Getting started with buprenorphine

CONFERENCE JOURNALIST

For someone who feels like they may not need treatment, presenting them with an option that they may not have known existed or had any knowledge of perhaps not receiving the correct information may cause them to then consider needing treatment.

Jeffrey DeVido, MD, MTS, discussed the importance of buprenorphine and how clinicians can start treatment at the 2023 Annual Meeting. Psychiatric time CME Global Conference. DeVido is chief of substance abuse services at the Marin County Department of Health and Human Services, Department of Behavioral Health and Recovery Services, and a volunteer assistant clinical professor in the Department of Psychiatry and Behavioral Sciences at the University of California in San Francisco (UCSF), UCSF Weill Institute for Neurosciences.

DeVido began the presentation by sharing some background information and a review of buprenorphine, noting that it is a Mu receptor partial agonist that produces little euphoria and has a long half-life and affinity for high binding, allowing it to block or displace other opioids. Approved by the U.S. Food and Drug Administration (FDA) for the office-based treatment of opioid use disorder (OUD) and pain, buprenorphine is a good pain reliever with few adverse effects and relatively safe in case of overdose.

DeVido also addressed some common concerns associated with buprenorphine, including initiation, precipitated withdrawal, diversion, duration of treatment, and the drug’s potential effects on pregnancy and urine drug testing. Focusing on initiation, DeVido shared 3 steps for clinicians to begin buprenorphine treatment:

• Stop the patient from taking opioids: The patient may enter withdrawal, but clinicians may incorporate certain symptomatic medications such as clonidine, dicyclomine, loperamide, and lorazepam.
• Initiate buprenorphine: start either in the office or at home at 2 to 4 mg, then 2 to 4 mg every 2 to 3 hours thereafter until cravings and withdrawal subside . Clinicians should also monitor for precipitous withdrawal.
• Continue taking buprenorphine: The patient can take the medication indefinitely (maintenance) or the medication can be gradually reduced (withdrawal management).

DeVido followed up with some updates, noting that the X waiver is gone, with all buprenorphine prescriptions now only requiring a standard Drug Enforcement Administration (DEA) registration number. There is also no patient limit and clinicians who prescribe controlled substances (II-V) are now required to complete 8 hours of training for new requests and refills.

DeVido concluded by noting that although the patient must have a diagnosis of OUD to continue with buprenorphine, clinicians do not need to be addiction specialists to make that diagnosis.

He also advised clinicians to help patients avoid long-term worry and to offer OUD patients the full range of medication-assisted treatment (MAT) options available to them before deciding of a treatment plan. He also emphasized using a collaborative approach when working with patients, highlighting the potential of buprenorphine treatment to facilitate this.

Buprenorphine offers, in my opinion, a great opportunity for a collaborative approach to working with patients, DeVido said. And that can provide an opportunity to be able to work with someone in such a way that they move from feeling like they don’t need treatment to saying: Hey, maybe I’ll try thiswhich has a strong chance of saving that person’s life.

Visit PsychiatricTimes.com regularly for more up-to-the-minute information about the 2023 Psychiatric Times World CME Annual Conference. Email us at PTEditor@mmhgroup.com if you would like to share your thoughts and ideas gleaned from this or other conferences.