A practical guide for buprenorphine initiation in the primary care setting

Roberto León-Barriera; Samantha Jayne Zwiebel; Vania Modesto-Lowe

doi:10.3949/ccjm.90a.23022

ABSTRACT

Buprenorphine is a safe and effective treatment for opioid use disorder but remains underutilized because a major challenge of conventional buprenorphine initiation (termed induction) is that the patient must already be in opioid withdrawal. Previous legal barriers and clinician lack of familiarity with the unique pharmacology of buprenorphine have also limited its use. In this review, we outline changes regarding buprenorphine prescribing laws and physician perceptions of buprenorphine. We also review buprenorphine pharmacology and novel low-dose buprenorphine induction procedures that can be adopted in primary care settings to improve treatment acceptability, retention, and outcomes.

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Roberto León-Barriera, MD⇑

Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA

Address:
Roberto León-Barriera, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213; ral187{at}pitt.edu

Samantha Jayne Zwiebel, MD, MA

Assistant Professor of Clinical Psychiatry, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Vania Modesto-Lowe, MD, MPH

Medical Director, Hartford Behavioral Health, Hartford, CT; Department of Psychiatry, University of Connecticut, Community Faculty, University of Connecticut, Farmington, CT