Buprenorphine Initiation for the Uninitiated 1) WAIT FOR MODERATE WITHDRAWAL SYMPTOMS - Precipitated withdrawal can be caused by buprenorphine displacing a full opioid agonist. To avoid precipitated withdrawal, begin initiation during moderate withdrawal. - Moderate withdrawal symptoms: e.g. COWS Score 6-10 or substantial patient discomfort. - Consider the BUP Home Induction app for guidance. 2) START LOW DOSE BUPRENORPHINE - Begin with a first dose of 4mg for patients in moderate withdrawal. - Consider starting with 2mg for patients at higher risk of precipitated withdrawal. - Pro tip: Rx 8mg BID, then have the patient cut the film in half for the first day's doses. 3) WAIT 4 HOURS, GIVE 4MG - If the first dose is well tolerated, the patient can take a second 4mg dose later that day. 4) UPTITRATE & REASSESS - The following day, start 8mg BID - reassess adequacy after 7 days. - A majority of patients do well on a total dose of 16mg buprenorphine daily for maintenance therapy. #Buprenorphine #Initiation #Prescribing #Addiction #Management
