Stephen A. Martin, MD, EdM; Lisa M. Chiodo, PhD; Jordon D. Bosse, MS, RN; Amanda Wilson, MD
Financial Support: By the CleanSlate Research and Education Foundation.
Disclosures: Dr. Martin reports personal fees from CleanSlate Research and Education Foundation during the conduct of the study and personal fees from CleanSlate Addiction Treatment Centers outside the submitted work. Dr. Chiodo reports that her spouse has stock in CleanSlate Addiction Treatment Centers. Dr. Wilson reports owning stock in CleanSlate Addiction Treatment Centers. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1652.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Corresponding Author: Stephen A. Martin, MD, EdM, Barre Family Health Center, UMassMemorial Health Care, 151 Worcester Road, Barre, MA 01005-9099; e-mail, email@example.com.
Current Author Addresses: Dr. Martin: Barre Family Health Center, UMassMemorial Health Care, 151 Worcester Road, Barre, MA 01005-9099.
Dr. Chiodo and Mr. Bosse: College of Nursing, University of Massachusetts, 228 Skinner Hall, 651 North Pleasant Street, Amherst, MA 01003-9299.
Dr. Wilson: 46 Sovereign Way, Florence, MA 01062.
Author Contributions: Conception and design: S.A. Martin, L.M. Chiodo, A. Wilson.
Analysis and interpretation of the data: S.A. Martin, L.M. Chiodo, J.D. Bosse, A. Wilson.
Drafting of the article: S.A. Martin, J.D. Bosse, A. Wilson.
Critical revision of the article for important intellectual content: S.A. Martin, L.M. Chiodo, J.D. Bosse, A. Wilson.
Final approval of the article: S.A. Martin, L.M. Chiodo, J.D. Bosse, A. Wilson.
Obtaining of funding: A. Wilson.
Administrative, technical, or logistic support: J.D. Bosse, A. Wilson.
Collection and assembly of data: S.A. Martin, L.M. Chiodo.
Buprenorphine has been used internationally for the treatment of opioid use disorder (OUD) since the 1990s and has been available in the United States for more than a decade. Initial practice recommendations were intentionally conservative, were based on expert opinion, and were influenced by methadone regulations. Since 2003, the American crisis of OUD has dramatically worsened, and much related empirical research has been undertaken. The findings in several important areas conflict with initial clinical practice that is still prevalent. This article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment. For each area, evidence for needed updates and modifications in practice is provided. These modifications will facilitate more successful, evidence-based treatment and care for patients with OUD.
Martin SA, Chiodo LM, Bosse JD, Wilson A. The Next Stage of Buprenorphine Care for Opioid Use Disorder. Ann Intern Med. ;169:628–635. doi: 10.7326/M18-1652
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Published: Ann Intern Med. 2018;169(9):628-635.
Published at www.annals.org on 23 October 2018
Hospital Medicine, Tobacco, Alcohol, and Other Substance Abuse.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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