Patients who have Polysubstance Abuse

Patients who abuse more than one substance may or may not be dependent upon all of them, so it is crucial for you to assess the entire range of a patient's substance use before starting treatment.

Follow these steps when treating an opioid-dependent patient who also has an another substance use disorder:

1. Stabilize the patient's opioid use problem first, which may include starting buprenorphine treatment.
2. Gradually withdraw them from the other substance(s)
3. Emphasize that formal counseling and recovery group meetings are mandatory because buprenorphine will not treat other drug problems.
4. Make it clear that ongoing use of other substances will not be tolerated during buprenorphine treatment.

Note that this is just one approach - some clinicians require their patients to address their other substance abuse first (stopping on their own or going through detoxification) before starting buprenorphine treatment. For instance, alcohol or benzodiapine dependence can be life-threatening and should not be overlooked in favor of treating opioid dependence.

Additional considerations: