Sublocade vs SL Buprenorphine after Release from Jail

Topics: Buprenorphine | Incarceration | long-acting buprenorphine | OUD

REVIEW OF: Lee JD et al, JAMA Netw Open 2021;4(9):e2123032 STUDY TYPE: Randomized comparative effectiveness trial When people with opioid use disorder (OUD) are released from incarceration, they have a high risk of overdose—especially if they are not prescribed any medication for OUD. We know that methadone, sublingual buprenorphine/naloxone (SL

Perioperative Management of Patients on Buprenorphine Maintenance

Topics: Addiction | Addiction Treatment | Buprenorphine | Medical Comorbidities | Medication | Opioid epidemic | Opioid Use Disorder | Opioids | Pain | Pharmacology | Suboxone | Substance Use | Substance use disorders

CATR: Can you tell us about your background? Dr. Acampora: I used to work as a cardiac anesthesiologist. Later, my interest turned to addiction medicine, and I trained in psychiatry and addiction psychiatry. I currently work in a pain clinic where I helped develop a strategy for managing buprenorphine in the perioperative period. CATR: Where does th

Add-On Buprenorphine for Methamphetamine Use Disorder

Topics: Buprenorphine | Methamphetamines | Stimulant use disorder

REVIEW OF: Kheirabadi GR et al, J Clin Psychopharmacol 2021;41(1):45–48 STUDY TYPE: Randomized controlled trial Methamphetamine (meth) addiction is notoriously difficult to treat. There are no FDA-approved medications, and even the most promising trials have mixed results. People withdrawing from meth experience dysphoria, anxiety, mood instabil

Buprenorphine Treatment

Topics: Addiction Treatment | Buprenorphine | Buprenorphine Induction | Detoxification | Medication for Opioid Use Disorder (MOUD) | Opioid Use Disorder

CATR: Dr. Capurso, given your role as an expert on various things related to addiction and the editor-in-chief of The Carlat Addiction Treatment Report, we’ve had several discussions about buprenorphine treatment. To begin with the basics, why use buprenorphine at all? Dr. Capurso: Buprenorphine binds to the mu-opioid receptor, the very same receptor

A New Buprenorphine Dosing Strategy for Easier Induction From Fentanyl

Topics: Buprenorphine | fentanyl | induction | medication of opioid use disorder (MOUD) | Opioid Use Disorder

REVIEW OF: Antoine D et al, Am J Addict 2021;30(1):83–87 The escalating rate of opioid overdose deaths has been linked to the rise of illicit fentanyl. Increasing evidence shows that fentanyl and its analogues, such as carfentanil and acetylfentanyl, are fast replacing heroin as the most commonly used illicit opioid for many people with opioid use

Buprenorphine Induction Without Withdrawal

Topics: Buprenorphine | Buprenorphine Induction | medication of opioid use disorder (MOUD) | Opioid Use Disorder

REVIEW OF: Ahmed S et al, Am J Addict 2021;30(4):305–315 Buprenorphine is notorious for precipitating withdrawal in patients who have recently taken opioids. Its high receptor affinity and partial agonism at the mu receptor can make inductions tricky. Giving it too soon can cause severe withdrawal, yet giving it too late means patients are in disco

Suboxone vs. Vivitrol for Opioid Use Disorder: How Do you Choose?

Topics: Addiction Treatment | Buprenorphine | Medication for Opioid Use Disorder | Naltrexone | Opioid Use Disorder

REVIEW OF: Nunes EV Jr et al, Am J Psychiatry 2021;178(7):660–671 For decades, methadone and buprenorphine (Bup) have been upheld as the gold standard of opioid use disorder (OUD) treatments, with naltrexone largely considered second line. However, a pair of landmark studies challenged that wisdom by showing the non-inferiority of long-acting injec

Starting Buprenorphine: Is Timing Everything?

Topics: Buprenorphine | Dosage Timing | Opioid Use Disorder

Review of: Jakubowski A et al, J Subst Abuse Treat 2020;119:108140 Buprenorphine is a safe and effective treatment of opioid use disorder (OUD), but studies show that less than two-thirds of patients treated with buprenorphine are still in treatment 6 months later (Timko C et al, J Addict Dis 2016;35(1):22–35). Since the highest rate of dropout is

Perioperative Pain Management in Opioid Use Disorder

Topics: Buprenorphine | Collaborative care | Free Articles | Methadone | Opioid Use Disorder | Opioids | Pain

When your patients with opioid use disorder (OUD) develop pain due to medical illness or trauma, pain management can get tricky. When they seek pain control, they may be perceived as “drug seeking” in medical settings. Studies have shown that providing adequate pain management for these patients is a particular challenge (Department of Veterans Affa

Kratom: A Primer

Topics: Buprenorphine | Opioids | Pain | Withdrawal

Many mental health providers are starting to hear about kratom from their patients. Consumed in Southeast Asia (except for Malaysia, where it is banned) for centuries, it’s a plant that has opioid-like qualities but is not regulated. Kratom is a tropical tree with the scientific name Mitragyna speciosa, native to Southeast Asia. Kratom is widely av

Supporting Patients With Pain and Addiction

Topics: Buprenorphine | Clinical practice | Opioid Use Disorder | Opioids | Pain

CATR: What kind of work do you do, Dr. Manhapra? Dr. Manhapra: I run a clinic at the Hampton VA Medical Center helping patients with treatment-resistant chronic pain and disability. We see patients who have trialed many pain management treatments including injections, procedures, surgeries, and psychological pain treatments, all of which have failed. T

When to Stop Addiction Treatment: How Long Is Enough?

