Bulleted clinical pearls at the end of each chapter, as well as specific clinical recommendations and detailed case discussions throughout, make it easier for readers to retain knowledge and integrate it into their clinical practice. The guide also features sample documentation and scales, including a treatment contract and a patient consent, that can be used to model documents in practice.
Among the numerous other revisions included in the second edition are the following: Information about new formulations of buprenorphine A discussion of the Comprehensive Addiction and Recovery Act CARA Changes to induction and maintenance target doses and recommendations for home inductions Information on diversion control plans Advice for working with Alcoholics Anonymous and Narcotics Anonymous A discussion on integrating buprenorphine into residential and inpatient opioid treatment programs.
This edition can also be used to complete the 8 hours of qualifying training required for the buprenorphine waiver. By a thorough reading of the material covered in the chapters of this book and successful completion of the posttest, physicians can meet the buprenorphine waiver training requirement. Written in a jargon-free style that does not require expertise in substance use disorder treatment, Office-Based Buprenorphine Treatment of Opioid Use Disorder is an accessible, indispensable reference for primary care physicians, psychiatrists, nurse practitioners, residents, medical students, and anyone with an interest in learning about and prescribing buprenorphine.
General Opioid Pharmacology Chapter 3. Efficacy and Safety of Buprenorphine Chapter 4. Patient Assessment Chapter 5. Clinical Use of Buprenorphine Chapter 6.
Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence…
Psychosocial and Supportive Treatment Chapter 8. Referral, Logistics, and Diversion Chapter 9. Methadone, Naltrexone, and Naloxone Chapter Psychiatric Comorbidity Chapter Medical Comorbidity Chapter Acute and Chronic Pain Chapter Opioid Use by Adolescents Chapter Handbook of Office Based Buprenorphine Treatment of Opioid Dependence , Second Edition is an invaluable guide to any provider licensed to prescribe this evidence-based medication assisted treatment for Opioid Dependence.
In addition to being an excellent guide for prescribers of Buprenorphine, this text serves as an excellent learning tool for medical students, residents, fellows in addiction medicine or addition psychiatry, and medical providers interested in treating this challenging, but potentially very rewarding population. Hays, M. The Handbook of Office Based Buprenorphine Treatment of Opiate Dependence , 2e is the long sought after missing link to effective and comprehensive Opiate treatment.
This masterful manuscript provides the expert clinical guidance that both novice and experienced practitioners will find to be immediately useful. The comprehensiveness of this handbook is unmatched and invaluable for those seeking to provide state of the art competent Opiate dependence treatment. Baxter, Sr. This book is the most up-to-date resource on the principal office-based treatment for opioid-dependent patients. Because it draws on the leadership of the addiction field, and is comprehensive and clearly focused, both experienced physicians and those new to these patients can turn to it with great confidence.
The Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence , Second Edition, provides a thorough tour of every aspect of using this medication to care for patients and, through its clear, well-organized structure, encourages the reader to pinpoint precisely and readily the specific guidance needed even in the midst of a clinical encounter. This book serves as a perfect companion to buprenorphine training courses because it codifies and amplifies all the knowledge gained in the course.
Saxon, M. Treatment for addictive disease must break through long-existing stigma to be incorporated into the fabric of the medical treatment community. Education is the key to breaking through stigma. Martin AJ. New national study finds buprenorphine reduces heroin use. The New York Academy of Medicine. March 7, Accessed October 25, Integrating buprenorphine therapy into HIV primary care settings.
April Superiority of directly administered antiretroviral therapy over self-administered therapy among HIV-infected drug users: a prospective, randomized, controlled trial. Directly administered antiretroviral therapy in methadone clinics is associated with improved HIV treatment outcomes, compared with outcomes among concurrent comparison groups. The effectiveness of community maintenance with methadone or buprenorphine for treating opiate dependence. Br J Gen Pract. Clinic-based treatment of opioid-dependent HIV-infected patients versus referral to an opioid treatment program: a randomized trial.
Ann Intern Med. Buprenorphine: how to obtain a waiver. Accessed December 9, April , p. Buprenorphine: physician waiver qualifications. A randomized trial of an interim methadone maintenance clinic. Am J Public Health. Ball JC, Ross A. The effectiveness of methadone maintenance treatment. New York: Springer-Verlag; The effects of psychosocial services in substance abuse treatment. Legal Action Center. Confidentiality: a guide to the Federal laws and regulations. Overcoming policy and financing barriers to integrated buprenorphine and HIV primary care.
Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction: a treatment improvement protocol, TIP Page Salsitz E, Wunsch MJ. ASAM physician clinical support system guidance. December 31, What is precipitated withdrawal? Wesson DR, Ling W.
J Psychoactive Drugs. Rockville, MD: U. Kaminski DM. Buprenorphine: the new kid on the block. The CASE adherence index: a novel method for measuring adherence to antiretroviral therapy. New data from the addiction severity index: reliability and validity in three centers. J Nerv Ment Dis. Qual Life Res. J Clin Epidemiol. Radloff LS. The CES-D scale: a self-report depression scale for research in the general public.
