The Bernese method (also called micro-induction) is a way of starting Suboxone that doesn’t require waiting in withdrawal. Instead of stopping your 7-OH (or product containing MGM-15, or pseudo) and holding through escalating symptoms before your first dose, you take tiny pieces of a Suboxone strip while continuing your normal dose, and step the buprenorphine up over 7 days. The 7-OH product gets dropped only once enough buprenorphine (the active ingredient in Suboxone) has built up to bridge through.
A note on terms used below: sublingual means under the tongue (how Suboxone strips dissolve), buprenorphine is the active drug in a Suboxone strip, and the community shorthand for it is bup.
When it helps
Micro-induction is the alternative when the standard “wait for withdrawal symptoms to climb before your first dose” approach has a higher failure rate or isn’t tolerable. The strongest fits:
- You’ve been on long-acting kratom synthetics (MGM-15 at community-reported 9–15 hour duration, pseudo, or MIT-A/DHM). The wait stretches to 36–72+ hours and the standard approach has a documented higher failure rate.
- You’ve tried standard induction and gotten precipitated withdrawal. Even with the right timing, the receptor switch-over can be too sharp.
- You’re on a stacked product where you don’t know which compound (or combination) you’re coming off.
- You can’t tolerate the wait. Life, work, prior trauma around active withdrawal, severe baseline symptoms.
For most 7-OH-alone users (short half-life, clears fast), the standard induction is faster, has decades of evidence behind it, and works. Micro-induction is for the specific cases above. The standard approach is covered on Suboxone (Buprenorphine/Naloxone), with the timing tool on COWS & SOWS Guide. SR-17 is another option entirely if Suboxone isn’t right for you.
How to do it
Two community-used schedules, both built on the BC 7-day shape (Suen et al. 2024). All doses go under the tongue. You stay on your normal 7-OH (or MGM-15 / MIT-A / pseudo) dose for the first 6 days while building the buprenorphine up alongside. On day 7 you stop the synthetic and shift to a regular daily Suboxone dose.
The difference is where you land on day 7. The lower target (4 mg/day) reflects the community’s experience that 2 mg twice daily is often plenty for 7-OH dependence and lines up with the site’s low-and-slow dosing rationale. The higher target (8 mg/day) matches the published BC 7-day schedule and is what most prescribers will reach for by default. Either can be adjusted on day 7+ if symptoms aren’t covered.
| Day | Lower target (4 mg/day) | Higher target (8 mg/day) |
|---|---|---|
| 1 | 0.5 mg once | 0.5 mg once |
| 2 | 0.5 mg twice daily | 0.5 mg twice daily |
| 3 | 0.5 mg twice daily | 1 mg twice daily |
| 4 | 1 mg twice daily | 2 mg twice daily |
| 5 | 1.5 mg twice daily | 3 mg twice daily |
| 6 | 2 mg twice daily | 4 mg twice daily |
| 7+ | 2 mg twice daily, or more if symptoms require it; then regular daily dosing | 4 mg twice daily, or more if symptoms require it; then regular daily dosing |
Each dose is a small fraction of a standard 2 mg or 8 mg Suboxone strip, cut by hand. No special script or compounded preparation is needed. See Custom Suboxone Dosing for the strip-cut math (which fraction of which strip hits which dose).
Other variants
The BC 7-day above is the most commonly used schedule. These are alternatives a prescriber may suggest in specific situations:
- 4-day accelerated: 0.5 mg four times daily rising to 8 mg three times daily by day 4. Faster, higher dropout in outpatient data.
- Transdermal start: a Butrans 20 mcg/hr buprenorphine patch for the first ~7 days, then a transition to strips under the tongue. Useful if cutting and dosing small strip pieces several times a day isn’t workable (Menard & Jhawar 2022, n=7; 5 of 7 succeeded).
- 8-hour rapid home variant: 1 mg of buprenorphine/naloxone (an eighth of a 2 mg strip) hourly for 8 hours after a ≥24-hour wait, then a standard 8 mg twice-daily dose (Alexander & Woford 2025, n=9; 7 of 9 succeeded). Closer to standard induction with smaller increments.
