- Next Steps: Get Started Prescribing Buprenorphine!
- How to Assess and Treat Patients with Comorbid Health Issues
- How to Conduct Buprenorphine Induction
- Phases of Buprenorphine Treatment
- Basic Induction and Dosing Guidelines
- Preparing for Induction
- Standard Induction Protocol
- Dealing with Complications During Induction
- Establishing a Maintenance Dose of Buprenorphine
- Tapering and Discontinuation of Patients from Buprenorphine
- Procedure for Detoxification (Medically Supervised Withdrawal)
- How to Establish and Manage a Buprenorphine Practice
- How to Manage Challenging Patients
- How to Comply with Rules, Regulations, and Recordkeeping
- How to Understand Insurance and Billing Issues
- How to Screen for Substance Abuse
- How to Refer Patients to an Addiction Specialist
- Review: What is Buprenorphine?
Basic Induction and Dosing Guidelines
Standardized dosing protocols are available, but induction should be conducted through careful observation and the dosing should be adjusted accordingly
Buprenorphine induction and maintenance doses may differ for each patient. When planning induction, first consider whether a patient is dependent upon short-acting opioids (e.g. heroin, most prescription narcotics) versus long-acting opioids (e.g. methadone). It will take longer for patients who are dependent on long-acting opioids to prepare for induction (longer abstinence period in the days prior to induction).
Most patients can be started and maintained on the buprenorphine/naloxone combination tablet (generic or brand name: Zubsolv™) or film (brand name: Suboxone®). The combination formulation contains a 4:1 ratio of buprenorphine and naloxone. The monotherapy tablet is recommended for use in those who are pregnant or have a naloxone allergy.
This patient handout explains buprenorphine, its makeup, and how it works to treat withdrawal.
Buprenorphine/Naloxone Combination Film or Tablets -- What do They Mean for You?
Your physician has prescribed buprenorphine/naloxone combination tablets (generic or Zubsolv™) or film (Suboxone®) for you. There are a few things you should know before you begin taking it.
What is buprenorphine?
Buprenorphine is a type of drug called an opioid, similar to heroin, methadone or Oxycontin®. Taking buprenorphine will prevent you from going into withdrawal and should stop you from craving other opioids.
What is naloxone?
Naloxone counteracts opioids --including buprenorphine. If you take naloxone while you have an opioid in your system, or if you are dependent on opioids and find that you go into withdrawal without them, naloxone can trigger withdrawal.
That doesn't make sense --why would my doctor prescribe a drug which will send me into withdrawal?
Your buprenorphine/naloxone combination medication will not send you into withdrawal --provided you take them as your doctor prescribes!
If you dissolve the tablets or film under your tongue, or if you accidentally swallow one, the naloxone will not affect you --your body breaks the naloxone down too quickly for it to take effect! However, if you inject a combination tablet or film, the naloxone will take effect. You will probably not feel anything from the buprenorphine, and you could go into withdrawal.
|How Taken Buprenorphine Naloxone||What you feel|
|Under the tongue (as directed)||