Initiating Buprenorphine for Patients Using Fentanyl

Presented by Brian Hurley, MD, MBA, DFASAM, FAPA, President-Elect; American Society of Addiction Medicine. Recorded 7-April-2023, visit intnsa.org/elearning-portal/v.... The United States is currently experiencing the worst overdose crisis in our history, driven by the increasing potency and variety of opioids, central nervous system depressants, and stimulants present throughout the drug supply. Treatment of opioid use disorder with buprenorphine is a well demonstrated and empirically validated intervention that reduces opioid use, reduces the risk of overdose, and increases treatment retention. Fentanyl’s increasingly presence within the United States’ drug supply is associated with increasingly common clinical challenge of buprenorphine-precipitated withdrawal during standard dosing approaches, due to fentanyl’s pharmacologic properties. Despite these challenges, patients with opioid use disorder involving fentanyl as compared with opioid use disorder without fentanyl are both well demonstrated to experience similar rates of treatment retention after buprenorphine is initiated. There is not yet a consensus on a uniform consensus on how to best adapt buprenorphine initiation protocols for patients whose opioid use disorder involves fentanyl. This webinar will review variations on buprenorphine dosing that can be considered for patients with opioid use disorder involving fentanyl. The presenters will review the evidence for and describe low dose buprenorphine initiation of protocols, high dose buprenorphine initiation of protocols, approaches to help support patients stop using full agonist opioids for a longer period of time, and a clinical approach to referring patients to alternative medications for opioid use disorder.

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Do you know how I stopped? I just stopped I did not use suboxone, methadone or anything else I just stopped taking the pills. I was not going to allow myself to get to the point where I was injecting, smoking, snorting pills or anything else I wanted my life back and it was a war let me tell ya it was a very painful 4 weeks but I did it and so can you as long as you want it all to end also for those who do quit your war is not over after those 2-4 weeks you still will deal with PAWS post acute withdrawal syndrome. You can be a year clean then suddenly one day you feel as though your in withdraw again, But suck it up because that is all in your head and it passes within a day. No one should be subjected to long term opiate maintenance programs, these are designed from the people who do not want to quit, so if your desire is to have your life back then it would make no sense to trade one drug for another would it?