Induction

Description: 
A learning activity that includes the different clinical models of buprenorphine induction, the associated evidence, and the pros and cons of each.
Source: 
PCSSMAT.org
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Clinical staff can assist with most steps of the buprenorphine induction process if a consistent plan is in place.

  • Educate the staff on buprenorphine treatment and addiction. The more information and involvement that they have, the smoother your practice will run and the better care your patients will receive.

  • Be sure to explain every staff member's role to your patients so they know who to ask for help or if there is a problem during induction.

Related Resources: 
Description: 
The Objective Opiate Withdrawal Scale (OOWS) contains 13 physically observable signs, rated present or absent, based on a timed period of observation of the patient by a rater.
Source: 
Reprinted from Handelsman, L., Cochrane, K. J., Aronson, M. J., et al. (1987) Two new rating scales for opiate withdrawal. American Journal of Drug and Alcohol Abuse, 13 (3), 293–308. By courtesy of Marcel Dekker, Inc.
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Patient Handouts: 
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Description: 
This form provides a list and a place to document important information that should be recorded during the intake assessment, including whether the patient is pregnant, taking other drugs, on methadone or has other addiction behaviors.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Commonly Used Forms: 
Description: 
This form can be used by nurses to note the areas that should be covered during a follow-up visit for patients on buprenorphine treatment.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Commonly Used Forms: 
Description: 
This PDF Document contains the Clinical Opioid Withdrawal Scale (COWS), a common instrument used to assess a patient's opioid withdrawal severity.
Source: 
California Society of Addiction Medicine (CSAM)
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Patient Handouts: 
Description: 
This flow chart for buprenorphine treatment displays the steps to patient recovery, from initial patient contact or referral, through intake process, induction, day #2, stabilization, maintenance, and tapering.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Physician stage in practice: 
Description: 
The Subjective Opiate Withdrawal Scale (SOWS) contains 16 symptoms whose intensity the patient rates on a scale of 0 (not at all) to 4 (extremely).
Source: 
Reprinted from Handelsman et al. 1987, p. 296, by courtesy of Marcel Dekker, Inc.
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Patient Handouts: 
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Description: 
This patient questionnaire from the California Society of Addiction Medicine (CSAM) is useful when beginning a new patient on buprenorphine maintenance treatment.
Source: 
California Society of Addiction Medicine (CSAM)
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Commonly Used Forms: 
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Related Resources: 
Description: 
This PDF Document contains the Clinical Opioid Withdrawal Scale (COWS), a common instrument used to assess a patient's opioid withdrawal severity.
Source: 
California Society of Addiction Medicine (CSAM)
field_vote: 
Patient Handouts: 
Description: 
This form provides a list of possible symptoms that a patient may have during buprenorphine treatment, possible causes, and recommended management of the symptoms.
Source: 
Colleen LaBelle, RN/Boston Medical Center
field_vote: 
Physician stage in practice: 
Description: 
This continuing education course instructs physicians, physician assistants, and nurse practitioners who prescribe narcotics on some the requirements and subtleties of buprenorphine treatment that can lead to effective and relatively safe treatment of opioid use disorder.
Source: 
Clinical Tools, Inc.
field_vote: 
Description: 
The Objective Opiate Withdrawal Scale (OOWS) contains 13 physically observable signs, rated present or absent, based on a timed period of observation of the patient by a rater.
Source: 
Reprinted from Handelsman, L., Cochrane, K. J., Aronson, M. J., et al. (1987) Two new rating scales for opiate withdrawal. American Journal of Drug and Alcohol Abuse, 13 (3), 293–308. By courtesy of Marcel Dekker, Inc.
field_vote: 
Patient Handouts: 
Tags: 
Description: 
The Subjective Opiate Withdrawal Scale (SOWS) contains 16 symptoms whose intensity the patient rates on a scale of 0 (not at all) to 4 (extremely).
Source: 
Reprinted from Handelsman et al. 1987, p. 296, by courtesy of Marcel Dekker, Inc.
field_vote: 
Patient Handouts: 
Tags: 

 

This information is not current

 

Standardized dosing protocols are available, but induction should be conducted through careful observation and the dosing should be adjusted accordingly

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Patient Handout: Buprenorphine or Naloxone Combination-What Does It Mean for You?

Description: 
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 provider 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 provider 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)
  • Works properly
  • Broken down by the body
  • No withdrawal; reduced craving
Swallowed (accidental)
  • Broken down by body
  • Medicine will not work; you could go into withdrawal or feel cravings
Injected (abuse)
  • Blocked by naloxone
  • Blocks effects of opioids
  • You could go into withdrawal very quickly

 

 

 

*We are using brand names since there is a difference in the product that is not reflected in the generic name. We are not advocating one brand or the other.

Buprenorphine maintenance can be divided into three phrases: induction, stabilization, and maintenance.

Induction

The goal of the induction is to find the patient's ideal daily dose of buprenorphine. The ideal daily dose minimizes both side effects and drug craving. For most opioid-dependent patients, the daily dose is 12 to 16 mg/day of the buprenorphine+ naloxone combination film or tablet. Induction usually takes 2 to 4 days to complete.

Stabilization

Description: 
This web page provides information for the patient on pronunciation, brand names, common uses, how to use, missed doses, precautions, side effects, drug interactions, proper storage, and more.
Source: 
Kaiser Permanente
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Description: 
This web page provides information for the patient on pronunciation, brand names, common uses, how to use, missed doses, precautions, side effects, drug interactions, proper storage, and more.
Source: 
Drugs.com
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Description: 
This SAMHSA guideline provides information on buprenorphine treatment for nurses and other clinical support staff who assist with buprenorphine induction and maintenance.
Source: 
SAMHSA
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Physician stage in practice: 
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