Symptoms

Description: 
Presently, methadone is the recommended treatment for opioid-dependent pregnant women, but is associated with neonatal abstinence syndrome (NAS). NAS is characterized by opioid withdrawal symptoms in the newborn, which often requires longer hospitalization and treatment. Buprenorphine, FDA-approved in 2002 for the treatment of opioid dependence in non-pregnant individuals, hasn't been extensively studied during pregnancy. Yet, a new study in the New England Journal of Medicine (NEJM) found that buprenorphine offers an alternative to methadone in the treatment of opioid-dependent pregnant women. The study compared buprenorphine to methadone in 131 mothers and their newborns at eight international sites.
Source: 
New England Journal of Medicine
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DSM-5 Criteria for Opioid Withdrawal

Description: 
Lists DSM-5 Criteria for Opioid Withdrawal

Opioid withdrawal occurs in opioid-dependent individuals who reduce or stop their opioid use or who take an opioid antagonist (precipitated withdrawal). Because of its high affinity but low activity at opioid receptors, buprenorphine can act as an antagonist in some patients.

DSM-5 Criteria for Opioid Withdrawal


A. Either of the following:

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DSM 5 Criteria for Opioid Withdrawal

Description: 
Lists the clinical criteria for opioid withdrawal.

DSM 5 Criteria for Opioid Withdrawal (APA, 2013)

A. Either of the following:

  1. cessation of (or reduction in) opioid use that has been heavy and prolonged (several weeks or longer)
  2. administration of an opioid antagonist after a period of opioid use

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Common Side Effects of Buprenorphine

Description: 
Patient Handout

These Are The Common Side Effects of buprenorphine

Buprenorphine is safe to use for most patients. Some people do experience side effects, but most of buprenorphine's side effects are not dangerous --they're just unpleasant.

Common minor side effects include:
Nausea Sweating
Constipation Headache
Drowsiness Depression
Disturbed sleep

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DSM 5 Diagnostic Codes Related to Substance Use Disorders

Description: 
DSM-IV and DSM 5 Diagnostic Codes Related to Substance Use Disorders (*Note: DSM 5 was released in May 2013 and includes significant changes to diagnosis. For example, it does away with separate "dependence" and "abuse" diagnoses and combines them into "substance use disorder.")


The ICD-10 compliance date is October 1, 2015.


This is a table listing the diagnostic codes for substance use disorders.

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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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Efectos secundarios comunes del Suboxone (Common Side Effects of Suboxone® (en Español))

Description: 
Describes the common side effects of Suboxone®.

Suboxone es seguro usar para la mayoría de pacientes. Algunas personas experimentan efectos
secundarios, pero la mayoría de los efectos secundarios no son peligrosos – simplemente son
desagradables.

Efectos secundarios menores incluyen:

La náusea
Dolor de la cabeza
Sudar
La somnolencia
El estreñimiento
La depresión
El sueño agitado

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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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