Before prescribing medication, your provider will perform a series of clinical assessments and lab tests to diagnose your substance use disorder. Based on your test results and history of withdrawal symptoms, your provider will recommend the most appropriate treatment plan. For severe cases, medically-supervised detox may be recommended.
After the initiation phase is over, our patients typically feel much better physically and are eager to start getting their life back on track. During this phase you will stabilize on to a regular daily dose of buprenorphine and other medication as prescribed, meet your provider once every 1-2 weeks, and take advantage of counseling and community resources.
As you manage your withdrawal at home using dosing instructions for either conventional initiation, micro-initiation (low dose), or macro-initiation (high dose), you will have daily check-ins with a registered nurse and frequent provider visits at an outpatient clinic near you. If possible, arrange for a responsible adult to be with you at all times during initiation.
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To prevent precipitated withdrawal using conventional initiation, patients must wait 36 hours after last using fentanyl before taking their first full dose of buprenorphine. If the patient cannot abstain from fentanyl for 36 hours, micro-initiation (where the dose of buprenorphine is gradually increased over several days) or macro-initiaton (where a high dose of buprenorphine is taken on day 1 before dropping to a conventional dose) may be safer and more effective.
Precipitated withdrawal is common when fentanyl users take a full dose of buprenorphine too soon after their last use of fentanyl. Buprenorphine binds tightly to the opioid receptors in the brain, kicking other opioids off. The sudden replacement of a highly potent opioid like fentanyl with a "mild" opioid like buprenorphine leads to intense and severe withdrawal symptoms like vomiting, fever, muscle aches and diarrhea.
Precipitated withdrawal is common when fentanyl users take a full dose of buprenorphine too soon after their last use of fentanyl. Buprenorphine binds tightly to the opioid receptors in the brain, kicking other opioids off. The sudden replacement of a highly potent opioid like fentanyl with a "mild" opioid like buprenorphine leads to intense and severe withdrawal symptoms like vomiting, fever, muscle aches, and diarrhea.
Maintenance is the final phase of treatment where our patients are very stable and making consistent progress in their lives. Relationships are rebuilt and financial freedom starts to return. You will continue on your medication with monthly appointments and occasional lab tests to ensure your safety and monitor progress.
Medicaid Accepted
No Waitlists
Outpatient Clinic
No Penalties
Step 1: Assessment
Step 2: Initiation
Step 3: Stabilization
Step 4: Maintenance
During your first appointment, your provider will assess your substance use with lab testing, history of withdrawal symptoms, and your confidence in being able to abstain from fentanyl for the required length of time. Based on this and other information, your provider will recommend an initiation protocol that will help you transition from fentanyl to buprenorphine safely and with the least amount of discomfort possible.