Buprenorphine/naloxone (Suboxone) home dosing

Rapid 2-day home dosing plan

Your healthcare provider gave you a rapid 2-day buprenorphine/naloxone (Suboxone) treatment plan. This medicine is given to help treat an opioid use disorder. It’s important for you to take this medicine and follow the instructions carefully.

You’ve been given the number of doses of buprenorphine/naloxone that you need to take at home. You should have an appointment booked for day 3 with your healthcare provider. Together you’ll review your progress and make a plan for your ongoing treatment. Bring this handout to your follow-up appointment.

Watch this video to guide you through the home dosing process: https://youtu.be/dw7Ue21V618

What is buprenorphine/naloxone and how does it work?

Buprenorphine/naloxone (Suboxone) is a pill that has 2 medicines. The reason this medicine is given is to help you use other opioids less, so you can be safer and healthier.

Buprenorphine is a type of opioid (like heroin or methadone), but it works differently than other types of opioids. Buprenorphine helps treat withdrawal and can get rid of cravings more safely than other medicines. Once you get the right dose of buprenorphine, it will prevent withdrawal symptoms and can help you stop taking other prescribed or purchased opioids.

Naloxone (Narcan) is added to buprenorphine to prevent people from injecting it. When the pill is dissolved under the tongue, the naloxone doesn’t do anything. If injected, the naloxone can cause bad withdrawal symptoms or prevent opioids from working.

How do I take buprenorphine/naloxone?

Take buprenorphine/naloxone by mouth and dissolve it under your tongue. This medicine may take 15 to 30 minutes to dissolve. It’s important to dissolve this medicine under your tongue as it won’t work if you swallow it. After you take the medicine, wait at least 30 minutes before you eat or drink.

When should I take buprenorphine/naloxone at home?

Take this medicine only when you’re in moderate to severe withdrawal. This is the point when you feel like you want to use opioids to prevent more withdrawal symptoms.

It’s important that you feel really sick before you take your first dose of buprenorphine/naloxone. If you take it before you feel really sick, it can make your symptoms much worse.

To find out if you are ready, rate how you feel right now for each of the symptoms below on a scale from 0 to 4.

0 = not at all

1 = a little

2 = moderately

3 = quite a bit

4 = extremely

Add your numbers together, and if your total score is 17 or higher, you should be ready to start the medicine. If your score is less than 17, you may need to wait longer to start. The longer you can wait before starting, the better you’ll feel afterwards.

2-day dosing

Each dose of buprenorphine/naloxone is 2 mg. Be sure to wait at least 1 hour in between doses. You should feel a little better or about the same after you take each dose.

Do not take your next dose if at any point in this process you feel worse, sleepy, sedated, or have a hard time focusing. If this happens, call your clinic or pharmacist. Your dose may be too strong.

Day 1

Dose 1

Take dose 1 (2 mg) and wait 1 hour. It will take 30 to 45 minutes for this medicine to start working.

Time of dose 1:__________

Dose 2

About 1 hour after dose 1, check to see how you feel. If you feel better, about the same, or not much worse, take dose 2 (2 mg).

Time of dose 2:__________

Dose 3

Wait 1 hour after dose 2. If you feel better, about the same, or not much worse, take dose 3 (2 mg).

Time of dose 3:__________

Dose 4

Wait 1 hour after dose 3. If you feel better, about the same, or not much worse, take dose 4 (2 mg).

Time of dose 4:__________

Dose 5

Wait 1 hour after dose 4. If you feel better, about the same, or not much worse, take dose 5 (2 mg).

Time of dose 5:__________

Dose 6

Wait 1 hour after dose 5. If you feel better, about the same, or not much worse, take dose 6 (2 mg).

Time of dose 6:__________

Dose 7

Wait 1 hour after dose 6. If you feel better, about the same, or not much worse, take dose 7 (2 mg).

Time of dose 7:__________

Dose 8

Wait 1 hour after dose 7. If you feel better, about the same, or not much worse, take dose 8 (2 mg). This is your last dose for the day. The most you can take on day 1 is 16 mg (8 pills).