Appl Psychol Meas. Am J Addict. Total views: 5, A Problem 2. It is also important to remember that OUD exists on a continuum of severity. As a result, a scale for assigning severity exists and is based upon the number of criteria that have been met mild, moderate, severe. This severity distinction has treatment implications. Medical history: Lower back pain: Began after a fall at work 3 years ago; Lifting heavy objects at work exacerbated the injury; Currently takes extended-release morphine 45 mg twice daily to treat pain.
PDMP data does not show any additional controlled substance prescriptions other than the extended-release morphine prescription described above. I see you recently moved to the area and you are looking to establish care. Can you tell me what is going on? Since I ran out I've had some really bad nausea and diarrhea, and I feel really achy.
I've run out of my pain meds before and I felt the same way. I have tried to cut down on the amount of pills I take so that I can get to my next refill, but I need more pills to make these symptoms go away. In fact, I've had to skip work several times because my symptoms get so bad after running out of my medicine. Ibuprofen just didn't cut it either.
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Based on the information shared so far, is it correct to suspect John meets the criteria for OUD? Select the correct answer. In this scenario not all of the OUD criteria were assessed. Further discussion at this appointment and during future visits should assess whether he meets additional criteria suggesting moderate criteria or severe 6 or more criteria OUD. Medical history: Neck pain began following a motor vehicle crash 6 months ago; Takes extended-release oxycodone 20 mg twice daily Generalized anxiety disorder: No co-occurring depressive symptoms; Has taken alprazolam 1 mg up to three times daily for many years.
Other History: Has smoked a half-pack of cigarettes daily for 20 years; no history of illicit drug use or alcohol use. New data obtained today: PDMP does not reveal additional controlled substance prescriptions other than the opioid and benzodiazepine prescriptions described above. Urine drug test results from 1 week ago note the presence of oxycodone and benzodiazepines but no other controlled substances. Well, I have had neck pain following a whiplash injury I got from a car accident about six months ago. Gail, I am going to ask you a few questions about the pain you are experiencing.
On a scale of , with 10 being the worst pain, what number best describes your pain on average in the past week? Based on the information shared so far, is it correct to suspect Gail meets the criteria for OUD?
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In order to rule out OUD definitively, however, further discussion now or during future visits would need to assess whether or not she meets criteria. Her complaints of increased pain merit further exploration. Also, her continued concurrent use of opioids with benzodiazepines is risky. If you suspect OUD, you should not dismiss patients from care. Instead, use the opportunity to provide potentially lifesaving information and interventions.
You can use the DSM-5 criteria to assess for the presence of OUD or arrange for assessment with a substance use disorder specialist. You can perform urine drug testing UDT to obtain information about drug use that is not reported by the patient. You should also review data from your state's prescription drug monitoring program PDMP for opioids or other controlled medications that patients might have received from other providers.
Use statements such as:. You have developed a known complication of therapy that we should not ignore. It's helpful to put a name on it because it opens up a variety of approaches to help with your specific circumstance.
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Now, let's review some specific strategies you can use to help patients understand their diagnosis of OUD. Relationship-building skills include reflective listening and empathetic statements to destigmatize OUD diagnosis and treatment. How would you discuss with your patient that he meets the criteria for a diagnosis of OUD? Select the best response. Answer choice A is correct.
When talking with patients who meet the criteria for OUD, it's important to approach them with compassion, use relationship-building skills such as reflective listening and empathetic statements, and explain the treatment methods. For persons diagnosed with OUD, first determine the severity of the substance use disorder. Identify any underlying or co-occurring diseases or conditions, the effect of opioid use on your patient's physical and psychological functioning, the outcomes of past treatment episodes, and the patient's potential for overdose.
Consider offering a prescription of naloxone when one or more of these risk factors are present, and educate the patient and his or her family about the symptoms of opioid overdose and how to administer naloxone.
Office-Based Buprenorphine Treatment of Opioid Use Disorder, Second Edition
Then, identify any underlying or co-occurring diseases or conditions, the effect of opioid use on your patient's physical and psychological functioning, and the outcomes of past treatment episodes. A physical examination and laboratory testing should be conducted to ascertain conditions and symptoms related to addiction and its complications. Medication-assisted treatment MAT is considered the best treatment option for OUD as part of a comprehensive treatment plan.
Buprenorphine is likely to be safer than methadone for overdose risk, given its activity as a partial opioid agonist and lower potential for respiratory depression. Unlike methadone, the lack of required daily visits to a treatment center can also be an advantage. Another advantage of buprenorphine is the availability of long-acting injectable or implantable formulations that carry a low risk of diversion and can be managed as a monthly visit. Methadone therapy for OUD requires frequent opioid treatment program visits daily in early treatment and may be inconvenient or feel stigmatizing for some patients.
Naltrexone is available in both an oral formulation, taken daily, and an extended-release intramuscular injection formulation, administered once monthly. An advantage of naltrexone therapy is that there are no special regulatory requirements involved; any licensed clinician with the ability to prescribe medication can prescribe naltrexone.