mystreethealth.com | Telehealth Buprenorphine Care
Book online
Sample Patient Guide
mystreethealth.com | Telehealth Buprenorphine Care
For patients prescribed this exact plan by a MyStreetHealth clinician or another treating clinician · Follow the version given to you personally.
Adapted from patient buprenorphine induction guides, including NYU School of Medicine materials associated with Joshua Lee, MD, and the IT MATTTRs program/PCSS-MAT collaboration. Attribution does not imply endorsement of this specific handout or schedule.
This handout is for patients who were personally prescribed this exact wait-and-watch induction plan by a clinician who reviewed their case. Viewing this page online, receiving it from another person, or finding it through search does not mean you should start buprenorphine.
Do not start, change timing, skip doses, double doses, add doses, or substitute a different medication, strength, film, tablet, or schedule unless your prescribing clinician specifically instructed you to do so. Your personalized plan always overrides this sample handout.
This is one of several buprenorphine induction approaches. A wait-and-watch approach may be used for selected patients transitioning from short-acting opioids, certain prescription opioids, kratom, or concentrated 7-OH products. Methadone, long-acting opioids, fentanyl exposure, and concentrated 7-OH products may require a different or more cautious plan.
For kratom or 7-OH dependence, some patients use a wait-and-watch approach, while others use microinduction. The right approach depends on the product, dose, timing, prior opioid exposure, withdrawal symptoms, other substances, and clinical judgment. This handout is not a universal buprenorphine start. Do not combine instructions from different induction plans unless your clinician specifically tells you to. See the induction approaches overview.
Call 911 or go to the emergency room for trouble breathing, chest pain, confusion, fainting, repeated vomiting, severe dehydration, suicidal thoughts, severe sedation, or inability to stay awake.
Do not take your first buprenorphine dose just because 12 hours have passed. You also need to be in enough withdrawal.
Buprenorphine attaches very tightly to the same brain receptors affected by opioids, kratom, and 7-OH. If you start too soon, while those substances are still strongly affecting your body, buprenorphine can make withdrawal suddenly worse. This is called precipitated withdrawal.
Wait at least the amount of time your clinician told you to wait. Then check your withdrawal score in Step 2. Do not start until both are true: enough time has passed, and your withdrawal score meets the instruction below.
| 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 many U.S. regions, substances sold as heroin frequently contain fentanyl or are replaced by fentanyl. Unless the substance is lab-confirmed, assume fentanyl exposure is possible. The 12–24 hour wait applies only if your substance is actually heroin — if fentanyl exposure may have occurred, 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 may mean you are ready for your first dose, but only if you also waited the amount of time your clinician told you to wait. If your score is below 17, wait another hour and re-score.
Place the medication exactly as your clinician or pharmacy label instructed. Tablets are usually placed under the tongue. Films are usually placed under the tongue during induction unless your clinician specifically instructed cheek placement for your product. Let it dissolve fully, usually 5 to 15 minutes. Do not chew or swallow it. Try not to talk while it dissolves.
Your first dose may be 2 mg or 4 mg of buprenorphine, depending on the plan your clinician prescribed. Your pharmacy label may show buprenorphine/naloxone as 2 mg/0.5 mg, 4 mg/1 mg, or 8 mg/2 mg because the label also lists naloxone.
Take only the dose and form your clinician prescribed.
Do not split tablets. Do not split films unless your clinician specifically instructed you to do so.
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. Rest while the medication takes effect. Keep track of how you feel so you can answer the next step accurately.
Your support person, if you have one, can sit with you. Do not drive, work, operate machinery, make important decisions, or do anything safety-sensitive. Rest and stay somewhere safe.
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.
Take another 2 mg or 4 mg, whichever your clinician's plan specifies. Let it dissolve fully. Your running total after two doses depends on your plan and may be 4 mg (2 + 2), 6 mg (2 + 4), or 8 mg (4 + 4).
Before taking this dose, stop and contact your clinician if you have become sharply worse, very sleepy, confused, faint, short of breath, or unable to stay awake.
Once it is 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. Rest while the medication takes effect. Keep track of how you feel so you can answer the next step accurately.
Your support person, if you have one, can sit with you. Do not drive, work, operate machinery, make important decisions, or do anything safety-sensitive. Rest and stay somewhere safe.
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 rest period gives the second dose time to take effect. You do not need to take more medication just because a certain time has passed. Eat lightly, sleep, and rest if you can. Keep track of whether withdrawal returns, whether you feel over-sedated, or whether anything feels unsafe.
Take only the exact dose your clinician specified, commonly 2 mg or 4 mg, the same way as before. Your running total after this third dose depends on what you took earlier — typically anywhere from 6 mg up to about 12 mg over the day. Do not choose 2 mg versus 4 mg yourself unless your plan clearly tells you how to decide.
After this dose, do not take any more medication on Day 1 unless your clinician tells you to. Rest, do not drive, and continue to Step 13 on Day 2.
If you've already taken everything your clinician told you to take and still feel bad, contact your prescribing clinician. Do not add doses on your own.
The next dose depends on how the first day went. Your prescribing clinician will tell you the dose and timing. Common patterns may include:
Do not adjust your dose on your own.
Many patients begin to settle into an ongoing dose within the first several days, but some need dose or timing adjustments. Take it once daily or split it across the day only if your clinician instructed you to do so. Your prescribed dose is individualized. Tell your clinician how you are feeling at follow-up, including cravings, sleep, mood, withdrawal symptoms, side effects, and any return to opioid, kratom, or 7-OH use.
Medical sources