Time of dose 8:__________

Day 2

If you had to stop before taking all doses on day 1, do not begin your day 2 doses and call your clinic or pharmacist for follow-up information.

If you took all doses on day 1 and didn’t feel worse, sleepy, or sedated, you can start your day 2 doses.

Dose 1

Dose 1 on day 2 will be 8 pills (16 mg). Take dose 1 (16 mg) and wait 1 hour. It will take 30 to 45 minutes for this medicine to start working.

Time of dose 1:__________

Dose 2

Dose 2 will be 1 pill (2 mg). About 1 hour after dose 1, check to see how you feel. If you’re feeling OK, you do not need dose 2 and are done for the day. If you’re still having cravings or withdrawal, take dose 2 (2 mg).

Time of dose 2:__________

Dose 3

Dose 3 will be 1 pill (2 mg). About 1 hour after dose 2, check to see how you feel. If you’re feeling OK, you do not need dose 3 and are done for the day. If you’re still having cravings or withdrawal, take dose 3 (2 mg).

Time of dose 3:__________

Dose 4

Dose will be 1 pill (2 mg). About 1 hour after dose 3, check to see how you feel. If you’re feeling OK, you do not need dose 4 and are done for the day. If you’re still having cravings or withdrawal, take dose 4 (2 mg).

Time of dose 4:__________

Dose 5

Dose 5 will be 1 pill (2 mg). About 1 hour after dose 4, check to see how you feel. If you’re feeling OK, you do not need dose 5 and are done for the day. If you’re still having cravings or withdrawal, take dose 5 (2 mg).

Time of dose 5:__________

Dose 6

Dose 6 will be 1 pill (2 mg). About 1 hour after dose 5, check to see how you feel. If you’re feeling OK, you do not need dose 6 and are done for the day. If you’re still having cravings or withdrawal, take dose 6 (2 mg).

Time of dose 6:__________

Dose 7

Dose 7 will be 1 pill (2 mg). About 1 hour after dose 6, check to see how you feel. If you’re feeling OK, you do not need dose 7 and are done for the day. If you’re still having cravings or withdrawal, take dose 7 (2 mg).

Time of dose 7:__________

Dose 8

Dose 8 will be 1 pill (2 mg). About 1 hour after dose 7, check to see how you feel. If you’re feeling OK, you do not need dose 8 and are done for the day. If you’re still having cravings or withdrawal, take dose 8 (2 mg).

Time of dose 8:__________

Dose 9

Dose 9 will be 1 pill (2 mg). About 1 hour after dose 8, check to see how you feel. If you’re feeling OK, you do not need dose 9 and are done for the day. If you’re still having cravings or withdrawal, take dose 9 (2 mg). This is your last dose for the day. The most you can take on day 2 is 32 mg (16 pills).

Time of dose 9:__________

What else do I need to know?

When you start taking buprenorphine/naloxone, it usually takes 2 days to get the right dose of this medicine into your body. Until then, you may have some cravings or withdrawal symptoms.

It is important that you see your healthcare provider on day 3 to review your progress and make a plan for your ongoing treatment. Bring this handout to your follow-up appointment

While you’re taking buprenorphine/naloxone:

• Don’t use another type of opioid (“dope” or “down”) such as heroin, fentanyl, morphine, hydromorphone, methadone, Percocet, or Dilaudid. This can increase the risk for opioid poisoning. If you choose to use other opioids, use as little as possible to lower the risk of poisoning.
• Don’t take it with other medicines that make you sleepy or relaxed such as benzodiazepines (“benzos”), alcohol, sedatives, or sleep aids.
• Be careful doing any activity where you need to be alert.
• Stop taking it if it makes you feel worse, sleepy, or you have a hard time focusing.

If you have side effects that you’re worried about after you leave the Emergency Department, call Health Link at 811, go back to the Emergency Department, or call 911 for help.

To see this information online and learn more, visit MyHealth.Alberta.ca/health/pages/conditions.aspx?Hwid=custom.ab_suboxone_homedosingrapid2day_ac_adult.

For 24/7 nurse advice and general health information call Health Link at 811.

Current as of: July 5, 2021

Author: Addiction and Mental Health, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.