not sick from withdrawal. It does not cause a high if taken as prescribed.

Do I need counseling or other support?

You do not have to be in counseling to receive the medication, but counseling or support groups are often helpful. Ask your treatment provider about resources.

What if I feel judged or embarrassed?

People that struggle with opioid use commonly feel judged or embarrassed. However, opioid use disorder is a treatable health condition, and you deserve respect and support while you recover. Support groups and counseling can help with these feelings.

Methadone is another highly effective medication that is used to treat opioid use disorder. Methadone may work better than buprenorphine for some people. Unlike buprenorphine, which can be prescribed and taken at home, methadone can only be given by special clinics called opioid treatment programs (OTPs). OTPs require frequent in person visits to get your medication and are only located in some areas in our state. If you are interested in methadone, check the Washington State Opioid Treatment Program Guide to find out if there are programs near you.