Treatment Algorithm

Description: 
This document, first published in 2004 and revised in July 2013, is a model policy for state medical boards to use in developing their guidelines for use of opioids in treating chronic pain. These Model Guidelines provide the FSMB's policy on proper treatment of pain and the use of opioids when necessary to manage pain. Source: Federal State Medical Boards (FSMB)
Source: 
FSMB
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Day 2+

Description: 
Induction for Non-Physically Dependent Patients

This flow chart depicts clinical guidelines for Day 2 of induction for non-physically dependent patients. Guidelines are provided for whether agonist side effects emerge, whether side effects occur, and establishing a daily dose.

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Day 1

Description: 
Induction for Patients Physically Dependent on Long-Acting Opioids

This dosing flow chart depicts clinical dosing guidelines for patients physically dependent on long-acting opioids such as methadone. Guidelines are provided for what to do if the patient's withdrawal symptoms continue or return, and establishing the daily dose if the symptoms are relieved.

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Day 1

Description: 
Dosing Flowchart for Patients Physically Dependent on Short-Acting Opioids

This dosing flow chart depicts clinical dosing guidelines for patients physically dependent on short-acting opioids such as heroin. Guidelines are provided for what to do if the patient's withdrawal symptoms continue or return, and establishing the daily dose if the symptoms are relieved.

© 2012, Clinical Tools, Inc.

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Buprenorphine Induction for Patients Physically Dependent on Short- or Long-Acting Opioids

Description: 
This dosing flow chart depicts clinical guidelines for patients who are physically dependent on short- or long- acting opioids.

Guidelines are provided for if the withdrawal symptoms are present since the last dose, if the withdrawal symptoms continue, if the withdrawal symptoms return, and establishing the daily dose.

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Buprenorphine Dosing Algorithms

Description: 
A series of flow charts displaying the steps that should be followed when inducting a new patient into buprenorphine treatment.

Flow charts are included for patients addicted to short- and long-acting opioids, for non-physically dependent patients, and for patients switching from buprenorphine to buprenorphine/naloxone.

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Flow Chart

Description: 
Switch from Buprenorphine to Buprenorphine/Naloxone

This flow chart depicts clinical guidelines for switching a patient from buprenorphine to buprenorphine/naloxone. Guidelines are provided for whether the patient is pregnant, or if there is another compelling reason to continue monotherapy.

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Days 2+

Description: 
Buprenorphine Induction for Nonphysically Dependent Patients

This flow chart depicts clinical guidelines for Day 2 of induction for non-physically dependent patients. Guidelines are provided for whether agonist side effects emerge, whether side effects occur, and establishing a daily dose.

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Day 1

Description: 
Induction for Nonphysically Dependent Patients

This dosing flow chart depicts clinical dosing guidelines for nonphysically dependent patients. Guidelines are provided for if the patient has a history of opioid dependence, if the patient is currently dependent on opioids, and if opioid agonist side effects are observed.

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