Home/First visit
Your first visit, start to finish.
Most people put the call off because nobody tells them what they are walking into. So here is the whole thing — every step, in order, with nothing left vague. It takes about an hour, and most patients leave with the withdrawal already lifting.
Before you come in: one phone call
Everything starts with a conversation, and Dr. Tomlinson has it with you himself — not an intake coordinator, not a form. He will ask four things: what you are using, how much, how long, and when you last used. That last answer is the one that sets your appointment time, because starting buprenorphine too early is the one avoidable way this goes badly.
You are not committing to anything by calling. People call to ask what it costs, whether their employer could find out, or whether their situation is too far gone. Those are all reasonable questions and none of them take more than five minutes to answer.
What to have ready
- A photo ID and your payment for the visit.
- Your pharmacy — the name and the town. Your prescription goes there electronically.
- Any medications you take, including ones prescribed by other doctors, and anything for anxiety, sleep, or pain. This matters for your safety.
- An honest timeline of the last few days of use. Nothing about it is judged; all of it is used.
The visit itself, step by step
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Minute 0
You arrive and you are not processed
Small office, no waiting-room crowd, no clipboard maze. Call before you drive over — at any hour — and Dr. Tomlinson meets you at the door rather than leaving you sitting.
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The first 20 minutes
The conversation
Your history: what you have used, what you have already tried, what happened the last time you tried to stop, and what your life actually looks like — work, family, transportation, who knows and who does not. This is where the treatment plan gets built, so it is the part he does not rush.
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Then
The medical evaluation
A physical exam, vital signs, and an assessment of where you are in withdrawal — how far along you are determines whether it is safe to dose you now or in a few hours. Where it is relevant, testing is discussed with you rather than done to you.
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The turning point
Your first dose, taken here
You take the first dose in the office so that Dr. Tomlinson can watch how your body answers it and adjust immediately if it is not right. Most patients feel the withdrawal start to release within the first hour or two — the shaking settles, the crawling feeling in the legs eases, the sweat stops.
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Before you leave
A plan, a prescription, and a number that answers
You leave with a written plan, a prescription sent to your own pharmacy at pharmacy pricing, instructions for the next 48 hours, and the same phone number that will be answered at 2 a.m. if something feels wrong.
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Roughly every 28 days after
Follow-up with the same doctor
Early on he may want to see you sooner while your dose is being dialed in. Once you are stable, visits settle into a monthly rhythm with a physician who remembers your name, your job, and what you were fighting last month.
The timing question everybody asks
“How long do I have to wait after my last use?” There is no single number, and anybody who gives you one over the internet is guessing. It depends on what you were using — pills, heroin, fentanyl, and methadone all behave differently in the body — and on how your own system has responded before. Fentanyl in particular stores in body tissue and releases slowly, which is why the old twelve-hour rule of thumb no longer holds reliably.source
See the withdrawal timeline page for what the ranges look like — then call and get the number that applies to you.
What it costs, said plainly
A scheduled visit is $200, paid at the appointment. Nothing is billed to insurance, so no insurer ends up with a file describing your treatment. An unscheduled after-hours visit — the kind where he leaves his house and opens the clinic for one person — is $300, and you are told that before you drive over, never afterward. The full cost page is here.
Questions about the first visit
How long does the first visit take?
Plan on about an hour from the time you walk in. The conversation is the longest part of it, and it is the part that matters most.
What do I need to bring?
A photo ID, your payment for the visit, the name and address of the pharmacy you want to use, and a list of any medications you take — including anything prescribed by another doctor. If you do not have all of that, come anyway and tell us what you do have.
Do I have to be in withdrawal when I arrive?
For a standard start, yes — early withdrawal, not full-blown misery. There are also low-dose initiation approaches that begin buprenorphine gradually without waiting for full withdrawal, which is why we ask about your history on the phone before we tell you when to come in.
Will I get my prescription the same day?
In nearly every case, yes. You are evaluated, you take your first dose here where Dr. Tomlinson can watch how you respond, and you leave with a prescription for your own pharmacy.
What if I am honest about still using?
Then you have done the one thing that makes this work. Nobody here is shocked, and nothing you say gets you turned away. Inaccurate information is the only thing that can genuinely hurt you, because the timing of your first dose is calculated from it.
Can I bring my spouse, parent, or a friend?
Yes. Bring whoever helps you think clearly. They can sit in for the conversation if you want them there, and step out for the exam.
What if I cannot get there during the day?
Then come at night. Dr. Tomlinson answers his own phone around the clock and will open the clinic for a patient who cannot wait. An unscheduled after-hours visit is $300 instead of $200, and you are told that before you leave the house.
Sources
- British Columbia Centre on Substance Use, “Buprenorphine Basics — ED Induction” — https://www.bccsu.ca/wp-content/uploads/2021/12/LOUDintheED-Buprenorphine-Basics-ED-Induction.pdf
- New York State OASAS, “Low and High Dose Initiation of Buprenorphine” — https://oasas.ny.gov/system/files/documents/2022/07/low-high-dose-buprenorphine-initiation.pdf
You already know what the first step is.
One phone call, answered by the doctor himself, at whatever hour you are reading this.
Call 479-856-1505 — any hourIn a life-threatening emergency call 911. For a mental health crisis, call or text 988.