Buprenorphine Induction Strategies in the Era of HPSOs

For several years, the predominant substances involved in drug overdose deaths in the United States have been high-potency synthetic opioids (HPSOs), including fentanyl and its synthetic analogues. Clinicians throughout the country have found that standard buprenorphine induction strategies are no longer sufficient for successfully starting patients on buprenorphine without encountering significant problems with precipitated withdrawal and, in far too many cases, patients returning to opioid use. This presentation will discuss some of the newer high-dose and low-dose strategies for buprenorphine induction that have been utilized and summarized by several members of the American Society of Addiction Medicine (ASAM) in a recently published Clinical Considerations document. Hear the clinical situations in which certain strategies may be more advisable as well as the appropriate clinical setting (inpatient vs. outpatient) for the different strategies. Learner Objectives Discuss issues raised in patients who present after using HPSOs and other additives/contaminants. Distinguish clinical situations that result in preferences for high- dose or low-dose inductions. Determine when buprenorphine inductions are best performed in a hospital verses outpatient setting. Presenter Dr. Stephen M. Taylor, MD, MPH, DFAPA, DFASAM; President-Elect, American Society of Addiction Medicine Nursing CE This event is approved for Nursing CE with the California Board of Nursing.