≥12-hour-wait approach · For MyStreetHealth patients prescribed this specific plan
Adapted from the patient induction guides of NYU School of Medicine (Joshua Lee, MD) and the IT MATTTRs program (PCSS-MAT)
This handout is for patients prescribed this specific MyStreetHealth induction plan. Do not start, change timing, skip doses, double doses, or add doses unless your provider has instructed you to do so.
This is one of several buprenorphine induction approaches. It is sometimes used for patients transitioning from heroin, prescription opioids, or methadone — and sometimes for kratom or 7-OH dependence (which act on the same opioid receptors). It is generally not the first choice for fentanyl users (who usually need a microinduction approach). Your provider chooses the protocol that fits you — see the induction approaches overview.
Call 911 for trouble breathing, chest pain, confusion, fainting, repeated vomiting, severe dehydration, suicidal thoughts, or inability to stay awake.
Buprenorphine pushes other opioids off your receptors. If you take it before the previous drug has cleared, you can get sudden, severe withdrawal ("precipitated withdrawal"). Wait at least the time below since your last use — your provider may tell you to wait longer.
| Drug you've been using | Fits this protocol? | Minimum wait | Notes |
|---|---|---|---|
| Hydrocodone (Vicodin), oxycodone IR (Percocet) | ✓ Yes | 12–24 hours | Short-acting. Provider may want you closer to 24. Assumes pills are real, not counterfeit. |
| Heroin | ⚠ With caution | 12–24 hours | In the current US drug supply, "heroin" is almost always fentanyl-contaminated or fentanyl sold as heroin. The 12–24 hour wait only applies if your substance is actually heroin — if it may have contained fentanyl, talk to your provider; you may need a microinduction approach instead. |
| Long-acting Rx opioids (Oxycontin, MS Contin, ER morphine) | ⚠ With caution | ~36 hours | Wait time only reliable if pills came from a licensed pharmacy. See warning below. |
| Methadone | ✓ Yes | ≥48 hours | Long half-life. Some clinicians wait longer. |
| Kratom (leaf) | ⚠ With caution | ~24 hours | Mitragynine has a ~24-hour half-life — but potency varies between brands and batches. |
| Concentrated 7-OH | ⚠ With caution | ~12 hours | Short-acting alkaloid — but content varies widely between products. |
| Fentanyl | ✗ No — use microinduction | N/A | Fentanyl accumulates in body tissue, so this protocol can cause precipitated withdrawal even after long waits. Talk to your provider about a microinduction approach. |
If any of these apply, talk to your provider — the standard protocol may not be the right fit, and a microinduction approach may be safer.
The SOWS (Subjective Opioid Withdrawal Scale, Handelsman 1987) is a 16-item self-check. Score each item 0–4, then add up the total. A total of 17 or higher means you are ready to take your first dose. Below 17 → wait another hour and re-score.
Place the medication under your tongue or in the side of your cheek. Let it dissolve fully — usually 5 to 15 minutes. Do not chew, swallow, or talk while it dissolves.
4 mg can be two 2 mg films or tablets, or half of an 8 mg film or tablet — take whichever form your prescriber gave you.
Once it's fully dissolved, set a timer for 1 hour from when you took the dose.
Do nothing demanding. Sit or lie down. Sip water. Eat lightly if you can — toast, crackers, broth. The medication is doing its work; you don't need to do anything else.
Your support person, if you have one, can sit with you. Don't drive, don't make decisions, don't try to work. Just rest.
Make sure your timer or alarm is set so you don't lose track of the hour.
Compare how you feel now to how you felt just before you took the dose. There are three possible answers:
Note your answer (A, B, or C) and continue to Step 6.
Did you answer A (better) or C (worse) in Step 5? Then this step is not for you. Do NOT take a second dose. Go back to Step 6 and follow the instruction for your answer.
If your Step 5 answer was B, take another 4 mg the same way as Step 3 — under the tongue or in the cheek, let it dissolve fully. Your running total is now 8 mg.
Once it's fully dissolved, set another timer for 1 hour from when you took the dose.
Do nothing demanding. Sit or lie down. Sip water. Eat lightly if you can — toast, crackers, broth. The medication is doing its work; you don't need to do anything else.
Your support person, if you have one, can sit with you. Don't drive, don't make decisions, don't try to work. Just rest.
Make sure your timer or alarm is set so you don't lose track of the hour.
Compare to how you felt just before you took this second dose. Three possible answers:
Note your answer (A, B, or C) and continue to Step 10.
Did you answer B or C in Step 9? Then this step is not for you. Go back to Step 10 and follow the instruction for your answer.
This long rest period lets the second dose take full effect. You don't need to watch the clock — eat, sleep, rest. Just notice how you're feeling over the next several hours.
Take the dose your prescriber specified (commonly 2 or 4 mg), the same way as before. Your running total is now in the 10–12 mg range.
If you've already taken everything your prescriber told you to take and still feel bad, contact your provider. Do not add doses on your own.
The next dose depends on how the first day went. Your provider tells you the dose and the time. Common patterns:
Do not adjust your dose on your own.
Most patients have settled into a single daily dose by ~48 hours after starting. Take it once a day at the same time, or split it across the day if your prescriber instructed. Your prescribed dose is individualized — tell your provider how you're feeling at follow-up (cravings, sleep, mood, withdrawal) so they can fine-tune.