Logistics of buprenorphine treatment

Overdose Recognition & Prevention

Description: 
It is important to be able to recognize and prevent overdose in your patients.
Signs and symptoms of buprenorphine overdose:
  • Cold, clammy skin
  • Weakness
  • Constricted pupils (Note: after brain damage occurs, pupils may dilate)
  • Hypotension
  • Loss of consciousness/unresponsiveness
  • Respiratory depression

Of these, respiratory depression may be fatal if untreated (SAMHSA, 2004).

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Overdose: Treatment

Description: 
Buprenorphine overdose can be treated by following the recommended steps.

Buprenorphine overdose is treated with supportive care and an opioid antagonist, such as naloxone, to displace the buprenorphine. Recommendations for treating opioid overdose, for adults, are as follows:

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Naloxone for Overdose

Description: 
Naloxone can be used as a rescue medication if the patient has overdosed.
Naloxone Overdose Reversal Kit

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Remind patients of key points relevant to successful induction covered the day of induction. These include:

Related Resources: 
Description: 
This web page provides educational materials on buprenorphine treatment including information on different stages of treatment, patient stories, educational essays, and a glossary.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Patient Handouts: 

For most patients, you will be able to determine a stabilization dose by day 2 or 3 during induction. However, prescription refills should still be given in small amounts (one week at a time) during the induction process and first few weeks of treatment so the patient can be closely monitored.

Tablets

Tablets

Sublingual buprenorphine tablets: A generic version of the combination buprenorphine HCl with naloxone HCl dihydrate tablet, similar to the combination sublingual tablets formerly marketed as Suboxone, is available in 2 mg and 8 mg strengths, both in 30-count bottles. The 2 mg tablet can be cut to yield 0.5 mg doses; the 8 mg tablet can be cut to yield 2 mg doses for precise dosing.

Related Resources: 
Description: 
Find the links to each buprenorphine formulation's medication guide here
Source: 
FDA
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Patient Handouts: 

Patient Handout: Buprenorphine or Naloxone Combination-What Does It Mean for You?

Description: 
This patient handout explains buprenorphine, its makeup, and how it works to treat withdrawal.

Buprenorphine/Naloxone Combination Film or Tablets -- What do They Mean for You?


Your physician has prescribed buprenorphine/naloxone combination tablets (generic or Zubsolv®*) or film (Suboxone®) for you. There are a few things you should know before you begin taking it.


What is buprenorphine?
Buprenorphine is a type of drug called an opioid, similar to heroin, methadone or Oxycontin®. Taking buprenorphine will prevent you from going into withdrawal and should stop you from craving other opioids.


What is naloxone?
Naloxone counteracts opioids --including buprenorphine. If you take naloxone while you have an opioid in your system, or if you are dependent on opioids and find that you go into withdrawal without them, naloxone can trigger withdrawal.


That doesn't make sense --why would my provider prescribe a drug which will send me into withdrawal?
Your buprenorphine/naloxone combination medication will not send you into withdrawal --provided you take them as your provider prescribes!


If you dissolve the tablets or film under your tongue, or if you accidentally swallow one, the naloxone will not affect you --your body breaks the naloxone down too quickly for it to take effect! However, if you inject a combination tablet or film, the naloxone will take effect. You will probably not feel anything from the buprenorphine, and you could go into withdrawal.

 

 

 

How Taken Buprenorphine Naloxone What you feel
Under the tongue (as directed)
  • Works properly
  • Broken down by the body
  • No withdrawal; reduced craving
Swallowed (accidental)
  • Broken down by body
  • Medicine will not work; you could go into withdrawal or feel cravings
Injected (abuse)
  • Blocked by naloxone
  • Blocks effects of opioids
  • You could go into withdrawal very quickly

 

 

 

*We are using brand names since there is a difference in the product that is not reflected in the generic name. We are not advocating one brand or the other.

Description: 
One-page handout that provides graphics and a description of the pharmacology of buprenorphine in layman's terms.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Patient Handouts: 
Description: 
Provides patients with an in-depth look at what to expect from buprenorphine treatment including preparing for treatment, urine testing, counseling, and effects on sleep and relationships.
Source: 
The National Alliance of Advocates for Buprenorphine Treatment (NAABT)
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Physician stage in practice: 

Clinical staff can assist with most steps of the buprenorphine induction process if a consistent plan is in place.

  • Educate the staff on buprenorphine treatment and addiction. The more information and involvement that they have, the smoother your practice will run and the better care your patients will receive.

  • Be sure to explain every staff member's role to your patients so they know who to ask for help or if there is a problem during induction.

Related Resources: 
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: 
This form provides a list and a place to document important information that should be recorded during the intake assessment, including whether the patient is pregnant, taking other drugs, on methadone or has other addiction behaviors.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Commonly Used Forms: 
Description: 
This form can be used by nurses to note the areas that should be covered during a follow-up visit for patients on buprenorphine treatment.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Commonly Used Forms: 
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 flow chart for buprenorphine treatment displays the steps to patient recovery, from initial patient contact or referral, through intake process, induction, day #2, stabilization, maintenance, and tapering.
Source: 
Colleen LaBelle, RN/Boston Medical Center
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Physician stage in practice: 
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.
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Patient Handouts: 
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Description: 
This patient questionnaire from the California Society of Addiction Medicine (CSAM) is useful when beginning a new patient on buprenorphine maintenance treatment.
Source: 
California Society of Addiction Medicine (CSAM)
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Resource Type: 
Commonly Used Forms: 
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