Buprenorphine: An Overview for Clinicians

August 23, 2019

Scott Steiger, UCSF School of Medicine

Triveni DeFries, UCSF School of Medicine

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).

Practitioners who wish to prescribe buprenorphine must complete a waiver application which can be found on the SAMHSA website.

Buprenorphine: An Overview for Clinicians (PDF) 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

Rural areas and Native Americans / Alaska Natives: California MAT Expansion Project
Emergency departments and hospitals: California Bridge Program
Primary care: Addiction Treatment Starts Here Resource Hub
Jails and the court system: MAT in County Criminal Justice
Treatment centers and SUD counselors: MAT in residential treatment

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