Template:Suboxone protocol: Difference between revisions

(Created page with "*For [https://www.mdcalc.com/cows-score-opiate-withdrawal Clinical Opioid Withdrawal Scale] (COWS) >=8: 4 to 8mg, observe 30 to 45min, redose if COWS remains >=8. Then discharge home with 16 mg a day to bridge until follow-up (an X-waiver is no longer required to prescribe buprenorphine). *For Clinical Opioid Withdrawal Scale (COWS) 0-7: Consider observing the patient until their COWS score is >8 for the standard buprenorphine induction. Alternatively, you can prescribe...")
 
No edit summary
 
(One intermediate revision by one other user not shown)
Line 1: Line 1:
*For [https://www.mdcalc.com/cows-score-opiate-withdrawal Clinical Opioid Withdrawal Scale] (COWS) >=8: 4 to 8mg, observe 30 to 45min, redose if COWS remains >=8. Then discharge home with 16 mg a day to bridge until follow-up (an X-waiver is no longer required to prescribe buprenorphine).
*For [https://www.mdcalc.com/cows-score-opiate-withdrawal Clinical Opioid Withdrawal Scale] (COWS) ≥8: give 4 to 8mg of [[Buprenorphine]], observe 30 to 45min
*For Clinical Opioid Withdrawal Scale (COWS) 0-7: Consider observing the patient until their COWS score is >8 for the standard buprenorphine induction. Alternatively, you can prescribe consider unobserved home induction instructions available on paper <ref>A Guide for Patients Beginning Buprenorphine Treatment at Home https://medicine.yale.edu/edbup/quickstart/Home_Buprenorphine_Initiation_338574_42801_v1.pdf</ref><ref>A Patient’s Guide to Starting Buprenorphine at Home from ASAM https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf</ref> and app<ref>Buprenorphine Home Induction  Apple App Store https://apps.apple.com/us/app/buprenorphine-home-induction/id1449302173</ref> <ref>Starting Buprenorphine from Google Play Store https://play.google.com/store/apps/details?id=com.amstonstudio.bup&hl=en_US&gl=US</ref>.  
**Redose if COWS remains ≥8. Then discharge home with 16 mg a day to bridge until follow-up (an X-waiver is no longer required to prescribe buprenorphine).
*For Clinical Opioid Withdrawal Scale (COWS) 0-7: Consider observing the patient until their COWS score is >8 for the standard buprenorphine induction.  
**Alternatively, you can prescribe consider unobserved home induction instructions available on paper <ref>A Guide for Patients Beginning Buprenorphine Treatment at Home https://medicine.yale.edu/edbup/quickstart/Home_Buprenorphine_Initiation_338574_42801_v1.pdf</ref><ref>A Patient’s Guide to Starting Buprenorphine at Home from ASAM https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf</ref> and app<ref>Buprenorphine Home Induction  Apple App Store https://apps.apple.com/us/app/buprenorphine-home-induction/id1449302173</ref> <ref>Starting Buprenorphine from Google Play Store https://play.google.com/store/apps/details?id=com.amstonstudio.bup&hl=en_US&gl=US</ref>.  


*If sublingual tablets/films unavailable then intravenous/intramuscular formulation (dose 0.3-0.9 mg every 6-12 hours) has been used for opioid withdrawal in the ED<ref>Berg ML, et. al. Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. Drug Alcohol Depend. 2007 Jan 12;86(2-3):239-44. https://doi.org/10.1016/j.drugalcdep.2006.06.014. Epub 2006 Aug 22. PMID: 16930865.</ref> and hospitalized<ref>Welsh CJ, Suman M, Cohen A, et al. The use of intravenous buprenorphine for the treatment of opioid withdrawal in medically ill hospitalized patients. Am J Addict. 2002;11(2):135-40 https://doi.org/10.1080/105500490290087901</ref> patients.  
*If sublingual tablets/films unavailable then intravenous/intramuscular formulation (dose 0.3-0.9 mg every 6-12 hours) has been used for opioid withdrawal in the ED<ref>Berg ML, et. al. Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. Drug Alcohol Depend. 2007 Jan 12;86(2-3):239-44. https://doi.org/10.1016/j.drugalcdep.2006.06.014. Epub 2006 Aug 22. PMID: 16930865.</ref> and hospitalized<ref>Welsh CJ, Suman M, Cohen A, et al. The use of intravenous buprenorphine for the treatment of opioid withdrawal in medically ill hospitalized patients. Am J Addict. 2002;11(2):135-40 https://doi.org/10.1080/105500490290087901</ref> patients.  


[[File:Buprenorphine in ED.png|thumb|NIH National Institute on Drug Abuse ED Buprenorphine algorithm<ref>https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/algorithm.pdf</ref>]]
[[File:Buprenorphine in ED.png|thumb|NIH National Institute on Drug Abuse ED Buprenorphine algorithm<ref>https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/algorithm.pdf</ref>]]

Latest revision as of 19:46, 17 July 2024

  • For Clinical Opioid Withdrawal Scale (COWS) ≥8: give 4 to 8mg of Buprenorphine, observe 30 to 45min
    • Redose if COWS remains ≥8. Then discharge home with 16 mg a day to bridge until follow-up (an X-waiver is no longer required to prescribe buprenorphine).
  • For Clinical Opioid Withdrawal Scale (COWS) 0-7: Consider observing the patient until their COWS score is >8 for the standard buprenorphine induction.
    • Alternatively, you can prescribe consider unobserved home induction instructions available on paper [1][2] and app[3] [4].
  • If sublingual tablets/films unavailable then intravenous/intramuscular formulation (dose 0.3-0.9 mg every 6-12 hours) has been used for opioid withdrawal in the ED[5] and hospitalized[6] patients.
NIH National Institute on Drug Abuse ED Buprenorphine algorithm[7]
  1. ↑ A Guide for Patients Beginning Buprenorphine Treatment at Home https://medicine.yale.edu/edbup/quickstart/Home_Buprenorphine_Initiation_338574_42801_v1.pdf
  2. ↑ A Patient’s Guide to Starting Buprenorphine at Home from ASAM https://www.asam.org/docs/default-source/education-docs/unobserved-home-induction-patient-guide.pdf
  3. ↑ Buprenorphine Home Induction Apple App Store https://apps.apple.com/us/app/buprenorphine-home-induction/id1449302173
  4. ↑ Starting Buprenorphine from Google Play Store https://play.google.com/store/apps/details?id=com.amstonstudio.bup&hl=en_US&gl=US
  5. ↑ Berg ML, et. al. Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. Drug Alcohol Depend. 2007 Jan 12;86(2-3):239-44. https://doi.org/10.1016/j.drugalcdep.2006.06.014. Epub 2006 Aug 22. PMID: 16930865.
  6. ↑ Welsh CJ, Suman M, Cohen A, et al. The use of intravenous buprenorphine for the treatment of opioid withdrawal in medically ill hospitalized patients. Am J Addict. 2002;11(2):135-40 https://doi.org/10.1080/105500490290087901
  7. ↑ https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/algorithm.pdf
Retrieved from "https://www.wikem.org/w/index.php?title=Template:Suboxone_protocol&oldid=374102"