Boulder Care

QuickStart transition instructions

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QuickStart is one way to start buprenorphine. You use Narcan (naloxone) to bring on withdrawal on purpose, then right away take a high dose of buprenorphine-naloxone (the medicine in Suboxone) to quickly stop it. We recommend having an adult you trust with you while you do it.

  • Pros: It's the fastest way to start. You don't have to wait around in withdrawal first, and the whole process takes less than an hour.
  • Cons: The withdrawal is short but intense, usually 30 to 60 minutes, and it isn't safe for everyone.

Don't use QuickStart if you:

  • Are pregnant
  • Have heart disease, like a past heart attack
  • Are experiencing active psychosis

Before you start

Read through every step, and talk it through with your support person before you begin. If anything is unclear or worries you, ask your care team.

Make a plan for when and where you'll do QuickStart, and what you'll do if it takes longer or feels harder than expected. Having a plan can make you feel more comfortable and helps the process go more smoothly.

What you'll need

  • At least 24 mg of buprenorphine-naloxone. Getting a full 24 mg dose is very important. Keep a few extra films or tablets close by in case you can't dissolve the full dose. Don't worry if you need to take extra because the first ones didn't fully absorb. We'll make sure you have what you need afterward.
  • One 4 mg dose of Narcan nasal spray. If you're using injectable naloxone instead, confirm the dose with your clinician. Don't use more than this, since it can make your withdrawal worse.
  • Any premedications your clinician prescribed. These help with symptoms like anxiety, restlessness, muscle discomfort, nausea, or vomiting. Take them as your clinician recommended.
  • A glass or bottle of water to take the premedications.
  • A timer, like the one on your phone, to tell you when an hour has passed after the premedications.
  • A bathroom nearby. Most people have some nausea, vomiting, or diarrhea, and your symptoms will usually be the ones you normally get in withdrawal.

Step by step

  1. Exactly one hour before you plan to use Narcan, take your premedications.
  2. From this point on, don't use any other opioids. They might ease withdrawal for a moment, but they make the transition longer and raise the chance of precipitated withdrawal (sudden, intense withdrawal).
  3. Set your timer and wait one full hour. Read through the next steps while you wait so you're ready.
  4. Take a sip of water to moisten your mouth. This helps your body absorb the buprenorphine.
  5. Use the full 4 mg dose of Narcan.
  6. Then, right away, put the full 24 mg of buprenorphine-naloxone under your tongue and let it dissolve. Try not to swallow.

Dissolving the full 24 mg is critical. If you throw up before the films dissolve or lose any of the medication another way, take more until you've fully dissolved 3 films or tablets. There's no risk in taking too much buprenorphine-naloxone at this point, especially if the first ones didn't absorb. People safely take 32 or 40 mg during this process. If you don't get enough, your withdrawal will be more intense.

What withdrawal will feel like

For most people, withdrawal gets very intense and is at its worst about 30 minutes after using Narcan. Common symptoms include nausea, vomiting, diarrhea, sweating, shaking or shivering, anxiety or restlessness, and muscle twitches or spasms.

About 45 minutes after Narcan, symptoms usually start to ease and you'll likely feel very tired. It's safe and okay to go to sleep. Your withdrawal symptoms should be minimal when you wake up.

If it doesn't go smoothly

Most people have a short stretch of intense withdrawal, about 30 to 60 minutes. Some people stay in withdrawal for many hours. This isn't common, but it's good to be prepared.

  • If your symptoms haven't gotten any better after 2 hours, call Boulder at 888-316-0451. You can reach an on-call medical provider 24/7, even when Boulder is closed.
  • If you're very worried, or something feels clearly different from your usual withdrawal, you can go to a hospital.

Before you start, talk with your care team and your support person about who you'll call and what you'll do if your withdrawal doesn't improve within two hours. If this method doesn't work the way you need, we'll be ready to help you try another option.

Day 2 and after

The next day, you'll likely need 16 to 24 mg (2 to 3 tablets or films). Some people take it all at once, and others spread it out throughout the day. Follow up with your care team to find the right daily dose for you, especially if you're still having withdrawal symptoms.