QuickStart Summary

This method involves putting yourself into withdrawal using naloxone (Narcan) and then immediately taking a high dose of buprenorphine-naloxone to quickly stop the withdrawal. It is a short process, but often intense.

We recommend having a trusted, adult support person with you during this process.

If you have any of the following medical conditions, you should not use QuickStart:

1. Pregnancy
2. Heart disease (such as a past heart attack)
3. Active psychosis

Before you start

Review the entire process

We want you to clearly understand the steps. Please read through the entire process, and talk through it with your support person before you start this treatment. Let your Care Team know if you have any questions or concerns.

Make a plan

Choose when and where you will do QuickStart. Make a plan for what you will do if you have a more difficult or longer experience than is expected. Having a plan can make you feel more comfortable and will make the process much smoother and likely more successful.

Gather supplies

Please gather the following supplies before you start.

24mg buprenorphine-naloxone: AT LEAST 24 mg. We recommend having easy access to a few extra films during the transition in case you are unable to dissolve the full 24 mg dose. It is very important to get a full 24 mg dose. Don't worry if you have to take a few extra strips/tablets because the first ones don't get as fully into your system. We will work to make sure you have the doses you need later on.

4mg Narcan: 4 mg nasal spray (one dose). If injecting intramuscular naloxone, confirm the appropriate dosage with your clinician. We DO NOT recommend using any more than this because it can make your withdrawal worse.

Premedication

• 0.2mg Clonidine: for anxiety and restlessness
• 600mg Gabapentin: for anxiety and muscle spasms
• 8mg Ondansetron: for nausea and vomiting

Water: a glass or bottle of water to help take the pre-medication

Timer: A timer—eg.on your phone—set to 1 hour after the premedication to notify you it is time to use the Narcan

Bathroom: Plan to be in or near a bathroom during your withdrawal symptoms. Most people experience some nausea, vomiting, or diarrhea so this is important. We have generally found that your usual withdrawal symptoms will be the ones you also experience with QuickStart.

Transition Process

Take the premedications Exactly one hour before you’re ready to use the Narcan to start the process, take the premedications:

• 0.2mg Clonidine: for anxiety and restlessness
• 600mg Gabapentin: for anxiety and muscle spasms
• 8mg Ondansetron: for nausea and vomiting

Do not use any other opioids (such as fentanyl) after this point Even though this can relieve withdrawal in the short term it also makes the transition to treatment longer with more chance of precipitated withdrawal.

Set your timer to 1 hour and wait one full hour

Wait one full hour after taking the medications to use the Narcan.

Please review the next steps while you’re waiting to ensure you get them right.

Moisten your mouth with water to allow better absorption of the buprenorphine when you take it

Administer 4m Narcan (one full dose)

>>>THEN IMMEDIATELY<<<

Take the full 24 mg buprenorphine-naloxone under your tongue

It is CRITICAL to dissolve the full 24mg of buprenorphine-naloxone under your tongue.

Avoid swallowing.

If you vomit before the films dissolve or otherwise lose any of the buprenorphine-naloxone, take more films/tablets until you have fully dissolved 3 films/tablets.

There is no risk in taking too much buprenorphine-naloxone at this point, especially if the first strips are not absorbed.

People safely use 32 or 40 mg during this process.

If you don’t get enough, the withdrawals will be more intense.

Withdrawal & Symptoms

For most people withdrawal will get very intense and be worst about 30 minutes after Narcan.

Occasionally people will experience withdrawal for many hours.

If your withdrawal symptoms have not gotten any better after 2 hours, call Boulder support at 866-901-4860.

Even when Boulder is closed you will be able to speak to an on-call medical provider.

If you are very worried or if you experience something clearly different from your typical withdrawal symptoms you can go to a hospital.

Symptoms of withdrawal usually include nausea, vomiting, diarrhea, sweating, shaking/shivering, anxiety/restlessness, and muscle twitches/spasms.

About 45 minutes after Narcan we expect your withdrawal symptoms to get less intense and for you to feel very tired.

If you feel tired it is safe and OK to go to sleep!

Your withdrawal symptoms should be minimal after you wake up.

Day 2 and onwards

The next day you will likely need 16 to 24 mg (2-3 tablets or films). Sometimes people like to take them all at once and others like to space them out throughout the day.

Follow up with your care team to find the best daily dose for you, especially if you continue to experience any withdrawal symptoms!

What to do if your Quick Start process does not go smoothly

Most people using Quick Start have a shorter time period of intense withdrawal (30-60 min). However, some people have a different reaction to the process and may find themselves in withdrawal for many hours. This is not a common reaction but it is something to be aware of.

Make sure you have talked with your Care Team about what to do if you have an unexpected and extended period of withdrawal or other symptoms that concern you. Talk with your support person about who to call and what your plans are if your withdrawal does not improve within two hours. Remember that you can call Boulder 24/7 at 866-901-4860 and we will connect you to a medical provider. If you are very worried you can go to a hospital. If this method doesn’t work the way you need we will be ready to help with another option.

Questions, concerns, or feedback?

You can send a message to your Care Team in the app with non-urgent questions or feedback, or you can always call Boulder's 24/7 Support at 888-316-0451.