Assessing and Selecting Patients for Buprenorphine Treatment

Some patients are better suited than others for buprenorphine treatment. Additionally, some patients are more challenging than others, either due to complicated medical or psychiatric issues, or problematic behaviors.

When first starting your buprenorphine practice, you may want to treat "easier" patients until you feel 100% comfortable with the induction and stabilization processes. Use a checklist and/or treatment screening form to assess patients before initiating treatment.

Review these conditions that might make a patient a less optimal candidate for buprenorphine treatment:

  • significant medical problems (especially for psychiatrists)
  • significant psychiatric comorbidity (especially for non-psychiatrists)
  • chronic suicidal or homicidal thoughts (especially for non-psychiatrists)
  • polysubstance use, including alcohol dependence
  • dependence on benzodiazepines or other CNS depressants
  • significant pain not management with non-opioid treatment alone
  • frequent relapses in prior treatment attempts
  • administrative discharges from more structured treatment settings (i.e. methadone maintenance)
  • pregnancy (methadone is the standard of care for opioid-dependent pregnant women)
  • any other condition that you feel is outside your realm of expertise


Related Resources: 
TIP 40 Chapter 3: Patient Assessment
Description: 
Aids physicians in screening patients for opioid use disorders. Included are examples of screening instruments, recommendations of laboratory tests to complete, and medical disorders related to substance abuse.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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