The original Hammig schedule (29-day, historical)
The method was first published as a two-case report by Hammig et al. in Subst Abuse Rehabil 2016 (full text at Dove Press). The Bern team had been using it clinically since around 2010 for methadone-to-buprenorphine transitions, which were notoriously hard with standard induction.
| Day | Buprenorphine dose | 7-OH / synthetic dose |
|---|---|---|
| 1 | 0.2 mg under the tongue, once | Continued unchanged |
| 2 | 0.4 mg twice daily | Continued unchanged |
| 3–7 | +0.4 mg/day each day, reaching ~3.4 mg | Continued unchanged |
| 8+ | Step up by 20–30% per day | Begin taper |
| ~Day 29 | 24 mg/day buprenorphine | Discontinued |
Modern variants compress the 29-day schedule substantially; the BC 7-day above is the most commonly cited modern version.
How this compares to standard induction
| Standard induction | Bernese (micro-induction) | |
|---|---|---|
| Wait in withdrawal? | Yes, until COWS ≥ 12 (or SOWS ≥ 17) | No, you keep your 7-OH (or other synthetic) going |
| First buprenorphine dose | 2 mg under the tongue | 0.2–0.5 mg under the tongue (or a transdermal patch) |
| Time to full coverage | Hours, same day if induction succeeds | 5–10 days |
| Precipitated withdrawal risk | Real if timed early | Very low |
| Strongest fit | 7-OH alone, short-acting compounds | Long-acting synthetics, prior precipitated-withdrawal attempts |
| Evidence base | Decades, large trials | ~10 years, mostly case series; one registered trial |
| Hardest part | Tolerating the wait | Keeping your 7-OH product going while the buprenorphine ramps up |
Pharmacology of micro-induction
The standard “wait for COWS” approach exists because of one specific failure mode: when bup (high mu-receptor affinity, partial agonist) hits receptors that are heavily occupied by a full agonist, bup displaces the full agonist. Because bup’s intrinsic activation is lower than the full agonist’s was, the net opioid signaling drops sharply, that’s precipitated withdrawal. The standard fix is to wait until receptors are mostly cleared (COWS climbs as receptor occupancy drops), then introduce bup against an emptier receptor field.
Micro-induction works on the same pharmacology from the other direction. Receptor-occupancy imaging data summarized by De Aquino et al. (2021):
- 2 mg/day sublingual bup → ~41% mu-receptor occupancy
- 16 mg/day → ~80%
- 32 mg/day → ~84%
So a microinduction dose of 0.25–1 mg/day displaces only a small fraction of receptors at any given moment, staying below the displacement threshold that triggers withdrawal. Because bup has high affinity and slow dissociation, each tiny dose accumulates rather than washing out, gradually building up receptor occupancy while the full agonist continues to provide the dominant signal. Over days, the balance shifts. When bup occupancy is high enough, the full agonist can be tapered or stopped without a withdrawal cliff.
That’s the mechanism. It’s well-supported pharmacologically; what’s less well-tested is how often outpatients complete the protocol (see next section).
Clinical outcomes
Most published evidence is case series and small cohorts, not controlled trials. The 2020 systematic review (Ahmed et al.) covered 20 studies and 57 patients, 19 of those 20 were case series or case reports; 1 feasibility study; no controlled trials. All patients in the included studies reached their target dose, but the review explicitly noted “inconsistent reporting, selection bias, and poor quality evidence.”
Since then:
- A registered controlled trial (Wong et al. 2021, Vancouver General Hospital, n=50 inpatients, NCT04234191) compared rapid micro-induction vs. standard induction. Protocol registered; results have been slow to publish.
- Inpatient cohort (Button et al. 2022, n=72 attempts) showed 73.5% completion. 18% discontinued early, most commonly for inadequate pain control or preference for methadone.
- Outpatient cohort (Suen et al. 2024, n=175 attempts in the fentanyl era) showed 34% completion, 38% for the 4-day, 28% for the 7-day. 28-day buprenorphine retention was 21% (4-day) and 18% (7-day).
