Comorbidities

Buprenorphine should be used with caution in the following populations:

  • Elderly patients
  • Weak patients
  • Patients with severe hepatic, pulmonary, or renal impairment
  • Patients with myxedema or hypothyroidism
  • Patients with CNS depression
  • Patients with acute alcoholism

For the complete list of precautions, please refer to the resource provided below.

Related Resources: 
Description: 
Find the links to each buprenorphine formulation's medication guide here
Source: 
FDA
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Patient Handouts: 
Description: 
Discussing the psychosocial aspects of treatment in patients receiving Buprenorphine/Naloxone
Source: 
Physician Clinical Support System (PCSS-MAT)
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Description: 
Guideline document discussing interactions between buprenorphine and HIV medication.
Source: 
Physician Clinical Support System (PCSS)
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Medical complications can result from the opioid itself, as well as from the way it is administered. The main medical complications among the opioid-dependent population are related to injecting heroin.

View ReferencesHide References
Kleber H, Weiss R, Anton R, et al. Practice guideline for the treatment of patients with substance use disorders, 3rd edition. American Psychiatric Association. 2010. Available at: http://www.guideline.gov/content.aspx?id=24158 Accessed on: 2015-06-30.
Related Resources: 
Description: 
This publication discusses the medical co-management of hepatitis infection and opioid abuse.
Source: 
Center for Substance Abuse Treatment (CSAT)
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Resource Type: 
Description: 
Discussing the psychosocial aspects of treatment in patients receiving Buprenorphine/Naloxone
Source: 
Physician Clinical Support System (PCSS-MAT)
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Description: 
Guideline document discussing interactions between buprenorphine and HIV medication.
Source: 
Physician Clinical Support System (PCSS)
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Description: 
This chapter of TIP 43 is aimed to help treatment providers identify co-occurring medical problems in patients who are addicted to opioids.
Source: 
Substance Abuse and Mental Health Association (SAMHSA)
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Physician stage in practice: 
Description: 
A website that explains the 5 A's for tobacco cessation.
Source: 
US Department of Health and Human Services
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Description: 
A 585 page report by the National Center on Addiction and Substance Abuse document the evidence defining and describing the disease of addiction/risky substance use. It describes the need for and effectiveness of wide screening and interventions treatment and disease management tools and therapies as well as the populations in greatest need of therapies. The barriers to treatment, training and education gaps, and consequences and costs of inadequate prevention and treatment are all described. Finally, profound gaps between those who need treatment and those who receive quality care are described.
Source: 
National Center on Addiction and Substance Abuse
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Resource Type: 
Description: 
This web page provides brief recommendations for monitoring patients undergoing buprenorphine treatment using liver function tests, and the proper actions to take if a patient develops hepatitis.
Source: 
PCSS Guidance
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Appropriateness for Office-Based Treatment With Buprenorphine

Description: 
This page describes points physicians should consider when determining if a patient is appropriate for office-based buprenorphine treatment.

You should answer the following questions for each patient before starting office-based buprenorphine treatment:

Diagnosis

Does the patient have a diagnosis of opioid use disorder?

  • Approximately how long has the patient been dependent?
  • On which opioid(s) is the patient dependent, and how is the drug ingested?
  • How much of the drug does the patient use daily/weekly?

Other Medications

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Physician stage in practice: 
Description: 
This TIP, Substance Abuse Treatment for Persons With Co-Occurring Disorders, revises TIP 9, Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse. The revised TIP provides information about new developments in the rapidly growing field of co-occurring substance use and mental disorders and captures the state-of-the-art in the treatment of people with co-occurring disorders. The TIP focuses on what the substance abuse treatment clinician needs to know and provides that information in an accessible manner. The TIP synthesizes knowledge and grounds it in the practical realities of clinical cases and real situations so the reader will come away with increased knowledge, encouragement, and resourcefulness in working with clients with co-occurring disorders.
Source: 
U.S. Department of Health and Human Services, SAMHSA
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Resource Type: 
Description: 
This guideline discusses management of psychiatric medications in patients receiving buprenorphine/naloxone, and answers the question "How do I manage medications for co-occurring psychiatric disorders in a patient receiving buprenorphine/naloxone (bup/nx) for the treatment of opioid dependence?"
Source: 
PCSSmentor.com
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