A Guide to Expanding the Use of Buprenorphine Beyond Standard Initiations for Opioid Use Disorder.
Publication Title
Drugs in R&D
Document Type
Article
Publication Date
12-1-2023
Keywords
washington; renton; spokane; Pregnancy; Female; Adolescent; Child; Humans; Buprenorphine; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Analgesics, Opioid
Abstract
Buprenorphine has become an important medication in the context of the ongoing opioid epidemic. However, complex pharmacologic properties and varying government regulations create barriers to its use. This narrative review is intended to facilitate buprenorphine use-including non-traditional initiation methods-by providers ranging from primary care providers to addiction specialists. This article briefly discusses the opioid epidemic and the diagnosis and treatment of opioid use disorder (OUD). We then describe the basic and complex pharmacologic properties of buprenorphine, linking these properties to their clinical implications. We guide readers through the process of initiating buprenorphine in patients using full agonist opioids. As there is no single recommended approach for buprenorphine initiation, we discuss the details, advantages, and disadvantages of the standard, low-dose, bridging-strategy, and naloxone-facilitated initiation techniques. We consider the pharmacology of, and evidence base for, buprenorphine in the treatment of pain, in both OUD and non-OUD patients. Throughout, we address the use of buprenorphine in children and adolescent patients, and we finish with considerations related to the settings of pregnancy and breastfeeding.
Area of Special Interest
Mental Health
Area of Special Interest
Neurosciences (Brain & Spine)
Specialty/Research Institute
Behavioral Health
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Neurosciences
DOI
10.1007/s40268-023-00443-5
