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SUBOXONE treatment can be broken down into 5 phases:
Intake
Induction
Stabilization
Maintenance
Medically Supervised Withdrawal
The following are general descriptions of each of these phases; the details of your treatment will depend on the procedures adopted by your doctor's office.
Intake
Before you begin treatment, the doctor or nurse will ask you questions about your medical health history, your mental health history, and your substance use history, including your current opioid use. There are no wrong answers to these questions—the goal is to be sure that your doctor has accurate information so she or he can create a treatment plan that meets your needs. All the information you give will be held strictly confidential (for more on this, see Patients' Right to Privacy).
During this visit, you and your doctor will go over the pros and cons of SUBOXONE treatment (if you haven't already). Your treatment expectations, as well as your doctor's expectations of you, will be discussed. You will most likely be asked to provide a urine sample so the doctor's office can confirm any use of opioids and possibly other drugs. You may also need to have blood drawn: blood analysis is important for detecting any health conditions (such as anemia or hepatitis) that might interfere with your SUBOXONE treatment if not addressed.
Induction
The goal of induction is to switch you from your current opioid (heroin, methadone or a prescription painkiller) on to SUBOXONE. You MUST arrive for your induction already experiencing mild-to-moderate opioid withdrawal symptoms. This point cannot be emphasized enough. If you take SUBOXONE before you are in withdrawal, the medication will make you feel worse because it can cause withdrawal symptoms (for more on this, see Why Do I Need to Be in Withdrawal?).
Your doctor or nurse will assess your withdrawal symptoms and give you your first SUBOXONE dose in the office. Patients can begin to feel some relief within 20 minutes, although the full effects take about an hour, at which point your symptoms will be reassessed. Your doctor may suggest that you pass the time in the waiting area or by taking a short walk and returning to the office at a specific time. Depending on the extent to which the first SUBOXONE dose suppressed your symptoms, your doctor may decide to give you a second dose.
When you are ready to leave the office after your first induction visit:
During induction, daily appointments are not uncommon. This allows your doctor to adjust for your withdrawal symptoms and cravings. Induction can last anywhere from 2 to 7 days. Urine drug screening at every visit is also fairly standard during induction. Patients whose SUBOXONE dose may be too low often use other drugs to try to suppress the withdrawal symptoms and cravings; doctors look for this when evaluating whether a patient is at the right dose.
Intake and induction may both occur at the first visit, depending on your needs and your doctor's procedures.
Stabilization
During stabilization, your SUBOXONE dose is "fine tuned" about once a week, as needed. The goal is to find a dose where your withdrawal symptoms and cravings are suppressed, and you experience minimal to no side effects. You and your doctor will discuss your treatment options going forward, specifically, maintenance versus medically supervised withdrawal.
Maintenance
Once your dose is stabilized, the maintenance phase of treatment begins. During maintenance, your treatment compliance and progress will continue to be monitored.
Participation in some form of behavioral counseling is strongly recommended to maximize the likelihood of your treatment success. You and your doctor will discuss counseling options that meet your needs.
Your doctor may request urine samples from time to time. Some doctors find urine testing a helpful part of treatment because by verifying the absence of opioids in your system they can evaluate the effectiveness of your SUBOXONE dose. Talk with your doctor if you have questions about the role of urine testing in treatment.
During your ongoing maintenance treatment, your doctor will want to know if you experience any cravings. If you do, your dose may need to be adjusted.
Appointments are usually scheduled on a weekly basis, however, if treatment progress is good and goals are met, monthly visits may eventually be considered sufficient. The maintenance phase can last anywhere from weeks to years—depending on what you, your doctor, and, possibly, your therapist or counselor determine is best for your individual needs.
Medically Supervised Withdrawal
Length of therapy is up to your doctor, you, and sometimes your therapist or counselor. In this phase of medically supervised withdrawal, your doctor will slowly taper your SUBOXONE dose, taking care to see that you experience minimal withdrawal symptoms or cravings. Your dose can always be changed if you experience uncomfortable symptoms or cravings at the reduced dose.
