Office-Based Buprenorphine Treatment of Opioid Use Disorder (Online)-Module 3 - Additional Resource (Slide Handout Part 2)

Module 3 - Additional Resource (Slide Handout Part 2)

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This document summarizes different protocols and recommendations for the clinical use of buprenorphine in the treatment of opioid use disorder (OUD). The standard induction protocol involves assessing the patient's opioid withdrawal symptoms using scales such as the Clinical Opiate Withdrawal Scale or the Objective Opiate Withdrawal Scale. The initial dose of buprenorphine/naloxone is 2/0.5 or 4/1 mg, and it can be re-dosed in 2 hours if withdrawal symptoms persist. The target dose on the first day is 8/2 mg or 12/3 mg for patients using fentanyl. Patients should return to the clinic for re-evaluation the next day, and the dose can be increased if necessary. Most patients stabilize on a daily dose of 12/3-16/4 mg or higher. The FDA-approved dose range is up to 24/6 mg daily.<br /><br />There are also recommendations for outpatient induction and home induction protocols. Outpatient induction is suitable for patients with prior experience taking buprenorphine, while home induction should be a priority for most patients. Weekly office visits should be continued until the patient stabilizes in treatment, and progress can be monitored through telephone calls.<br /><br />The document also discusses high-dose and low-dose initiation protocols. Micro-dosing, also known as the Bernese method, involves gradual increases in buprenorphine dose while maintaining the use of illicit opioids or a full-agonist opioid. High-dose initiation is favored in emergency department settings, with a larger dose administered than in the standard protocol. <br /><br />Medication transition protocols from methadone to buprenorphine are covered, including conventional and low-dose techniques. The use of XR-naltrexone (Vivitrol) as an opioid antagonist therapy is also mentioned, but it notes that retention rates on methadone and buprenorphine are generally higher than on XR-naltrexone. <br /><br />The document briefly discusses managing acute and chronic pain in patients receiving buprenorphine treatment. For acute pain, non-opioid alternatives are recommended first, but if necessary, buprenorphine can be used in divided doses up to 32 mg. Severe acute pain in the perioperative setting and chronic pain in patients with OUD require individualized approaches, and a multidisciplinary pain team may be beneficial. Limited evidence supports long-term opioid therapy for chronic non-malignant pain, and treatment agreements/informed consent should be implemented.<br /><br />Overall, the document provides an overview of different protocols and recommendations for the clinical use of buprenorphine in the treatment of OUD, including induction, transition, and pain management.

Keywords

protocols

recommendations

buprenorphine

treatment

opioid use disorder

induction protocol

withdrawal symptoms

dose

pain management

methadone