Dealing with Complications During Induction

Each practice should have a contingency plan in place in case of complications during induction. Before starting your buprenorphine practice, you may want to establish a relationship with another buprenorphine provider in your area for consultation if problems arise.

Severe adverse reactions to buprenorphine during induction are exceedingly rare - the most commonly reported adverse reaction is the development of precipitated opioid withdrawal. You can minimize the risk of precipitated opioid withdrawal by documenting that the patient is in opioid withdrawal prior to induction (using an opiate withdrawal scale instrument), and then dosing carefully. Patients should also be closely monitored between doses so that you can manage any side effects or adverse events that may occur.

Additionally, complications can arise when patients are taking medications that interact with buprenorphine, such as benzodiazepines. Taking a thorough history and conducting urinalysis prior to induction should reduce the likelihood of such problems occurring.

Managing Withdrawal Symptoms

Patients' withdrawal symptoms during induction can be treated with non-opioid medications. These are sometimes called "comfort meds" and are most often needed by patients transferring from long-acting opioids:

  • Anxiolytics (use very carefully and in limited quantities)
  • Non-opioid pain relievers (NSAIDs or acetaminophen), while considering risks vs. benefits
  • Antidiarrheal agents
  • Antiemetics
  • Antispasmodics
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)
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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
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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.
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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: 
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: 
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