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Buprenorphine Initiation: Short-Acting Opioids

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Created on November 21, 2024

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Transcript

Evaluation. Identify and refer urgent problems. History, laboratory, medical examination, prenatal care, mental health, psychosocial assessment, social, and environmental factors. Discuss treatment options, patient-centered "choice and voice," TIC, informed consent. Safety/efficacy with either buprenorphine+naloxone and burprenorphine. Plan for outpatient if stable and < 22-24 weeks or inpatient initiation if unstable and > 24 weeks.

Unobserved "home" initiation after office visit.

IInpatient initiation: anticipated 24-72 hours.

Observed office initiation. Plan for 2-4 hours visit.

Admission to inpatient facility. Click for more information.

#1. Abstain from opioids 12-24 hours.

#2. Start scheduled ancillary meds. Click for more information.

Sober/family support to help with dispensing medications, self-care. Click for more information.

Warm hand-off: encourage daily phone and office Q3-7d f/u, group/peer coach/ doula support, prenatal, mental health, psychosocial tx. Adjust bup in 2nd/3rd trim. Ongoing smoking cessation, overdose prevention/narcan.

Sober/family support to help with dispensing medications, self-care. Upon opioid cessation, start ancillary meds TID/QID: gabapentin 300mg, hydroxyzine 25-50mg, dicyclomine 20mg, tizanidine 2mg. Start bup 0.5mgQ6Hx2 -> 2mgQ6Hx2 -> 4mgQ6Hx2 -> 8mg BID/TID.

Admission to inpatient facility, VS, COWS. Gabapentin 300mg TID, hydroxyzine 25-50mg TID, dicyclomine 20mg TID, tizanidine 2mg TID. Start bup 1mgQ6Hx2 -> 2mgQ6Hx2 -> 2mgQ6Hx2 -> 4mgQ6Hx2 -> 8mg BID/TID.

#1. Abstain from opioids 12-24 hours. COWS>10. Start buprenorphine 1-2 mg. Q2Hx2 (monitor x 1-4hrs -> home) -> 4mgQ2Hx2 -> 8mgBID/TID. #2. Start scheduled ancillary meds TID/QID: gabapentin 300mg, hydroxyzine 25-50mg, dicyclomine 20mg, tizanidine 2mg. Start bup 1-2 mg Q2H -> mg4Q2H -> 8mg BID.