The Bernese Method: Reducing Withdrawal Symptoms

Anyone who has been through detox for opioid use disorder (OUD) has had to stop using opioids for a period of time and likely experienced mild to moderate withdrawal symptoms and cravings before starting medication treatment.

Buprenorphine is one of the medications approved to treat OUD, both for detox and on-going treatment. Unfortunately, withdrawal symptoms can be very painful, and not all people can bear the physical discomfort between stopping opioid use and starting buprenorphine. This gap can be a barrier for buprenorphine treatment or result in a relapse.

However, there are approaches to treatment that can help your loved one wean off substances gradually. Developed in Switzerland, the Bernese Method^[1] allows your loved one to continue using their opioid of choice at first, while adding in small, increasing doses of buprenorphine at the same time. This gradual approach has led to promising results, as patients report the process to be more manageable and less overwhelming.

What is the Bernese Method?

People undergoing treatment through the Bernese Method can continue using heroin, fentanyl, pain pills, etc., while also taking a low dose of buprenorphine. The initial buprenorphine dose is calculated to reduce the risk of withdrawal symptoms.

Over the course of several days or weeks, the dose of buprenorphine slowly increases. This slow and steady approach allows the individual’s system to adapt to the presence of buprenorphine.

In addition to buprenorphine, they may be given other medications to help with sleep, depression, anxiety or other concerns. Support in the form of individual and group counseling may also be offered. This holistic approach addresses the psychological and social aspects of opioid use disorder.

As the dose of buprenorphine increases and your loved one’s reliance on their original opioid decreases, they can fully transition to buprenorphine. This means they stop using their opioid of choice and are stabilized on an optimal dose of buprenorphine. This is the dose that effectively manages cravings and withdrawal symptoms.

Can treatment happen at home?

In addition to being an easier way to start buprenorphine treatment for some people, the Bernese Method can be done on an outpatient basis or at home. With the help of a buprenorphine prescriber, your loved one may benefit from the following suggestions:

• Talk to the prescriber about the amount of buprenorphine to be taken each day. They may need to have scissors on hand to cut buprenorphine films into the proper doses, as well as a way to store the “microdoses.” Below is a sample schedule.^[2] However, this can vary in terms of the amount of buprenorphine taken and the length of time it takes to taper off of opioids. In this example, the patient takes .5mg of buprenorphine on the first day, and this gradually increases to 12mg by day 7. For some people, the optimal dose of buprenorphine can be as high as 24mg. The intent is to reach a dose where your loved one is comfortable and not having cravings. Note that they stop using all other opioids on day 7 but again, this can vary according to the schedule agreed to with the healthcare provider.

Day 1: 0.5 mg once a day

Day 2: 0.5 mg twice a day

Day 3: 1 mg twice a day

Day 4: 2 mg twice a day

Day 5: 3 mg twice a day

Day 6: 4 mg twice a day

Day 7: 12 mg (stop other opioids while continuing buprenorphine daily)

Other tips

• Encourage your loved one to plan for work coverage or vacation days, childcare and other responsibilities for the length of the treatment schedule. It also helps to have a plan for the day that your loved one has to stop using all other opioids. They may need extra support that day as it’s not uncommon to feel anxious about stopping.
• Keep other medications on hand for side effects may help, including:
  • Tylenol or Advil for headache
  • Imodium for diarrhea
  • Dramamine, ginger or mint for nausea
  • Benadryl for anxiety
    It’s important to note that some people still feel some mild withdrawal symptoms.
• Have a trusted friend or family member in your loved one’s life who knows what their plan and goals are can also be helpful to stay the course.
• Always remember safety first. Keep naloxone (e.g., Narcan) on hand to reverse an overdose. Encourage your loved to never use substances alone, and consider downloading the Brave or Canary apps or using the Never Use Alone service.
• Have your loved one ask their healthcare provider about how best to contact them throughout treatment should they have any questions or concerns.

Before starting the Bernese Method, your loved one must complete a thorough assessment of their medical history, substance use and overall health. This helps healthcare providers tailor the treatment plan to their specific needs.

If your loved one is interested in this approach, they can talk to their healthcare provider to put together a plan. Any healthcare professional with a DEA license can prescribe buprenorphine. Harm reduction organizations in your area may be able to give you referrals as well. You can find more information about harm reduction and medications to treat opioid use disorder on our website.