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Narrative Review: Buprenorphine for Opioid-Dependent Patients in Office Practice

Lynn E. Sullivan, MD; and David A. Fiellin, MD
[+] Article, Author, and Disclosure Information

From Yale University School of Medicine, New Haven, Connecticut.

Grant Support: Dr. Sullivan was supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program and the National Institute on Drug Abuse Physician Scientist Award (NIDA K12 DA00167), and Dr. Fiellin was supported by the National Institute on Drug Abuse (NIDA R01 DA019511 and NIDA R01 DA020576-01).

Potential Financial Conflicts of Interests: None disclosed.

Requests for Single Reprints: Lynn E. Sullivan, MD, Yale University, 367 Cedar Street, PO Box 208093, New Haven, CT 06520-8093; e-mail, lynn.sullivan@yale.edu.

Current Author Addresses: Drs. Sullivan and Fiellin: Yale University, 367 Cedar Street, PO Box 208093, New Haven, CT 06520-8093.

Ann Intern Med. 2008;148(9):662-670. doi:10.7326/0003-4819-148-9-200805060-00006
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The profile of opioid dependence in the United States is changing. Abuse of prescription opioids is more common than that of illicit opioids: Recent data indicate that approximately 1.6 million persons abuse or are dependent on prescription opioids, whereas 323 000 abuse or are dependent on heroin. Despite this prevalence, nearly 80% of opioid-dependent persons remain untreated. One option for expanding treatment is the use of buprenorphine and the buprenorphine–naloxone combination. Buprenorphine is a partial opioid agonist that can be prescribed by trained physicians and dispensed at pharmacies.

This article addresses the clinical presentation of a patient with opioid dependence and describes the relatively new practice of office-based treatment with buprenorphine–naloxone. The different components of treatment; the role of the physician who provides this treatment; and the logistics of treating this growing, multifaceted patient population are also examined.





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