Inpatient completion is high; outpatient completion is much lower. That’s the gap that matters for most people in this community, because most micro-inductions for kratom-derivative dependence will be done at home, not in a hospital. The dropoff comes mostly from people abandoning the protocol partway through, inadequate symptom relief during the overlap, life getting in the way of the dosing schedule, or returning to the 7-OH product when it feels easier than continuing the slow ramp.
For the right person micro-induction works, but plan for the support structure that an inpatient setting would provide: a prescriber who’s reachable when symptoms get rough mid-overlap, a clear plan for helper medications to ease the rough patches, and a few people who know what you’re doing and can help you stay on the schedule. That’s the variable that drives completion.
The kratom-derivative evidence gap
There is essentially no published micro-induction-specific evidence for 7-OH, MGM-15, or any kratom-derived compound. The handful of buprenorphine-for-kratom case reports in the literature all used different approaches:
- Hendler et al. 2026 (7-HMG use disorder), methadone stabilization first, then standard transition. Not Bernese-style overlap.
- Kiyokawa et al. 2023 (home induction for kratom use disorder, n=2), standard COWS-gated home induction starting at 2/0.5 mg. Both patients abstinent at 2 years. Not micro-induction.
- A mitragynine pseudoindoxyl case in Psychoactives 2026, opposite end of the spectrum, macro-dose induction at 32 mg day 1.
If you’re considering the Bernese method for MGM-15, pseudo, or any of the other kratom synthetics, you’re extrapolating from the methadone and fentanyl literature. The pharmacologic rationale (a long-acting full agonist with receptor adaptation that benefits from a gradual ramp) is the same shape, and prescribers familiar with micro-induction will recognize that immediately. But there’s no published cohort that has tested this for the kratom synthetics specifically. Anyone telling you “this is the proven protocol for MGM-15” is overstating what the literature shows.
A handful of people in this community have used micro-induction successfully for 7-OH, MGM-15, and stacked synthetic products, generally with a prescriber who understood the rationale and was willing to adapt. The volume of community experience is small. If you’ve used it, the Discord and subreddit are the places to share what worked, community knowledge here is ahead of the published literature.
You usually don’t need prescriber buy-in on the protocol
The “sourcing small doses” framing common in older write-ups overstates the problem for our audience. A standard Suboxone prescription is 8 mg buprenorphine strips (with a small amount of naloxone). An 8 mg strip cuts into eighths for 1 mg per piece, or sixteenths for 0.5 mg, enough granularity for any of the schedules above. People in this community doing micro-induction generally do it with strips from a standard prescription, divided themselves.
What that changes: you’re not asking a prescriber to bless a custom schedule, you’re getting the same Suboxone prescription anyone starting MAT gets. The intake conversation, kratom or 7-OH dependence, ready to come off, want to start Suboxone, is the same regardless of how you plan to do day 1.
If you do want your prescriber engaged on the protocol
Some people want their prescriber to know the specific schedule, either as a backstop if something goes sideways, or because the intake conversation centers on the standard “wait for COWS” approach and you want to discuss something different. Most primary-care prescribers haven’t trained on micro-induction; telehealth prescribers vary. The conversation goes better if you bring:
- A specific reason. “I’ve been on a long-acting kratom synthetic with a community-reported 9–15 hour duration, and I’m concerned about a precipitated-withdrawal failure on standard induction” lands differently than “I read about this online.”
- A specific protocol you’re willing to discuss. Pointing at the BC 7-day schedule or the original Hammig 2016 paper gives them something concrete to engage with, rather than putting them in the position of designing a novel protocol on the fly.
- A reference to the guideline body that recognizes it. The ASAM 2020 National Practice Guideline focused update explicitly recognizes low-dose initiation (0.25–2 mg sublingual or 5–20 mcg/hr transdermal) as an option. The BC Centre on Substance Use has a patient resource specifically on this method. Knowing these exist helps if your prescriber’s first reaction is “I’ve never done that.”
