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i have had very good success using COWS score- i think that you are right that it is acting as a short acting opioid- but there may be some long term effect aka methadone as well. so i would have the patient come in 48 hours after last dose and check cows- if they are legit over 5, it should be safe to start- by legit over 5 i mean that there is at least one observable symptom- runny nose, elevated HR, dilated pupils, I think 24 hours is too soon because they are self administering at 24 hours and in my experience, users tend to self medicate to avoid wdrl not to treat it...you may find you have to go a little higher the first week (say 20 to 24 mg buprenorphine) as if there still is fentanyl on board, the buprenorphine may not displace all of it. let us know how it works out.
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