The Curbsiders Addiction Medicine Podcast S2 Ep11: #22 Low Key Pearls for Low Dose Bup With Amelia Goff FNP and Eleasa Sokolski, MD
Sep 14, 2023
Amelia Goff FNP and Eleasa Sokolski, MD join the hosts to discuss low-dose buprenorphine starts for opioid use disorder, covering physiology, protocols, and troubleshooting challenges faced by patients. They also talk about different formulations of buprenorphine, counseling patients, and considerations for specific patient populations. The episode provides valuable insights on outpatient low dose starts and concludes with key takeaways.
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Precipitated Withdrawal with Buprenorphine After Fentanyl
- Mr. A tried buprenorphine after 12 hours off fentanyl, but his withdrawal worsened.
- This highlights the risk of precipitated withdrawal when buprenorphine is taken too soon after fentanyl.
Buprenorphine and Fentanyl Interaction
- Buprenorphine's strong affinity for opioid receptors can displace full agonists like fentanyl.
- This displacement, coupled with fentanyl's long half-life, can cause precipitated withdrawal if buprenorphine is introduced too soon.
Patient Education on Buprenorphine and Fentanyl
- Explain to patients that fentanyl can remain in the body for extended periods.
- Use visual aids, like hand gestures or drawings, to illustrate how buprenorphine can displace fentanyl, leading to withdrawal.