- A willingness to be honest about what you’re using. Micro-induction requires you to keep taking your 7-OH (or other synthetic) during the overlap. If your prescriber needs to know what compound and what dose you’re continuing, telling them is part of the deal.
If your current prescriber isn’t comfortable with the protocol, the Telehealth Providers comparison flags which providers have specifically mentioned kratom or 7-OH experience.
When to skip micro-induction
- You’re on 7-OH alone at a moderate dose, with short use history. Standard COWS-gated induction is faster and well-evidenced for this case.
- You don’t have stable access to your 7-OH product for the overlap period. Micro-induction requires you to keep dosing through days 1–7+. If you can’t reliably do that (running out mid-overlap, source disruption), the protocol falls apart and you’re worse off than a clean standard induction.
- You don’t have a prescriber on board. Self-running a micro-induction from films cut by hand, with no clinical backstop if symptoms get rough, is a much higher-risk version of this protocol than the published cohorts describe. Some people do it; it’s not the safe version.
- You’re in acute withdrawal already. If you’ve already been off your 7-OH for 12+ hours and your COWS is climbing, you’re in a position where standard induction is the cleaner move. Micro-induction starts from a stable baseline of regular dosing, not from active withdrawal.
For any of these, see Suboxone (Buprenorphine/Naloxone) for the standard approach, or SR-17 if Suboxone isn’t right for you at all.
Sources
- Hammig R, Kemter A, Strasser J, et al. Subst Abuse Rehabil 2016;7:99–105 (PMID 27499655), original Bernese method case report; full text
- De Aquino JP, Parida S, Sofuoglu M. Clin Drug Investig 2021 (PMC8020374), pharmacology of micro-induction, receptor-occupancy data
- Ahmed S, Bhivandkar S, Lonergan BB, Suzuki J. Drug Alcohol Depend 2020, systematic review of micro-induction studies
- Klaire S, Zivanovic R, Barbic SP, et al. Am J Addict 2019 (PMID 30901127), rapid micro-induction case series
- Wong et al. 2021 RCT protocol (PMC7881636), registered comparison of rapid micro-induction vs. standard
- Button D, Hartley J, Robbins J, et al. J Addict Med 2022 (PMC8595358), hospitalized cohort, n=72
- Suen LW, Joshi N, Coffin PO, et al. J Addict Med 2024 (PMC11762237), largest outpatient cohort to date, 4-day vs. 7-day comparison
- Menard & Jhawar 2022 (PMC9317019), transdermal buprenorphine micro-induction
- BC Pharmacy Association, microdosing/Bernese method tables
- ASAM 2020 National Practice Guideline focused update, recognizes low-dose buprenorphine induction as an option
- Hendler R et al. J Addict Med 2026 (PMID 41875249), 7-HMG use disorder case (methadone-mediated, not Bernese)
- Kiyokawa M et al. Fam Pract 2023, kratom home induction case series (standard, not Bernese)
Reminder. This page describes a clinical method that requires a prescriber’s involvement to do safely. Reading about the protocol is not the same as having a clinician who’s tracking your symptoms, your bup dose, what you’re still using, and your helper meds. If your current prescriber isn’t comfortable with micro-induction, that’s a reason to find a different prescriber, not to run the protocol unsupervised.
Where to read next
- Suboxone (Buprenorphine/Naloxone): the standard COWS-gated induction approach, the community’s low-and-slow dosing rationale, and the receptor-occupancy data
- COWS & SOWS Guide: the timing tool for standard induction (not needed for micro-induction)
- Why Suboxone Might Not Be Working: once you’ve stabilized, the serotonergic/adrenergic gap and what fills it
- Custom Suboxone Dosing: the practical mechanics of cutting films to micro-induction doses (0.25, 0.5, 1 mg)
- Suboxone Rapid Taper: what happens after you’ve stabilized, regardless of which induction method got you there
- Telehealth Providers: prescriber comparison; flags which providers explicitly handle kratom/7-OH
- SR-17: the other community-discussed pathway off the synthetics, if Suboxone isn’t the right fit