Starting buprenorphine is a strong step toward recovery from opioid use disorder, and a good first day mostly comes down to timing. Buprenorphine is the medicine in Suboxone and other brands. Here is what induction day is like, why your provider asks so many questions about when you last used, and what the first days look like.
What "induction" means
Induction is the medical word for starting buprenorphine. Buprenorphine is a partial opioid agonist. That means it acts on the same parts of the brain as other opioids, but at low to moderate doses its effects are weaker. SAMHSA, the federal Substance Abuse and Mental Health Services Administration, says it can ease withdrawal symptoms and cravings and lower the potential for misuse. Suboxone combines buprenorphine with naloxone. SAMHSA says naloxone is added to make misuse of the medicine less likely.
Why timing matters
The FDA label for Suboxone sublingual film says the first dose should be given when objective signs of moderate opioid withdrawal appear, and not less than 6 hours after the patient last used opioids. "Objective signs" are signs your provider can see or check, not only how you feel inside.
Why wait? Because buprenorphine is a partial agonist, the label warns that it may bring on withdrawal if it is taken before the effects of another opioid have worn off. This is called precipitated withdrawal: withdrawal set off by the new medicine instead of by stopping. The 6 hours is a minimum, not a goal. Your provider sets the timing for you, based on what you used, how much and when.
If you take methadone or another long-acting opioid, the label says you may be more likely to have precipitated and longer-lasting withdrawal when starting. For these patients it recommends starting with buprenorphine alone, without naloxone. Make any switch with your provider, never on your own. For opioid use disorder, methadone is taken daily. Hope Integrative Medicine does not prescribe methadone and is not a methadone clinic.
Why fentanyl can change the plan
Fentanyl has made timing questions more common. A 2024 study at three Philadelphia hospitals looked at patients who used fentanyl and then started buprenorphine. The researchers note that with regular use, fentanyl can build up in muscle and fat, and they are still studying whether that buildup raises the risk of precipitated withdrawal. This is why your provider asks exactly what you used and when, and why the plan may look different if fentanyl is part of the picture.
What happens on induction day
Expect honest, detailed questions. Your provider will ask about every substance you have used, including alcohol and sedatives, and the time of your last use of each. A point-of-care urine drug or fentanyl test, done in the office, can add to the picture. Your provider checks your withdrawal signs before the first dose.
The first dose dissolves under the tongue. The label recommends this under-the-tongue (sublingual) route during induction to keep naloxone exposure low and reduce the risk of precipitated withdrawal. The label describes starting with a small dose and adding more in steps on day 1, then a single daily dose on day 2. Your provider decides the amounts. Tell your provider right away if you feel worse after a dose.
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The first days and follow-up
The first days are about finding a dose that controls cravings and withdrawal. The label says that from day 3 on, the dose is adjusted up or down in small steps to keep you in treatment and suppress withdrawal. Plan on follow-up visits while your dose is being set, and be open about how you feel.
A few safety basics from SAMHSA: while taking buprenorphine, do not use illegal drugs, drink alcohol, or take sedatives, tranquilizers or other drugs that slow breathing. Store it out of reach of children and pets. The FDA label also asks patients and caregivers to learn about overdose reversal medicines such as naloxone. SAMHSA says the length of time on buprenorphine is tailored to each patient, and that medicines for opioid use disorder can be used long term.
A question to bring to your next visit
"Based on what I use and when I last used it, when should I take my first dose, and what should I do if I feel worse after it?"
In an emergency, including a possible overdose, call 911. If you or someone you know is struggling, call or text 988 to reach the 988 Suicide & Crisis Lifeline, which is also there for alcohol or drug use concerns.
Starting buprenorphine at Hope Integrative Medicine
Our addiction medicine providers prescribe buprenorphine (Suboxone, Subutex, Sublocade, Brixadi) and naltrexone, including Vivitrol, for opioid use disorder, with counseling and regular follow-up. Hope provides hybrid in-person and virtual MAT care, with local labs for urine drug screens and periodic vitals checks close to home. Treatment typically begins with an in-person assessment in West Ashley, where point-of-care urine drug and fentanyl tests are available, followed by weekly in-person or virtual visits before moving to a monthly schedule. Each plan is tailored to the patient and their situation. This hybrid model helps us reach patients in rural South Carolina where access to care is limited. New patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
Sources: Thakrar AP, et al. Buprenorphine-Precipitated Withdrawal Among Hospitalized Patients Using Fentanyl. JAMA Network Open (2024); SUBOXONE sublingual film prescribing information, FDA label via DailyMed (revised December 2025); SAMHSA, Buprenorphine (updated April 6, 2026); SAMHSA, Treatment Options for Substance Use Disorder (updated August 25, 2025); 988 Suicide & Crisis Lifeline.
This article is general information, not medical advice, and does not create a patient–provider relationship. Every situation is different, so see a provider who can evaluate yours and develop a plan of care. Any medication discussed here may not be right for you: the right choice depends on your diagnoses, other health conditions and current medicines, so take medication only as directed by the provider managing your care. If you are ever in doubt about an emergency, call 911 or go to the nearest emergency room.
Frequently Asked Questions
The FDA label says the first dose should be given when objective signs of moderate opioid withdrawal appear, and not less than 6 hours after you last used opioids. Your provider sets the exact timing for you.
It is withdrawal brought on by buprenorphine itself. The FDA label warns it can happen if buprenorphine is taken before the effects of another opioid have worn off.
It can. In a 2024 study, 11.5% of hospital patients who used fentanyl had precipitated withdrawal after starting buprenorphine, and researchers are studying whether fentanyl building up in the body plays a role. Tell your provider exactly what you used and when.
SAMHSA advises against drinking alcohol or taking sedatives, tranquilizers or other drugs that slow breathing while taking buprenorphine.
SAMHSA says the length of treatment is tailored to each patient and that these medicines can be used long term. Talk with your provider before making any change.