11
Î NEW – The FDA recently approved several new buprenorphine
formulations for treatment of OUD.
• Since data regarding the effectiveness of these products are currently limited,
clinicians should use these products as indicated and be mindful of emerging
evidence as it becomes available.
Î MAJOR REVISION – Patients' psychosocial needs should be assessed,
and patients should be offered or referred to psychosocial treatment
based on their individual needs, in conjunction with buprenorphine in
the treatment of OUD.
• However, a patient's decision to decline psychosocial treatment or the absence
of available psychosocial treatment should not preclude or delay buprenorphine
treatment, with appropriate medication management.
• Motivational interviewing or enhancement can be used to encourage patients to engage
in psychosocial treatment services appropriate for addressing their individual needs.
Î Clinicians should take steps to reduce the chance of buprenorphine
diversion.
• Recommended strategies may include frequent office visits (e.g., weekly in early
treatment); drug testing, including testing for buprenorphine and metabolites; and
recall visits for medication counts.
• Refer to ASAM's Sample Diversion Control Policy
3
for additional strategies to
reduce the risk for diversion.
Î Drug testing should be used to monitor patients for adherence to
buprenorphine and use of illicit and controlled substances.
• For additional guidance see The ASAM Appropriate Use of Drug Testing in Clinical
Addiction Medicine
4
.
Î Patients should be seen frequently at the beginning of treatment until
they are determined to be stable.
ÎWhen considering a transition from buprenorphine to naltrexone,
providers should note that 7–14 days should typically elapse between the
last dose of buprenorphine and the start of naltrexone to ensure that the
patient is not physically dependent on opioids before starting naltrexone.
Î When considering a transition from buprenorphine to methadone,
there is no required time delay because the transition to a full mu-
opioid agonist from a partial agonist does not typically result in an
adverse reaction.
Î There is no recommended time limit for pharmacological treatment
with buprenorphine.
• Patients who discontinue buprenorphine treatment should be made aware of the
risks associated with opioid overdose, and especially the increased risk of death if
they return to illicit opioid use.
• Treatment alternatives including methadone (see p. 8–9) and naltrexone
(see p. 12), as well as opioid overdose prevention with naloxone, should be
discussed with any patient choosing to discontinue treatment.
