Buprenorphine: An Overview for Clinicians

Scott Steiger, UCSF School of Medicine
Triveni DeFries, UCSF School of Medicine


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Buprenorphine, an FDA-approved medication for addiction treatment and pain relief, cuts opioid overdose death rates in half. Yet nearly 80% of Americans with opioid use disorder (OUD) do not receive buprenorphine or other medication-assisted treatment (MAT).

Buprenorphine: An Overview for Clinicians provides answers to frequently asked questions, aiming to increase prescriber comfort with prescribing buprenorphine throughout the health care system. Once the basics are mastered, buprenorphine can be as straightforward to prescribe as medications for other medical conditions. It covers the following topics:

About Buprenorphine

  • Buprenorphine compared to methadone and naltrexone
  • Accessibility obstacles
  • How to start a patient on buprenorphine
  • Where can a patient start buprenorphine?

Dosage, Duration, and Monitoring

  • Maintenance dosage
  • Treatment duration: detox, maintenance, tapering
  • Monitoring and diversion
  • Substance use
  • Behavioral health treatments

Pain Management with Buprenorphine

  • Advantages of using buprenorphine for chronic pain
  • Elderly patients with chronic pain
  • Treating pain in the emergency department and hospital
  • Hospitalized and perioperative patients on buprenorphine

Legal and Administrative Facts

  • Laws regulating buprenorphine prescribing
  • Getting prescriptions approved by health plans
  • Documentation required by federal and/or California laws

 

Resources

MAT for Opioid Use Disorder: Overcoming Objections (CHCF)

Practice Guidelines

National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (ASAM)
Treatment Improvement Protocol 63: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (SAMHSA)
Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence (World Health Organization)
Clinical Practice Guideline for Management of Substance Use Disorder (Dept. of Veterans Affairs)
Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office (PDF) (Federation of State Medical Boards)

Pregnancy

Medications to Treat Opioid Use During Pregnancy — An Info Sheet for Providers (SAMHSA)

Health Care Settings