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High-Dose Induction

veena.radhakrishnan

Created on June 26, 2024

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Transcript

Key Aspects and Considerations

Standard induction

Rapid Therapeutic Dosing

Ideal for Emergency Care

Precipitated Withdrawal Risk

Unlike low-dose initiation, high dose buprenorphine initiation can lead to precipitated withdrawal. Patients need counseling on this potential risk before starting.
With a therapeutic dose typically reached in just one to three buprenorphine doses, this approach is practical for patients in opioid withdrawal, especially in ED settings. It remains an option in outpatient and inpatient care.
High-dose buprenorphine initiation involves opioid cessation and withdrawal symptoms, but it rapidly achieves therapeutic buprenorphine levels within hours, not days.

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Induction Strategy

High-dose induction

Click on the numbers for more information. Click on the image to enlarge.
This is the Buprenorphine Quick Start guide provided by the California Bridge Program. Click on the numbers to hear insight and tips from Kathryn M. Basques, MSW, MSN, APRN, PMHNP-BC.
ED Buprenorphine Quick-Start Guide A resource provided by the California Bridge Program
Precipitated Withdrawal

If withdrawal occurs suddenly and is severe and worsening, we consider precipitated withdrawal, which we will address in the following sections.

Administer 1st Dose

If the person is showing at least two objective signs of withdrawal, has a COWS score of at least 8, and states that they feel bad and wish to start buprenorphine, you would proceed to administer 8-24mg of buprenorphine.

Administer 2nd Dose

If after 30-60 minutes, the person's withdrawal is improved, give a second dose of 8-24mg, not exceeding 32mg.

Option for Self-directed Start

This guide specifically mentions the ED, but the first part of the decision tree offers a self-directed option if the patient is not in opioid withdrawal at the time of the encounter.

Withdrawal Not Improved

Consider options for why withdrawal is not improving, such as the natural progression of worsening withdrawal, which happens when you start with a lower dose initially or the patient has a heavier tolerance.