Topics: Addiction Treatment | Alcohol use disorder | Buprenorphine | Clinical practice | Medication adherence | retention

When a patient with a substance use disorder (SUD) has that “reachable moment” and/or recognizes the need to seek help, we know the importance of decreasing barriers to start treatment. However, what is less clear is when to stop treatment. What indicators suggest stable recovery? Recovery process The DSM-5 definition of remission from SUD is ba

Opioid Use Disorders and Serious Mental Illness

Topics: Addiction Treatment | Alcohol use disorder | Behavioral treatment | Bipolar Disorder | Buprenorphine | Co-occurring disorders | Collaborative care | Depression | Literacy | Medical Comorbidities | Methadone

CATR: Please tell us about your clinical focus. Dr. Gomez-Luna: My principal role is within an organization called Behavioral Health Care, a behavioral health organization in Connecticut that serves a wide array of populations, from children and adolescents all the way to late adulthood (www.bhcare.org). We provide clinical services to communities for

“What About the Implant, Doc?” Appraising Various Formulations of Buprenorphine

Topics: Buprenorphine | extended-release | Medication | Medication adherence | Opioid epidemic | Opioid Use Disorder | Pharmacology | safety | Side Effects

With other epidemics in the world dominating our attention, let’s not forget the epidemic of opioid-related deaths. Unlike the current viral epidemic, the opioid epidemic is eminently treatable. The figure on page 3 shows the reduction in heroin overdoses in Baltimore, MD, as increasing numbers of patients received opioid agonist treatment (Schwartz R

Updated Guidelines for Treating Opioid Use Disorder

Topics: Addiction Treatment | Buprenorphine | Medication | Methadone | Opioid epidemic | Opioid Use Disorder | Pain | Pharmacology

Before the COVID-19 pandemic, America was in the grip of an opioid crisis. Now, the medical community is sounding alarms that shelter-in-place orders may have triggered drug and alcohol relapses (Silva MJ et al, Am J Manag Care 2020;26(7):1–3). The American Medical Association has noted that at least 30 states have reported increases in opioid-related

SAMHSA Relaxes Regulations on Methadone and Buprenorphine During COVID-19 Emergency

Topics: Buprenorphine | Coronavirus | COVID-19 | Methadone | Opioid epidemic | Opioid Use Disorder | Opioids | Outpatient | pandemic | Patient relationship

The Substance Abuse and Mental Health Services Administration (SAMHSA) has changed some prescribing rules to help minimize in-person contact while maintaining access to medications for opioid use disorder (OUD). Methadone Patients starting methadone continue to require an in-person medical evaluation at an opioid treatment program (OTP) prior to sta

Treating Addiction in Patients Transitioning to/from Incarceration

Topics: Addiction | Addiction Treatment | Buprenorphine | Clinical practice | Incarceration | Methadone | Naltrexone | Opioid epidemic | Opioid Use Disorder | Opioids | Overdose | Prison | Substance use disorders

CATR: Could you tell us a bit about your background in working with people with addiction in the criminal justice system? Dr. Cropsey: I am a clinical psychologist and professor in the Department of Psychiatry at the University of Alabama at Birmingham. I conduct research and provide clinical care to patients with addiction within the criminal justice

Can Buprenorphine Improve PTSD Symptoms?

Topics: Addiction | Addiction Treatment | Antidepressants | Buprenorphine | Co-occurring disorders | Comorbidity | Dual diagnosis | Medication | Opioid Use Disorder | Pharmacology | PTSD | Research Update | SSRIs

Review of: Lake EP et al, Am J Addict 2019;28(2):86–91 For many years, the mainstay of treatment for PTSD has been the SSRI class of medications, but many of our patients still suffer crippling symptoms despite optimal antidepressant medication dosing. PTSD is often accompanied by opioid misuse, sometimes in an effort to self-treat the hyperarousal

Switching from Buprenorphine to Extended-Release Naltrexone: Does it Work?

Topics: Buprenorphine | Naltrexone | Opioids | Research Update | Substance Use

Review of: Solli KK et al, Addiction 2018;113(10):1840-1849 Extended-release naltrexone (Vivitrol) has had some good data, yet getting patients on it remains a challenge, because an opioid-free period is required before starting it. Understandably, practitioners get nervous when patients stabilized on buprenorphine ask to be transitioned to extended-