Buprenorphine to treat opioid use disorder: A practical guide
Medication-assisted treatment is demonstrably superior to abstinence and counseling in maintaining sobriety. The authors examine this effective agent.
PRACTICE RECOMMENDATIONS
› Use signs of intoxication, signs of withdrawal, urine drug screening, and diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, to screen for, and diagnose, opioid use disorder. C
› Offer and institute medication-assisted treatment when appropriate to reduce the risk of opioid-related and overall mortality in patients with opioid use disorder. A
› Identify and treat comorbid psychiatric disorders in patients with opioid use disorder, which provides benefit during treatment of the disorder. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Four days later, Mr. R shows up at the clinic, apologizing for missing the appointment and assuring you that this won’t happen again. Rapid urine drug screening is positive for morphine. When confronted, he admits using heroin. He reports that his cravings had increased, for which he took buprenorphine and naloxone above the prescribed dosage, and ran out of films early. He then used heroin 3 times to prevent withdrawal.
Mr. R admits that he has been having cravings for oxycodone since the start of treatment for addiction, but thought he was strong enough to overcome the cravings. He feels disappointed and embarrassed about this; he wants to continue with buprenorphine, he tells you, but worries that you will refuse to continue seeing him now.
Using shared decision-making, you opt to increase the buprenorphine dosage by 4 mg (to 16 mg/d—ie, 2 films of buprenorphine and naloxone, 8 mg/2 mg) to alleviate cravings. You instruct him to engage his support network, including his family and NA sponsor, and to start outpatient group therapy. He tells you that he is willing to go back to weekly clinic visits until he is stabilized.
CORRESPONDENCE
Tanner Nissly, DO, University of Minnesota Medical School Twin Cities, Department of Family Medicine and Community Health, 1020 West Broadway Avenue, Minneapolis, MN 55411; nissl003@umn.edu.
