Withdrawal

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: 

Detoxification, or medically supervised withdrawal (MSW), involves using a medication to take a patient from an opioid-dependent to an opioid-free state. Patients who want to stop using opioids but not want to be maintained on buprenorphine may request MSW. Conducting MSW involves inducting the patient onto buprenorphine following the standard induction protocol and then tapering the patient back off of buprenorphine. The buprenorphine/naloxone combination formulation should be used in most cases.

Risks of MSW

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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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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Description: 
Guidelines from Boston Medical Center designed for patient maintained on buprenorphine underdoing invasive procedures.
Source: 
Colleen LaBelle, Boston Medical Center
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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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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.

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