The procedure for determining the proper dose of Suboxone is called induction. Before induction a medical evaluation of the patient is completed and the patient and doctor decide to transfer the patient’s dependence from their current opiate to Suboxone. The patient is instructed to take no opioids until they are in moderately severe withdrawal. Moderately severe withdrawal occurs when a patient is having moderately severe nausea, vomiting, diarrhea, or abdominal cramps in some patients. Others are having moderately severe restlessness, tremor, anxiety, or hot and cold chills. It’s better to wait a little longer than necessary rather than too soon to start Suboxone. If Suboxone is started too early and there is still a significant amount of opiates attached to the receptors in the brain, the Suboxone will knock off the more potent opiates and replace them with the weaker Suboxone. This will result in a worsening of withdrawal and taking more Suboxone may not give relief. The patient may have to wait 8 to 24 hours until the Suboxone starts to help. It may take even longer if the patient tries to transfer from high dose opiate tolerance, i.e. more than 60 mg of methadone per day.
Induction begins when the patient is in moderately severe withdrawal. The patient takes a first dose of one half of a Suboxone 8 mg tablet and waits for two hours to see if the withdrawal goes away. If they are still in withdrawal after two hours they take a second dose of half of a 8 mg tablet. Then they wait for 4 more hours. If they’re still in withdrawal at this point, they take a third dose of a half tablet again. Now the daily dose regimen can be calculated. The patient adds up total amount Suboxone taken during this six hour induction trial. That amount is taken twice a day. If a half tablet got the patient out of withdrawal, they take a half tablet twice a day. If it took 2 half tablets, they take one tablet twice a day. And if it took three of the half tablets to get out of withdrawal, they take one and a half tablets twice each day.